Mystery Of Unexplained Toothache

The root of the issue may not be the root

By Dr. Robert Brown;                                                                       

In my thirty five years of practicing “TMJ” treatment I never cease to be amazed when I see a patient with several root canals in a row on the most posterior teeth. The general condition of the mouth is usually acceptable, with no serious problem of decay, just the complaint of toothache. Yet several of the posterior teeth have been diagnosed as requiring endodontic treatment, and when done, the pain persists.

What likely has not been taken into consideration is that the same nerves that innervate these teeth also innervate our muscles. Often what actually happens is that a muscle spasm, occurring in one of the muscles of mastication , has been caused by excessive use. These spasms are easy to identify in the cheeks as knots or bumps that may be quite tender to the touch. Sometimes the muscle at fault is the temporalis muscle that goes from the lower jaw, under the cheek bone up along the side of the scull. Many times pain in this muscle is misdiagnosed as a migraine headache.

When these muscles become inflamed and dysfunctional the nerve that supplies them can create pain symptoms elsewhere known as trigger points. In the case of the temporalis muscle, depending on the location of the inflammation the trigger point can vary from above the eye, to the front teeth, the premolars, or the very back molars on the upper jaw. When the cheek or masseter muscle is affected the trigger point can vary from the ear, to over the eye to and to both upper and lower posterior teeth. Thus muscle pain from the jaw dysfunction can cause the dentist to feel a root canal is necessary when it may not be.

A quite simple method of testing for the cause is to chill the suspected muscle area causing toothache or migraine with an agent called ethyl chloride. If the trigger point becomes pain free we now know the problem is what we call MFPD (myofacial pain dysfunction). If the treating dentist is not well trained in TMD (Temporomandibular Joint Dysfunction) a referral to that type of specialist should be made.

Once again the specialist must diagnose the root cause of this series of symptoms which can vary from a bad bite, to a hormone imbalance, to excessive stress, bad oral habits, sleep apnea and more.

I the vast majority of cases I have the pain diminishing quite quickly. At AODTC (Advanced Oral Diagnosis and Treatment Center) we fabricate our orthotics in office allowing delivery within days, not weeks, hopefully bringing relief much sooner. I have been contracted with Kaiser for this specialty for over 30 years. Many other insurance companies cover this problem as well

Our office is located in Danville. Our phone is 925 837 8048. We have two websites; and Our initial exam is complimentary.