Case Study Introduction for Myofascial Pain
Many patients come to our dental clinic in hope for pain relief and answers caused by toothaches. This is usually after visiting many other dentists to no avail. The surprising thing is, many of these ‘toothache’ cases that we see have in fact, nothing to do with the teeth at all. Some of the possible causes are Myofascial pain, TMD (Temporomandibular Joint Disorders), or problems with the jaw muscles or bones.
The mouth, also known as the oral cavity, contains many other important organs such as the teeth, tongue, and ducts of the salivary glands. Our digestive system is an important and complex one, and it all begins with our mouth. The joints that hold these organs in our mouths together are delicate, fine and sensitive. Pain within our mouths can be hard to decipher with the intricate connections. Many moving parts are also hidden from our sight.
*Disclaimer: As of March 30, 2020, the ADA (American Dental Association) has officially recognised Orofacial Pain as its 12th dental speciality. Any reference to ‘specialisation’ is made in the context of the United States of America. Learn more on our Disclaimers and FAQ pages.
Patient Profile & Toothache Pain Symptoms
Madam Tan (not her real name) is in her 50s, and was in great pain from a persistent toothache. She believed that the pain came from an upper right molar tooth. Before she visited my dental clinic, she had already seen a general dentist plus two endodontists, who are root canal specialists.
Molar Tooth Pain Symptoms
Some of the symptoms for molar tooth pain include:
- Sharp or throbbing pain in the jaw
- Sinus pressure
- Jaw tenderness
- Swollen or bleeding gums
- Tight jaw muscles
- Pain when chewing
- Pain near the ear
- And more
As you can see from this long list of symptoms, such pain can be tricky to diagnose for a few reasons. For one, they affect all areas of the mouth. For another, they can overlap with many other disorders or causes of chronic pain.
The Patient’s Description of Her Chronic Toothache Pain
Madam Tan described her pain as a deep, dull ache on the right side of her head and face. Chronic pain is pain that persists for three months or longer; she experienced this debilitating pain at least thrice a week. Each episode could last for hours at a time, causing her great distress and limited her quality of life.
Dental Treatments for Molar Tooth Pain She Had Tried
When her pain intensified, Madam Tan underwent a root canal treatment in an attempt to stop the pain. To her dismay, the treatment did not work and the pain returned. Her endodontist then referred her to my clinical practice for further investigations.
Investigations We Took at Nourish Dental & TMJ Care
To pin down the root cause of the problem, I started by taking an x-ray. It showed no discernible problems with her teeth, including the areas where the pain was coming from. We also conducted other dental tests, yet none of them showed an abnormal result. It was therefore, not a dental issue.
Narrowing Down the Cause of General Toothache to Myofascial Pain
Upon further investigation and more dental tests, we found that she was actually suffering from TMD, or Temporomandibular Joint Disorder. Some of the pain in her jaw muscles were mimicking a toothache. This is also known as ‘Muscle (Myofascial) Toothache’ in informal terms.
The Challenge in Diagnosing Myofascial Pain & TMD
‘Toothache’ cases such as Madam Tan’s can be a challenge to diagnose with all the overlap in symptoms, and the complexity of our oral cavities. It can be difficult to pinpoint what and where the pain is truly coming from.
As a result, many people undergo unnecessary dental procedures, and suffer needless chronic pain. They try root canal treatments, tooth extractions, prosthodontic treatments and more. Yet none of these dental treatments provide them with the pain relief they seek.
This is because the root cause of their chronic pain isn’t addressed; their teeth may not even be the culprit. Chronic pain in our mouth area can stem from our muscles, ligaments, joints, jaws, and more. All these mouth structures need to be further examined. Especially when clinical tests show that ‘nothing is wrong’ with our dental health.
Toothache Awareness & TMD Therapies
Madam Tan is now on appropriate therapies to help control her pain. TMD pain manifests in different ways for every patient, so the treatment plan needs to adapt as well.
Both the patient and dental practitioner need to be aware that the cause of a toothache might not be from the teeth. The head and neck areas are complex anatomical regions; they contain a myriad of structures apart from our teeth. Pain can translate along any part along this pathway.
The reverse can also be true, where dental pain – a real toothache – can mimic muscular pain or even headaches.
For example, we had a patient who had excruciating jaw and neck pain and headaches that was actually due to TMD and comorbidities. And a patient who actually had Facial Migraine which manifested as teeth pain.
Myofascial Pain and TMD Can Be Tricky to Diagnose & Treat
Chronic pain such as myofascial pain and TMD can be tricky to diagnose and treat. When in doubt, always consult a trained pain management dentist. Our focus at Nourish Dental & TMJ Care is in the proper diagnosis, management and treatment of orofacial pain, which includes TMD / TMJ Disorders, myofascial pain and pain and sleep dentistry.
Dr. Eric Chionh is formally trained in Oral Medicine and Orofacial Pain, and holds a Singapore Dental Council approved qualification in these areas. You can find out more about Dr. Chionh and our dental practice on our About Page. Visit Our Services page to find out more about all dental and pain management services we provide.