Having a Toothache That's Not a Toothache?
By Mina Levi, DDS, 08/07/2014

At the dental office of Dentist San Francisco Mina Levi, DDS in the heart of Union Square, we see a number of interesting and educational dental cases. These cases can serve as learning models in order for patients to become educated about some of the symptoms they may be having, how to treat these symptoms, or what to do to prevent certain situations from occurring. In this article, we discuss a case of a toothache that a patient had that ended up not being caused by a tooth at all.
 
A 49 year old female A.M. saw Dentist Mina Levi DDS in San Francisco as an emergency due to severe pain. It extended to the ear and even radiated to her neck. She was certain that the back most tooth, her second molar, was the culprit.

Dr. Mina Levi examined the tooth. It had a large filling, but there was no evidence of decay or a fracture. The Dentist San Francisco examined all the other teeth on the right side of both jaws. They responded normally to temperature and percussion tests (where Dr. Mina Levi will tap each tooth to determine if the surrounding ligament and bone are inflamed). X-rays of the teeth revealed no evidence of decay or infection.

Dr. Mina Levi then palpated (using her finger to exert mild pressure) around the tooth, and there was no pain. Palpating the muscles of the right Temporomandibular Joint ("T.M.J.) caused SEVERE pain. The dentist asked the patient if she was aware of clenching or grinding her teeth. She said that she was aware that she clenched her teeth, and that she hasn't worn her night guard lately. She also mentioned that she was very anxious lately.

The patient was reassured that she did not need endodontic ("root canal") therapy. Her pain was due to muscle spasms of her T.M.J. and she was referred out to a specialist who  prescribed muscle relaxants and anti-inflammatory medications. She received also a Botox treatment for her muscle pain. Dr. Mina Levi made a night guard for the patient and advised her to start wearing it every night.

The T.M.J. muscles are just in front of, below and above the ear. So, it's easy to understand how the pain radiated to her ear. But, how, you may wonder, did they cause neck pain?
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Think of a fine Swiss watch. Each part is carefully calibrated to work in harmony with every other part. If just one part malfunctions (or is slightly "off,") the balance and harmony of the entire system is disrupted. So it is with the muscles of the head and neck. Grinding and clenching of the teeth irritates the T.M.J. muscles. This can cause slight changes in the person's posture. These postural changes, however slight, cause straining of the neck muscles and results in pain. So, you see, proper dental diagnosis requires understanding not just of the teeth, but of the fine-tuned, complex relationship of the oral cavity to the rest of the body.

If you are experiencing neck or jaw pain, or have toothache-like symptoms and would like to discuss TMJ and treatment options, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.