What causes mandible pain?

Causes of Mandible Pain

Temporomandibular disorders (TMD) are by far the most common non-dental cause of mandible pain, affecting 5-12% of the population with peak incidence at ages 20-40 years, while dental pathology remains the most frequent overall cause. 1

Dental and Oral Causes

Dental pathology is the most common source of acute mandible pain and is typically unilateral, localized within the mouth, and sometimes difficult to pinpoint to a specific tooth. 1

• Dental infections, caries, pulpitis, and periodontal disease cause the majority of acute mandible pain 1
• Chronic dental infections can mimic TMD, presenting with trismus and jaw pain that may confuse clinicians 2
• Oral mucosal diseases (lichen planus, herpes zoster, herpes simplex, recurrent oral ulceration, Sjögren's syndrome) present with pain associated with visible lesions 1
• Post-extraction complications and oral antral fistulas following dental procedures on upper premolars or molars can cause mandible pain 1

Temporomandibular Disorders (TMD)

TMD represents the leading non-dental etiology and affects 5-12% of the population, predominantly females aged 20-40 years. 1

• TMD encompasses muscle pain, disc displacement with or without limitation in opening, and joint pathology that can coexist in the same patient 1
• Depression, catastrophizing, and psychological factors significantly increase the risk of progression to chronic pain, with up to 30% of acute TMD cases becoming chronic 3, 4
• TMD is linked with comorbid conditions including back pain, fibromyalgia, and headaches, indicating systemic involvement 1
• Trauma to the jaw can precipitate TMD, leading to synovitis with pain, joint tenderness, limited movement, and joint sounds 4
• Temporal tendinitis (inflammation and degeneration of temporalis muscle tendon insertion on the coronoid process) frequently coexists with TMD 5

Salivary Gland Disorders

Salivary stones in the submandibular gland cause intermittent mandible pain characteristically occurring just before eating, with tenderness on palpation of the involved gland. 1

• Duct blockage results in slow or absent salivary flow from the affected duct, palpable on bimanual examination 1
• Tumors of salivary glands, particularly malignant tumors with perineural invasion, can cause intermittent pain 6
• Ultrasound imaging is the preferred diagnostic modality for salivary gland pathology 1

Arthritis and Inflammatory Conditions

Osteoarthritis is the most common arthritic disease affecting the temporomandibular joint, though rheumatoid arthritis and psoriatic arthritis may also involve this joint. 7

• Juvenile idiopathic arthritis (JIA) can cause TMJ arthritis requiring early aggressive systemic treatment to prevent growth disturbances and joint destruction 3
• Other systemic conditions occasionally affecting the TMJ include familial Mediterranean fever, systemic lupus erythematosus, gout, and Sjögren's syndrome 7
• Untreated synovitis may progress to cartilage damage, bone erosion, and joint deformity 4

Life-Threatening Causes Requiring Urgent Recognition

Giant cell arteritis presents with jaw claudication (pain with chewing), temporal region pain, scalp tenderness, visual disturbances, fever, and malaise, requiring immediate high-dose corticosteroid therapy to prevent permanent vision loss. 6

• Physical examination reveals absent temporal artery pulse, temporal artery tenderness, and possible tongue cyanosis 6
• Laboratory testing shows markedly elevated ESR and C-reactive protein 6
• Vision loss from ophthalmic artery involvement is a devastating complication of untreated disease 6
• Temporal artery biopsy must be obtained within 2 weeks of starting treatment, but corticosteroids (minimum 40 mg prednisone daily) should not be delayed while awaiting biopsy 6

Neurological Causes

Trigeminal neuralgia causes paroxysmal attacks of sharp, shooting, electric shock-like pain in the trigeminal distribution, triggered by light touch, washing, cold wind, eating, or brushing teeth, with a refractory period between attacks. 6

• MRI is required to exclude tumors, multiple sclerosis, or neurovascular compression 6
• Glossopharyngeal neuralgia presents with unilateral pain deep in the ear and/or back of tongue, tonsils, and neck, triggered by swallowing, coughing, or touching the ear 6
• Syncope can be provoked in rare cases of glossopharyngeal neuralgia, making this potentially dangerous 6

Maxillary Sinusitis

Acute maxillary sinusitis, most frequently caused by viruses or bacteria, can occur after dental infection or treatment to upper premolars or molars, especially extractions. 1

• Dental surgical procedures can result in oral antral fistula with oral and nasal discharge 1
• Imaging may reveal foreign bodies in the antrum requiring closure by oral/maxillofacial surgeons 1

Critical Diagnostic Pitfalls to Avoid

• Delayed recognition of giant cell arteritis in patients over 50 years old with jaw claudication can result in irreversible vision loss 6
• Chronic dental infections can masquerade as TMD, and failure to obtain appropriate imaging (CT scans) and laboratory tests (C-reactive protein) may miss insidious infection 2
• Overlooking psychological factors (depression, catastrophizing) increases risk of chronicity in TMD, as these factors reduce treatment success 3, 4
• The role of dental malocclusion has been greatly overemphasized historically and should not be assumed as the primary cause 7