How can my tooth be fine when it hurts so badly?

A 52-year-old lady recently came into my office to see me at the request of her dentist. The prior week she had been seen by a general dentist as well as an endodontist for evaluation of tooth pain. She was told by both practitioners that her tooth had no issues and given that the tooth was located near a sinus, they suggested seeing a sinus specialist. As I told her that her sinuses were also healthy, a wave of defeat and desperation seemed to cascade across her face. “Will anything help this pain go away?”, she inquired.

Two years prior, this kind lady had been forced to deal with some of the emotional trauma from her past. During this process she began to clench her teeth (also called bruxism). Sometimes she would catch herself clenching during the day, but most mornings she would wake up and find that her face and head felt exhausted and sore, almost as if she had been performing a strenuous exercise with these muscles all night long. And as you guessed it, she was. She was clenching her jaw so tightly at night that her cheeks occasionally had swelling from an inadvertent bite. She was prescribed a night guard by her dentist to protect her teeth, but the clenching continued.

After reviewing this patient’s history and imaging we headed back to an exam room for further discussion and examination. I slid a gloved finger gently inside her mouth so the headlight I was wearing could give me an unobstructed view for one more look to make sure I wasn’t missing anything. With a reassuring examination of her teeth, I began to isolate her facial muscles in my hands, one by one, feeling for any lumps, bumps, or pain. As I made my way up to her temple, I pressed into the muscle called the Temporalis finding a “knot”. At this, the patient jumped and said, “you made my tooth hurt!”.

Trigger points are the knots we feel in our muscles when placing enough pressure to feel below the skin. These areas can be “latent or inactive” or they can be “active” differentiated by the ability to refer pain to an area which is not directly connected by any nerves to the area in which the brain perceives pain. This sensation of feeling tooth pain for this patient was apparently coming from her temporalis muscles, a muscle that is directly involved (and damaged) from the teeth clenching she started doing a couple of years ago. Studies have shown that simply placing a patient in a stressful situation can transform a latent or inactive trigger point into an active trigger point implying that the emotion centers of the brain are involved in the trigger point activation process.

To treat this patient’s pain, we needed to get to the source. While the initial traumatic life event had long since passed, she couldn’t break the cycle of clenching. During my examination I had also identified a narrowing in the front portion of her nose. This area (called the nasal valve) can oftentimes be temporarily corrected by wearing something as simple as a breathe right strip. I provided her with a similar device and taught her how to correctly wear them. After wearing these for 5 days (about 12 hours every day she called the office with an update. The “tooth” pain was gone!

Clenching, or bruxism is a common reaction that many of us have to stressors. One constant “stressor” is a partial (or complete) nasal airway obstruction. Because our bodies were designed with the nose as the primary breathing channel, we will subconsciously make great effort to breathe through our nose. One method of compensation is to tighten our facial muscles (bruxism) to stabilize our upper airway for the inbreath through our partially obstructed nose. Simply relieving this obstruction can result in relief within minutes to days like what this patient experienced.

Ryan Vaughn, MD
Board Certified with the American Board of Otolaryngology - Head and Neck Surgery