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Toothaches of Muscular Origin

Updated: Feb 12

This is my fourth in a series of posts on orofacial pain.



In the first post, I briefly introduced the concept of non-dental toothaches, and highlighted different disorders that can present with symptoms that can mimic a regular toothache. The second was focused on identifying red flags when taking a pain history, while the third focused on trigeminal nerve examination.



You can catch up on the previous posts before reading the one below on toothaches of muscular origin.





Toothaches of Muscular Origin

Did you know that trigger points in masticatory (chewing) muscles can sometimes refer pain to teeth? With referred pain, the site where the patient feels the pain is different from the actual source of the pain.



The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) defines myofascial pain with referral as pain of muscle origin with referral of pain beyond the boundary of the muscle being palpated (1).



Taut bands, known as trigger points, are typically present within the involved muscles. Palpation of these trigger points results in pain referral to distant sites in the head and neck, including teeth.

Examples of Muscle Referral Patterns


The anterior temporalis muscle can refer pain to the maxillary (upper) incisors while the posterior temporalis can refer to the maxillary molars.


Temporalis muscle


The masseter muscle can refer pain to the maxillary or mandibular (lower) molars.



Masseter muscle


The anterior belly of the digastric muscle can refer pain to the mandibular incisors.



Digastric muscle

Examination Tips

The following strategies help differentiate between primary (odontogenic) toothache and muscular toothache.


If the toothache is muscular in origin, but the patient feels it on a tooth:

  • Application of heat or cold to the tooth would not increase the pain

  • Percussion and biting pressure on the tooth will not consistently increase the pain

  • Infiltration of local anesthesia around the painful tooth will not decrease the pain

However,

  • Palpation of the trigger point in the muscle will increase the toothache because this is the actual source of the pain

  • Trigger point injection with local anesthesia into the affected muscle will decrease the toothache.



Conclusion

Referred pain can be a source of confusion to both patients and clinicians. Therefore, it is essential to apply a systematic approach when evaluating oral and facial pain patients. As clinicians, we must listen to our patients and take the time to complete a thorough history and examination to avoid arriving at incorrect diagnoses and providing inappropriate treatment.



© 2022. Dr. Chizobam Idahosa.




  1. Schiffman E, Ohrbach R, Truelove E, Look J, et al; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27. doi: 10.11607/jop.1151. PMID: 24482784; PMCID: PMC4478082.


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