To Touch Or Not To Touch… Jaw Pain


Whenever my patients complain of pain in their jaw, I ask them to point to where it hurts. More often than not, they point to one of their chewing muscles. Other patients complain of dull, aching toothache pain, but can’t tell me which tooth is hurting them, or if the pain is coming from the upper or lower jaw. With these patients, I usually find the source of the pain is coming from their jaw closing muscles, and not in their teeth. The pain from their muscles is being referred by their nervous system to make the patient believe it is coming from their teeth. What brings about this type of masticatory muscle pain? The answer is: clenching.

A person clenches their teeth by forcefully holding their teeth together for a prolonged period of time. There are only three times when teeth should touch. They touch very lightly when pronouncing certain words or sounds. They touch momentarily every time we swallow. They touch periodically as we chew our food. Humans do not grind their food like horses or cows. Apart from these three types of tooth contact, a person’s teeth should be separated by a skinny eighth of an inch. In other words, when the jaw is at rest the teeth should not be touching. Dentists call this space between the teeth, the “freeway” space. When my patients are having head and neck pains and associated tension headaches I invariably find clenching to be the root of the problem.

What causes people to clench? Apart from momentary physical exertion, the most frequent cause is stress. Most people don’t realize that the way they are subconsciously dealing with the stress in their lives is to clench or grind their teeth together. The repetitive contraction of muscles without proper resting periods damages muscle fibers and stimulates pain receptors that effect your nervous system, thereby telling your brain you have pain. Referred pain and/or stimulation of headache is the result. My treatment options for patients with muscle associated head and neck pain are as follows:

  1. I teach them self-awareness and self-observation in hope of consciously breaking the habit of clenching and stopping themselves from doing it.
  2. I make a dental splint or orthotic that when worn does not allow the patient to clench as forcefully and is a physical reminder that draws attention to the fact they are clenching.
  3. In certain circumstances I inject muscles with BOTOX®, paralyzing to some degree the muscle and lessening its ability to contract.
  4. I release taut muscle bands of overworked muscles, referred to by most people as knots, or technically called myofascial trigger points. This is done by numerous techniques. Some of the techniques I utilize are pressure and massage, electrical stimulation, anesthetic injections, dry needling with acupuncture needles, and cold laser.

Over many years, clenching habits cause damage to the hard and soft tissues of the temporomandibular joint besides head and neck muscles. But that is another topic.