Is Your Ear Pain Really Caused By A Dental Problem?

Ear pain is something that the layman does not usually associate with dental pain, however they would be surprised to know that there are multiple reasons why such a thing could occur. ENT surgeons often refer patients to dentists when they are unable to locate the origin of a persistent earache.

 The Temperomandibular Joint (TMJ), in particular, is in close anatomic proximity to the ear. In fact, their embryonic development happens at the same time. A simple exercise to get an idea of how close they are to each other is to insert a finger in each of the ear and then open/close the mouth. You will be able to feel the joint move.

The teeth themselves can also be responsible for an earache, as it is not uncommon to feel referred pain from the teeth in the head and neck region. The exact origin of tooth pain can be notoriously difficult to pinpoint for a patient, so they can seek out medical attention before they seek out the opinion of a dentist.

Wisdom Teeth

Our wisdom teeth or our third molars are evolutionary remnants from a time when humans used to eat raw unprocessed food in the wild. Our jaw sizes used to be much bigger as well. However, over the course of thousands of years, there have been changes to our diet and our jaw sizes have reduced in size correspondingly.

This is the reason that our wisdom teeth, which are last to erupt in our oral cavity, often do not find the proper space to erupt completely and become stuck in uncomfortable positions. The result is a chronic trauma to the inside of the cheek, pain and inflammation.

This pain is often referred to the ears and may be mistaken for an earache. The wisdom teeth of the upper arch are the most commonly associated with an earache, however the malaligned wisdom teeth of the lower arch can also be responsible for the same.

Temperomanibular Joint (TMJ) Disorder

The TMJ is an extremely sensitive joint since a number of muscles, ligaments and cartilages work in conjunction with each other. Some symptoms like pain on speaking for too long or after chewing food can point towards a muscular weakness. Clicking on opening the mouth or even dislocation of the jaw, in which the patient is unable to close the mouth on their own are signs that something is not quite right with the joint functioning.

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As the joint starts to undergo more stresses than it has been built to withstand, the nerves which innervate the joint can get irritated by the inflammation and injury in the joint. This can result in pain being transmitted to the ear.

Returning the joint back to harmonious function is not an easy task and requires surgical, maxillofacial and occlusal correction. An infection from the joint can also easily spread to the nearby ear resulting in a secondary infection to the ear.

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Occlusal Disturbances

Our teeth can move from their correct positions over a period of time and move into positions which cause interference during everyday movements. This puts a direct strain on the supporting muscles of the joint leading to chronic pain.

The reasons why these occlusal disturbances develop are many. Some of the most common reasons for this are teeth which are extracted and then not replaced, parafunctional habits like bruxism and the natural wearing away of the teeth.

The teeth function best when they have a functional antagonist as well as teeth to their either side. The presence of these teeth locks them in their positions otherwise they drift from their desired positions.

What makes the identification of this difficult is the fact that simply the presence of mal aligned teeth does not mean that joint disturbances will occur. The same occlusion may cause multiple problems in one patient while have no effect whatsoever in the other.

In such a situation, the doctors are dependent on the patient’s symptoms to decide the course of treatment.

Decayed Teeth

The pain from our teeth is referred to the nearby areas of the head and neck. Once the decay has progressed sufficiently to reach the nerve rich pulp of the tooth, it is then transmitted through the nerve and is also felt in the other areas they innervate.

For the pain to radiate to the ear, the posterior teeth of the upper and lower jaw will have to involved. Accompanying symptoms will include pain on chewing, sensitivity, bad odor and a tendency for food to get stuck.

The nature of pain that is seen with decayed teeth is pretty easy to identify with patients complaining of a stabbing pain, pulsatile in nature and often aggravated at night.

Treatment

Once the cause of pain has been identified, treatment can begin. Most causes mentioned above are easy to treat. Extraction of the offending wisdom teeth is relatively straightforward and will bring an immediate relief to the patient after it is done. Occlusal disturbances may require extensive dental treatment with intentional root canals followed by crowns and even some extractions may need to be done. The end goal is to balance the occlusal forces equally through the teeth and to make sure that none of them are interfering with jaw movements.

If however a TMJ disorder has been identified as the cause of pain then the treatment can be long and complicated with a high chance that some amount of pain will never subside. The recurrence of pain to pre-treatment levels is also a distinct possibility.

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Often pain management is the only choice available to patients in such cases. The highest chance of success is in cases where there is a clear defect or structural abnormality present, but such cases are rare. In fact, the very identification of the TMJ disorder will require a skilled maxillofacial surgeon to have a close look and order some extra x rays, CT and MRI scans.