Pain in the upper jaw is provoked by injuries, purulent processes, ganglioneuritis, some dental and otolaryngological diseases, tumors, pathologies of the masticatory muscles, temporal arteritis. It can be weak, intense, constant, short-term, pressing, aching, jerking, shooting, bursting. The cause of the symptom is established on the basis of complaints, examination data, visualization methods, laboratory tests. Treatment is carried out using painkillers, antibiotics, local manipulations, surgical interventions.
Why there is pain in the upper jaw
Injuries
Damage occurs as a result of household, street, sports, automobile, industrial injuries. The bruise is characterized by moderate soreness, passing after a few days. Fractures of the upper jaw are accompanied by extremely intense acute pain, rapidly increasing edema, facial asymmetry, stepped dentition. With fractures of the alveolar process, lacerations are visible on the mucosa, sometimes the end of the displaced bone fragment is determined. Occlusal contact is sharply disrupted, the teeth are mobile.
With an isolated fracture of the walls of the maxillary sinus, there is severe aching pain in the upper jaw, the under-eye area, significant swelling, hemorrhages. Nasal breathing is difficult. With combined damage to the bone walls of the sinuses, a concussion clinic and profuse nosebleeds are detected. Perforation of the maxillary sinus occurs during dental manipulations. If the damage was not detected, then there is swelling of the cheek, nasal tone of speech, pressing or bursting pain in the jaw, sinus projections.
In some cases, radiating pain in the jaws is determined in patients with subluxation of the cervical vertebra. Irradiation to the back and shoulders is also possible. The clinical picture includes a forced position of the head, neck pain, muscle tension, sometimes dizziness, weakness, convulsions, paresthesia in the hands.
Dental reasons
Discomfort and non-intense painful sensations may be associated with the use of removable prostheses, orthodontic structures. Pulling, pressing, aching pains occur in children against the background of malocclusion, including due to deformation of the upper jaw with a cleft lip and cleft palate. Some soreness is the norm after extraction of teeth, especially molars and wisdom teeth.
With the development of alveolitis, the pain disappears, and then reappears 3-5 days after tooth extraction. Intense pulsating sensations are noted in the projection of the well, increase with the progression of inflammation, sometimes cover the upper jaw, half of the face. Attacks of severe pain, spreading along the course of the trigeminal nerve, are characteristic of acute diffuse pulpitis. More local pain is observed in acute periodontitis.
Purulent processes
Intense jerking, tearing, bursting pains occur with purulent inflammation of the upper jaw, nearby soft tissues. Combined with hyperthermia, deterioration of the general condition, intoxication syndrome. The most striking clinical picture unfolds in acute osteomyelitis. The disease begins suddenly, the symptom progresses rapidly, the temperature rises to high numbers. A fetid smell comes from the mouth, pus accumulates in the gingival pockets.
Periostitis is characterized by less pronounced symptoms. With a high intensity of pain syndrome, the general condition is slightly disturbed, the temperature is subfebrile. In patients with a parotid abscess, the abscess is limited, located in soft tissues, the condition is moderate or closer to satisfactory. With parotid phlegmon, the infection spreads rapidly, twitching, shooting pains increase with the slightest movements of the jaw, the condition is severe.
With abscesses of the salivary glands, the first symptoms are dryness of the mucous membrane, an unpleasant taste in the mouth. There is hyperthermia up to 40 ° C. The maximum soreness is determined in the projection of the affected salivary gland, supplemented by pronounced edema. There is irradiation in the upper jaw, neck, ear.
Neuralgia
With ganglionitis of the wing node, there is a clinical picture of trigeminal nerve neuralgia in the innervation zone of its 2 branches – n.maxillaris. An attack of intense shooting pain develops spontaneously, more often occurs at night. Pain in the upper jaw, eye, hard palate, and at the base of the nose prevail, spreading to nearby anatomical zones. The episode lasts from several minutes to several hours, supplemented by vegetative disorders: lacrimation, profuse salivation, hyperemia of half of the face.
Atypical facial neuralgia, which is more often detected in middle-aged women, is considered as another possible cause of the symptom. Pathology is provoked by dental manipulations. The pain is dull, sometimes burning. They do not reach the intensity typical for other neuralgias. They quickly transform from paroxysmal to permanent.
Diseases of ENT organs
In otolaryngology, the manifestation is more often provoked by odontogenic sinusitis against the background of injuries, dental diseases, endodontic treatment. The acute form is characterized by heaviness, bursting unilateral pains in the upper jaw, intensifying when lowering the head, throbbing headache. There is a sharp pain when chewing food, a subjective feeling of elongation of teeth. With chronic sinusitis, the clinic unfolds gradually. The symptom is also combined with a headache, gives in the forehead, temple, orbit.
Radiating pains in the upper jaw, orbit, and temporal region can be observed in acute purulent otitis, due to irritation of the trigeminal nerve during infiltration of the mucous membrane of the tympanic cavity. They are complemented by sharp pain in the ear, intoxication syndrome. A similar irradiation is found in mastoiditis, which develops simultaneously with otitis media or a few days later, manifests itself with abundant suppuration from the ear, pulsating pain behind the ear.
Tumors of the upper jaw
Against the background of benign neoplasia of the upper jaw (fibrom, cement, osteoma, osteoblastoclast), pain is usually non-intense, dull, aching. They do not occur in all patients. Slowly grow for a long time in parallel with the increase in neoplasm. Sometimes they are supplemented by progressive facial asymmetry. The exception is osteoid osteoma, characterized by intense pain syndrome, which increases with food intake and at night.
With malignant tumors of the upper jaw (cancer, sarcomas), pain appears already in the early stages. At first, periodic, dull, aching or pressing. They quickly intensify, become permanent, acute, painful, unbearable. They radiate into neighboring anatomical zones. They are supplemented by tooth loss, infiltration of nearby tissues, decay with the formation of ulcers, and an increase in regional lymph nodes.
Other reasons
Aching, initially paroxysmal, then constant pain in the upper and lower jaw are observed with bruxism, myofascial syndrome. In both cases, the cause is a constant excessive load on the chewing muscles. In patients with Horton’s disease, the symptom is due to irradiation, combined with a dull headache that gradually increases over several weeks, more pronounced in the temporal region.
Diagnostics
Determining the causes of the symptom is the responsibility of the dentist. Patients may need to be examined by an ENT doctor and a maxillofacial surgeon. Less often, consultations with a neurologist, traumatologist or rheumatologist are shown. The doctor collects complaints, examines the dynamics of the development of the disease, finds out possible provoking factors, establishes the nature of pain, their relationship with the time of day, food intake, and other circumstances.
Based on the survey data, general and dental examination, a diagnostic action plan is drawn up, which may include the following procedures:
- Radiography. X-ray examination of the upper jaw is used to detect tumors, purulent bone lesions, traumatic injuries, dental diseases. With sinusitis, radiography of the paranasal sinuses is performed, with mastoiditis, pictures of the temporal bone are taken.
- Other visualization methods. CT and MRI are used at the final stage of the examination with ambiguous radiography data, to detail the changes detected on X-rays. They allow to accurately determine the localization and prevalence of lesions in neoplasms, injuries, purulent inflammation, and other pathological processes.
- Otolaryngological techniques. Along with radiography and CT, anterior rhinoscopy, probing of the maxillary sinus, diagnostic puncture of the sinus are used in the diagnosis of odontogenic sinusitis. If mastoiditis is suspected, otoscopy, hearing examination with tuning forks, audiometry are performed.
- Punctures, biopsies. With deep parotid phlegmon, non-palpable area of fluctuation, puncture of the pathological focus is recommended. Enlarged lymph nodes against the background of bulky formations are an indication for a biopsy to exclude lymphogenic metastases.
- Laboratory tests. In inflammatory processes, an increase in ESR, leukocytosis, and a shift of the leukocyte formula to the left are detected in the general blood test. The study of purulent discharge makes it possible to identify the causative agent of the process, to determine antibiotic sensitivity. Histological or cytological analysis makes it possible to determine the type of neoplasm, differentiate malignant and benign tumors.
Treatment
Conservative therapy
Pain syndrome is stopped by analgesics. A plan of therapeutic measures is made taking into account the cause of the symptom. The following techniques are used:
Dental diseases. With alveolitis, the well is washed with hydrogen peroxide or nitrofural, applications with anesthetics and analgesics are applied. With pulpitis, periodontitis, the tooth cavity is treated and disinfected, regenerating and anti-inflammatory pastes are used, pain syndrome is eliminated with analgesics, antibiotics and sulfonamides are prescribed to combat inflammation.
Traumatic injuries. A conservative method of treating fractures of the upper jaw is the imposition of dental splints connected to a horseshoe-shaped brace in the forehead area. To immobilize the alveolar process, a splint is used- a bracket made of aluminum wire fixed to the teeth using a light-curing composite and adhesive material or metal ligatures, if necessary – in combination with a chin sling.
Purulent processes and ENT pathology. Patients are prescribed broad-spectrum antibiotics, after conducting a bacteriological study, the drug is replaced taking into account sensitivity. Additionally, immunocorrectors, detoxification, anti-inflammatory, antihistamines are used. Local treatment includes washing, dressings.
Ganglionitis of the wing node. To reduce pain, the nasal cavity is lubricated with dicaine, turunds with novocaine are injected. In severe cases, ganglioblockers, node blockades with anesthetics are recommended. Local administration of hydrocortisone is effective. Medications with antiallergic and restorative effects are shown.
Surgical treatment
Taking into account the etiology of the pain syndrome, the following interventions are possible:
- Oncological pathologies: curettage, resection or exarticulation of the jaw.
- Injuries: osteosynthesis of the upper jaw using titanium plates, mini-sutures.
- Purulent processes: opening and drainage of ulcers, sequestrectomy.
- Otolaryngological diseases: maxillarotomy, mastoidotomy, sanitizing surgery on the middle ear.
