6 Foods That Can Break Your Jaw

Just this week I treated two patients who unfortunately chose to eat foods that not only are known to often cause fractured teeth but also can at the same time create significant jaw injuries. Now, a particular food can’t actually “break” your jaw, but an injury in the jaw joint (TMJ) can certainly feel like it.

To start the conversation, picture this: the jaw joints (or “hinges”) and the attached ligaments allow you to open and close your mouth. The attached muscles and tendons provide the power for this movement. So, if you think about the jaw as an orthopedic system (just like the knee) it is subject to sprains, strains, ligament stretch, slipped cartilage and inflammation that at times can be severe. When you bite into or munch repetitively on hard or large food substances, you can cause significant painful damage to your delicate jaw joints.

Here are the top offenders:

1. Bagels
In New York City the unquestionable leading offender is the bagel. But it’s not the hot steamy variety that has just come out of the oven or the fake-out options in the grocery store such as Lender’s Bagels. The problems come from the overly-toasted, crisp beauties that are consumed daily with cream cheese or stacked high with tomatoes, onions and favorite delicacies and eaten like a sandwich.

The most treacherous situation occurs when a college student has no choice but to grab a 3-day old, shiny bagel wrapped in cellophane and then tries to eat it as he or she runs between classes. Inevitably, I find myself providing care to students returning for the Thanksgiving or Christmas break. And this week is no exception.

2. Biscotti
Next in line are those irresistible biscotti cookies that land on your table after overindulging at your favorite Italian restaurant. The coffee or tea is on the table for dunking, but what are the chances that you will dunk the biscotti before sinking your teeth into one of those “jaw crackers?” You first encounter firmness but that doesn’t deter you from trying to break off a piece with your front teeth. With each successive effort to win the battle, you are one step closer to traumatized and sprained TMJs.

For those who have been on the cusp of this occurrence you know exactly what I am talking about. For those of you have met your match and subsequently suffered with jaw pain, limited jaw motion or joint noise, I suspect you have since become dunkers.

3. Sourdough Pretzels
Not far behind biscotti is a snacking favorite, the infamous Sourdough Pretzel. While it’s OK to eat just one or two, something compels most of us to finish the entire bag even though our jaws begin to rebel after 10 minutes. The end results are tired jaw muscles, a headache in the temples, or a painful TMJ that prevents you from eating a normal diet for a few weeks.

4. Chocolate
Chocolate delicacies are also on the Jaw Breakers list. How many of you have bitten into a piece of chocolate that you anticipated would be soft? Unfortunately by the time your brain realizes that you are up against a piece of concrete your jaw muscles have contracted with such force that your TMJs are pushed beyond their limit. The end result has been reported as “I heard an explosion in my jaw joint and since then I can’t open my mouth or bring my teeth together properly!”

And don’t forget about the frozen Snickers and Milky Way bars that have been left in the freezer for a few months. One wrong decision here may become a midnight snack you would like to forget.

5. Sandwiches
Last but not least is that oversized burger on a bun or Panini sandwich. Though soft in consistency, the need to open your mouth like an alligator is all it may take to end up reaching for Advil to ease the sharp pain radiating into your ear or in severe cases, spending the next few hours in the emergency room with your jaw stuck in an open position.

6. Candy-Covered Apples
These ruby colored beauties on a stick are particularly dangerous because they look so delicious. Almost impossible to easily bit into, they have caused jaw problems for years, particularly around Halloween.

In Conclusion
Try to exercise some good judgment and restraint when contemplating your next bite. This is particularly true for women whose joint ligaments are more vulnerable to stretch and whose muscles are more prone to fatigue. If you sense you are pushing your luck, you are probably right!

Seek care if you have suffered the consequence of an overzealous bite, particularly if several weeks have passed and you’re still suffering.

A Toothache Can Be Caused By Arthritis

October 27, 2014 — by Dr. Donald Tanenbaum

Though it seems strange, a toothache can be caused by arthritis. This was what happened to one of my patients this past year. It all started when John began to experience acute pain in an upper right molar. His dentist could not find a reason for the pain, since upon evaluation there was no decay or other problem apparent. So John was sent home with instructions to use Advil or Tylenol and hope for the best.

But John’s tooth pain persisted. He returned to his dentist’s office where more x-rays were taken and a root canal procedure was scheduled, albeit reluctantly. But even after the root canal, John’s tooth still ached and at times a neighboring tooth seemed to hurt, as well. John’s complaints ultimately led to the extraction of the offending right molar.

Then John started to experience pain in the extraction site and the teeth surrounding it. To make matters even worse, the same scenario began to unfold on his left side. And still, his dental team (comprised now of a number of specialists) found nothing on x-rays or during examination to explain it.

John’s suffering grew to the degree that the quality of his life was completely compromised. In desperation, he agreed to yet another root canal and subsequent tooth extraction. No change.

By this time there was no doubt that the source of John’s wicked tooth pain had to be of non-tooth origin. His persistence in seeking care and his unwavering belief that “there must be something wrong with my tooth” led him finally to me.

We found the answer to John’s suffering and was buried in his medical history. About one year before his tooth problems began, he had sought care for multiple joint pain throughout his body. The diagnosis was a (systemic) inflammatory condition called Spondyloarthropathy, which causes pain similar to what is associated with arthritis. A rheumatologist prescribed a few months on Enbrel, a medication used to treat inflammatory autoimmune conditions, and John’s body pain symptoms went into remission.

Let’s discuss arthritis for a brief moment: Arthritis essentially means “inflammation within a joint.” This same type of inflammation can occur in tendons and ligaments, the attachment sites in muscles and joints that keep us moving and functioning. Ligaments are also what attach your teeth to their bony sockets. They are called periodontal ligaments. Therefore, unexplained tooth pain can be due to an irritable periodontal ligament.

John’s medical history was the key to finally figuring out why he experienced acute tooth (and tooth site) pain that did not respond to conventional dental treatment. His tooth pain was the result of irritated periodontal ligaments. It took only three weeks back on Enbrel for John’s tooth site pain to go away. If his arthritis condition flares-up again, his tooth pain may reemerge. But, for now John is pain-free and able to enjoy his life again.

Here’s the moral of the story: As a patient you must share your medical history with any doctor who is having difficulty with a diagnosis. And as medical professionals, we must remember to ask all the right questions, request records and collaborate with other doctors on behalf of our patients.

Pain is real and no stone should be left unturned to find the source.

Communter Train Operators To Be Treated For Sleep Apnea

October 15, 2014 — by Dr. Donald Tanenbaum

[NOTE: This post was previously published on October 15, 2014. In light of the recent announcement that Metro-North railroad will be starting a pilot project in January 2015 to test drivers for sleep apnea, I thought I’d post it again.

“The railroad’s 410 train operators and 20 more in training will be screened for the sleep disorder by a Metro-North health department,” according to the New York Post. “Those recommended for additional screening after the initial evaluation will be referred to a company that specializes in sleep disorders, according to the MTA.”

This is truly good news for anyone who uses the railroad every day to commute to and from work. Yes, the public is becoming more aware of the dangers of sleep disorders, but unfortunately, it sometimes takes a horrific accident such as this one to get things moving.]

On the morning of December 1, 2013 a Metro North derailment in the Bronx cost four passengers their lives and injured 59 more, many seriously. Although the National Transportation Safety Board has not determined the exact cause of the accident, the agency has stated that the driver suffers from a condition called Obstructive Sleep Apnea, also known as OSA.

OSA is characterized by excessive daytime sleepiness, which is a result of night after night of poor quality sleep. When you have OSA your airway is partially blocked and your breathing repeatedly stops and starts multiple times during the night. Your blood oxygen level drops causing your brain to be aroused – essentially waking you up.

The airway obstruction and thus the drop in blood oxygen levels can be caused by a number of risk factors of which you may have one or more:

Excessive weight
Large tongue
Big tonsils
Small lower jaws that fall backwards while sleeping
Long and floppy soft palates and uvulas.

If you snore, stop breathing, and toss and turn all night, it’s likely that you have OSA. Certainly if you are awakened frequently throughout the night, you will be exhausted when you get up and more exhausted as the day wears on.

Obstructive Sleep Apnea Treatment

Medical care for OSA is focused on encouraging patients to lose weight, a change in sleeping position, and even surgery in some cases. Tonsils, the uvula, and even the size of the tongue can be adjusted. But, the most common therapy is called C-PAP (continuous positive airway pressure) which involves the nightly use of a mask which is connected to a small machine that sits next to your bed.

As an alternative, or in addition to C-PAP, are oral appliances, which bring the jaw forward and move the tongue away from the airway. Ongoing research has shown that these appliances not only work well, but compared to C-PAP may be easier for patients to deal with night after night. Happily, there are now ways to test whether an oral appliance would be a good option for you (ahead of time while in your own bed!).

My Opinion About OSA Related Accidents

Let’s get back to last year’s Metro North accident. The driver reported that he had gone into a “daze” as the train careened many miles above the speed limit toward the curve. Before the accident, doctors had diagnosed him as obese and having hypothyroidism, high cholesterol, low testosterone, vitamin D deficiencies, B12 deficiencies, and mild high-frequency hearing loss.

But the driver had never been screened or examined for Obstructive Sleep Apnea until after the accident!

It’s impossible to ascertain how many deadly vehicle accidents are related to undiagnosed or poorly treated OSA. We will likely never know.

I believe that it should be mandatory for all drivers of public transportation vehicles (and all truck drivers who spend long hours on the road) to be tested and treated for OSA. Imagine…oral appliances could find their way into the overnight supplies carried by truck drivers who park at rest stops, pilots who sleep at airports, and train conductors who similarly catch a few hours of sleep during the course of their work schedules.

We have the tools, now is the time to become more effective educators and providers of care and keep the public safe from these mostly avoidable deadly disasters.

Read more about the Metro North accident here: http://www.huffingtonpost.com/2014/04/07/metro-north-driver_n_5107612.html

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with Obstructive Sleep Apnea.

Transcendental Meditation Can Ease TMJ Symptoms and Headaches

October 6, 2014 — by Dr. Donald Tanenbaum

In my practice I work with patients who suffer from facial pain, tight jaws, headaches (of a muscle or migraine variety), neck pain, or a combination of two or three symptoms. Some of my patients are poor sleepers and many of them grind and clench their teeth at night, resulting in problems with the TMJ (temporomandibular joint). But what most of these patients have in common is an extraordinarily high level of stress due to tension at work, overwhelming financial burdens, caring for aging parents, and more.

Sound familiar to you? Read on:

The logical way to reduce stress would be to make some big changes in your life, right? But that’s no simple task, if it’s possible at all. Unfortunately, when you live with stress over a long period of time your brain can become either fatigued, upset, or both. In this state you are more likely to develop physical ailments associated with the muscles of the head, neck and jaw. This perpetual state of mind-body imbalance can result in unhappy muscles resulting in facial pain, stiffness, spasms, limited head or jaw motion, and/or frequent muscle or migraine headaches.

The question then becomes “Are there treatment strategies that deal with the source of unhappy muscles instead of merely dealing with the end result?” This is where Transcendental Meditation (TM) comes in. Though it is far from being the only technique that addresses brain fatigue and upset, there is increasing scientific evidence that suggests that TM can help achieve mind-body balance.

How does TM work to ease TMJ symptoms and headaches?

The practice of TM promotes restful alertness of the mind. When you are in a restful alertness state there is improvement in the coordinated functioning of all parts of your brain (called EEG Coherence). EEG Coherence means that brain is operating in its most efficient way. In this state there is synchronization of the many types of brain waves communicating with your organ systems, and your organs are communicating in synchronization with your brain. When these communication pathways work well, muscles and joints are under a lower level of strain, they fatigue less, and they function more smoothly and easily.

Over time, people who practice TM report less pain, decreased strain, and more comfort in their face, jaw, neck and head.

As a doctor whose specialty is treating pain I will always have patients who need prescriptions, muscle or joint injections, oral appliances, exercises, rehabilitation and other relaxation strategies. But I now strongly advise all my patients to consider making Transcendental Meditation a part of their daily routine. So far, the feedback from my patients who practice TM is very encouraging.

After a consultation in my office I can refer you to one of the TM centers that I work with; sometimes even enabling you to receive a lowered fee to be trained.

Do you practice TM? Please feel free to share your experience here:

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat problems associated with facial pain, TMJ, and headaches.

Lockjaw – What To Do When You Can’t Open Your Mouth

September 16, 2014 — by Dr. Donald Tanenbaum

The clinical term “lockjaw” refers to a specific problem that can be the sign of a serious bacterial infection called Tetanus. Happily, due of the widespread use of the vaccine, it is extremely rare today for anyone in the U.S to develop it. But the expression “Lockjaw” lives on and is today what most people use to describe the scary feeling of waking up in the morning unable being unable to open your mouth without extreme pain.

In most cases, the causes of this kind of lockjaw are not because of a disease, but are usually related to overuse of the jaw muscle, which work much like a hinge. But that fact doesn’t mean that the average person doesn’t get very panicky when his or her mouth just won’t open without extreme pain.

If you were vaccinated for Tetanus as a child and you haven’t experienced any trauma or injury to your jaw, it’s likely that you can’t open your mouth because your jaw muscles are in spasm. Here are a few tips that should help ease the pain, help you open your mouth, and get you on your way:

Lockjaw: What To Do When You Can’t Open Your Mouth

First Thing In The Morning
If you wake up with jaw muscles which are in spasm and you can’t open your mouth or can only open it slightly, it’s a sign that you have either been overusing your jaw muscles during the day or you have been aggressively grinding or clenching your teeth during of the night. Unfortunately, grinding (also called bruxing) and clenching are common in today’s high-paced world especially for people who spend most of their working hours at a computer. Here’s what to do:

Lockjaw in the Morning
Use Moist Heat: Get into a hot shower and while the water is running on your face, gently massage your temples and your jaw. Do this for five minutes. Take a break and then do it for five more minutes. This simple method should ease the muscle spasms enough for you to gently ease your mouth open without pain.

What To Do During the Day To Avoid Lockjaw
Start to pay attention to behaviors or habits that overwork your jaw muscles and work to change them. These are commonly
• Nail biting
• Cuticle gnawing
• Chewing on pens or pencils
• Biting your lips or cheeks
• Clenching or grinding your teeth (especially while you are working at your computer)

When To See Your Dentist
If you are experiencing a locked jaw most mornings, and if you feel or hear “clicking” in the joint your jaw joint is probably “slipping.” This is a more serious problem that needs medical attention right away.

Aside from being really frightening most cases of lockjaw are not serious. Try to change some of your habits and you will probably experience a reduction in the occurrence of this painful problem.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, and TMJ. Find out more at www.tanenbaumtmj.com

Lingering Toothache After Root Canal

September 15, 2014 — by Dr. Donald Tanenbaum

Toothache pain typically occurs due to problems associated with pupal pathology, periapical pathology or both. In most cases (94% of the time) root canal treatment resolves the pain. But a small percentage of patients continue to experience toothache after root canal therapy; a toothache that is not responsive to medications and/or surgical procedures.

When this occurs a number of factors could be responsible including a tooth fracture that is undetected, untreated canals in the tooth that had not been visualized, or a persistent bacterial infection.

It does happen, however, that the lingering pain in the tooth or tooth site is due to referred pain from muscles of the jaw and neck, or referred pain from medical diseases outside the immediate tooth site region. In addition, causes of the pain may be due to nerve-related disorders, headache disorders and/or psychogenic disorders. When investigation suggests that the pain is not related to a lingering tooth or tooth site problem, the term Persistent Dentoalveolar Pain has been proposed.

When no regional medical disorder (pathology in the sinuses, pharynx, salivary glands, or thyroid glands) or distant disorder (cardiac-related) has been implicated, the pain that lingers is thought to be due to a neuropathic phenomenon. This is when an Orofacial pain expert should direct care.

The Risk Factors that Lead to Neuropathic Toothaches

Previous chronic pain problems experienced by the patient (particularly if female)
The duration of time that the pain was present before treatment was obtained
Pre-treatment pain in the tooth while chewing or when percussed
Pain in the tooth in between treatment sessions
Elevated psychological stress

In my practice I have identified these risk factors leading to neuropathic toothaches. I have developed courses of treatment that lead to an easing of the pain and give the patient a chance to live life without the persistent discomfort of lingering toothaches.

If a patient is experiencing persistent tooth pain and the above factors exist, I recommend pain management be started immediately with anticonvulsant or antidepressant medications (or both) and complemented by psychological approaches including meditation and cognitive behavioral therapies. Even acupuncture has proven to be useful at times.

TMJ Problems and Wisdom Tooth Removal – Is There a Right Time?

July 21, 2014 — by Dr. Donald Tanenbaum

When the recommendation has been made for wisdom teeth removal, and the patient has (or has experienced TMJ problems), some very important factors must be considered because TMJ problems and wisdom teeth removal sometimes don’t play nice with each other. The trauma to the jaw during surgery can make TMJ problems flare and potentially cause longer term problems including pain, additional joint noises and more challenging joint locking problems.

Consider the following case: An 18-year old female is preparing to go off to college in the fall. Although she is experiencing no pain symptoms associated with her wisdom teeth, her dentist and consulting oral surgeon have made a recommendation to have all four removed, in order to avoid potential problems while she’s away at college.

The patient and her parents are concerned that her recently stabilized TMJ problem (clicking, pain and sporadic morning locking) will flare up as a result of the extraction process. Is this a legitimate concern, or excessive worry?

Since TMJ problems are orthopedic in nature it is logical to assume that a difficult extraction event can cause a managed TMJ problem to resurface. This is particularly relevant if the patient mainly had joint problems that required care. Females more than males are at risk due to the fact that their TMJ structures are biologically more susceptible sprain and strain.

The following is my recommended list of questions that should be discussed before the patient goes ahead with the wisdom teeth extraction.

1. Should the teeth be left in place for a year or two to ensure further healing of the TMJ problem?

2. Should two teeth be taken out initially, instead of all four? (A lengthy surgery could therefore be avoided.)

3. Should a local anesthetic alone be used so that the patient could communicate with the surgeon if in fact she felt that the jaw was being stressed, or should sedation/general anesthetics be used to relax the patient’s muscles and diminish muscle tension due to fear.

4. Should an intravenous steroid be routinely used to minimize any potential muscle/ joint inflammation, which would lead to post extraction pain, and excessive/prolonged limited jaw motion.

Clearly there are no easy answers to these questions. The important message is that if your son or daughter is in this position, please be proactive and ask the difficult questions.

Some more questions to consider:

Is the jaw clicking and/or locking due to instability of the joint ligaments or movement of the shock-absorbing disc?

Are the wisdom teeth impacted in bone, are they fully or partially erupted, and if impacted, are they lying on their sides? (If they are lying on their sides, it will likely require more time and more bone removal to be extracted).

Is there inflammation of the gum tissues surrounding or overlying the wisdom teeth? Or is the plan to remove them designed to prevent possible acute periods of pain while the patient is at school or travelling overseas for an extended period of time?

Is there concern that the erupting wisdom teeth may cause undesirable tooth movement after orthodontics has been completed?

Does the patient’s gender and age make a difference in the outcome?

Patients with TMJ histories must be handled thoughtfully, and with an open mind. Remember, the removal of wisdom teeth is most often an elective procedure. Delaying their extraction may carry with it additional risks, but a patient with a history of TMJ problems, (particularly a young female) is always at risk during the extraction process.

5 Long-Term Effects of Bruxism

June 24, 2014 — by Dr. Donald Tanenbaum

Millions of people suffer the effects of bruxism, which is the involuntary grinding and or clenching of the teeth at night. There are many reasons why you may brux your teeth. Getting to the bottom of the causes and designing a course of treatment for bruxism sufferers is a large part of what I do daily in my practice.

Since it happens at night, you may not be aware that you are grinding! However, if you consistently wake up with an aching jaw or a morning headache, there’s a good chance that you are bruxing in your sleep.

So, why is this a problem?

Because the long-term effects of bruxism can be serious:

A Change In Your Profile: If you are noticing that your jaw is becoming more “square” it may be a result of bruxism. As you grind, your masseter muscles can get more and more bulky. This may not bother a man, but for women it is very concerning.

Sore and Worn Teeth: Bruxism can destroy your teeth! Not only can it wear them down, some people rip right through the enamel. Once enamel is compromised, the underlying dentin wears at a rate 6x faster than enamel. This affects your bite, your appearance, and even your health.

Jaw Pain: Some people experience jaw pain and soreness, especially in the morning. However, this pain can also linger through the day and even keep you from opening and closing your mouth without discomfort. Many individuals have daily ongoing pain in their face and jaw as a result of the nightly grind.

TMJ noises: Other consequences of bruxism may be the onset of jaw joint clicking as a result of strained ligaments and a dry joint environment that results from compression of the TMJs .Clenching in particular can squeeze all the moisture out of these joints leading to noisy, painful situations, and sometimes even lockjaw.

Headaches: Morning headaches in the temples are common in people who brux. As the temporal muscles fatigue during bruxism, lactic acid builds up which irritates the nerves in the muscle and the result can be a headache. In patients who suffer from migraines this is a particularly troublesome situation, as it can trigger a more severe situation.

If you are experiencing any of the above, there’s a good chance you are bruxing. The long-term effects of bruxism can impact your life. See your dentist for advice. If you have been treated by a dentist, and are still suffering, now’s the time to seek out the help of a dentist with extensive training in this field.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with jaw problems, TMJ, referred pain, nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.

5 Reasons You May Be Grinding Your Teeth

May 29, 2014 — by Dr. Donald Tanenbaum

Tooth grinding (also called bruxism) is a real problem for thousands of people. It can wear down teeth, loosen teeth, and even cause severe jaw muscle and TMJ pain. At times clicking and locking of the TMJs (Temporomandibular Joint) can result from longterm bruxism. If you think you have this problem you have probably asked yourself “Why do I grind my teeth at night?”

Research suggests that tooth grinding is likely to occur if the brain becomes aroused during sleep. There are two stages of sleep during which Bruxism is most likely to take place. These include Stage 2 Sleep, which is one of the first and lighter stages of sleep and lasts approximately 20 minutes and REM (Rapid Eye Movement Sleep). Most dreaming occurs during REM.

Here are some of the suspected reasons for brain arousal (and therefore teeth grinding) during sleep:

Insomnia – Individuals who have a hard time getting to sleep or staying asleep seemingly experience bruxism more often than those who don’t.
Sleep Apnea and Snoring – There is some evidence that in people who have obstructive sleep apnea (breathing stops while sleeping due to airway obstruction, prompting the brain to be aroused) that tooth grinding frequency increases.
New Motherhood – Being frequently awakened by a crying baby or anticipating a baby’s needs disrupts sleep and new moms report higher or new teeth grinding activity.
Medications – The use of antidepressants such as Paxil and Effexor have been shown in some people to induce tooth grinding.
High Achievers and Daytime Stress – People who operate at a high mental pace during the day tend to clench and grind more at night.

The Good News! There is treatment for teeth grinding regardless of the cause of the brain arousal. If you have insomnia, talk to your doctor. Medication or therapy or both can really help. Also, sleep apnea is very easy to detect (if your partner hasn’t already told you!) by a sleep study at home or at a clinic. If you are diagnosed with sleep apnea, there are a myriad of ways to treat it, from oral appliances to CPAP machines.

If the stresses of everyday life are causing your grinding, a custom made oral appliance (night guard) can work wonders. It won’t prevent you from grinding but it will ensure that your teeth aren’t damaged and that your jaw muscles and TMJs are not overworked.

For severe bruxism, you may need to see a TMJ specialist who can provide a variety of treatment options to address the origins and consequences of your bruxism.

Dr. Donald Tanenbaum is a specialist with offices in New York City and Long Island, NY. He is uniquely qualified to diagnose and treat facial pain associated with bruxism, TMJ, referred pain, nerve pain, and migraines. Find out more at www.tanenbaumtmj.com.

Lingering Toothache – Is It A Sprained Ligament?

May 1, 2014 — by Dr. Donald Tanenbaum

Fortunately for those of us who have experienced a lingering toothache, relief typically follows a visit to the dentist. Whether a filling, a crown (cap) or root canal therapy was necessary, pain reduction is common within 24-48 hours. But when a toothache won’t go away in spite of the fact that the tooth pulp is healthy based on examination and x- ray investigation, believe it or not, it may be due to a sprained ligament.

To understand how a toothache can be the result of a sprained ligament, a quick review off the anatomy of a tooth is essential:

Every tooth in the mouth is anchored to the bone in which it sits by a structure called the periodontal ligament or PDL. This ligament is no different than any other ligament in the body, and when healthy, is responsible for maintaining the tooth in a stable position. This ligament, which is mainly composed of water, also acts as a shock absorber. The PDL is teeming with nerve endings, which gives it a great capacity to guide our chewing movements and tell the brain how much force to exert based upon the consistency of food in the mouth.

In addition, the PDL is the “GPS system” of the oral cavity and is so fine-tuned in its functioning that it can find a small fish bone in the midst of a mouthful of food. This capability helps protect the teeth and the surrounding soft tissues from injury that could otherwise occur during normal function.

Tooth pain is typically the first symptom of a PDL sprain. Common ways that sprains happen are:
Biting on food that is harder than anticipated
Impact from an expanding airbag
Chin trauma that forced the teeth together
An accidental collision with a baby’s head
Dental or oral surgery
Daytime overuse such as nail biting or pencil chewing
Nighttime clenching or tooth grinding (bruxism)

Once sprained, these ligaments may take some time to heal simply because it is difficult, if not impossible, to avoid using the tooth or teeth involved during chewing, speaking, and even at times, swallowing. Over time if the PDL is continually insulted, the tiny nerve endings in the ligament will become sensitized (similar to being sunburned) and as a result pain levels will increase and often spread to the surrounding gum tissue and neighboring teeth. And, if daytime overuse behaviors continue and/or sleep bruxism persists, the pain will likely continue.

Because this problem is not in the tooth pulp, or due to compromise of hard tooth structure, any dental efforts to fix the problem will likely lead to even more exacerbation of the pain. Like all ligaments if a sprain occurs, rest and support are often needed in order for healing to occur.

The key therefore is to identify why the sprain occurred before treatment is planned. If due to a single and identifiable event, time is the best therapy as healing will usually occur. Taking an anti-inflammatory medication like Advil or Aleve for five to seven days can also help along with avoidance of chewing on the painful tooth. If you suspect that night clenching or grinding of the teeth is the cause, then the use of an oral appliance while sleeping may be the best remedy.

At times trauma to a tooth may cause ligament pain that lingers and becomes chronic due to nerve endings that begin to fire spontaneously even when provoked by normal daily activities like speaking, swallowing and eating even soft foods. These situations may require medications that work to quiet irritable nerve endings. The most important thing to remember is that these problems are not solved by root canal therapy and this direction of care should be avoided.

Lockjaw: What To Do When You Can’t Open Your Mouth

The Risk Factors that Lead to Neuropathic Toothaches

Because the long-term effects of bruxism can be serious:

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