Jaw pain may arise from either of the two bones that hold the teeth in the jaw — the maxilla (upper jaw) and the mandible (lower jaw). Jaw pain also includes pain in the temporomandibular joint (TMJ), where the mandible meets the temporal bone.
Jaw pain may develop gradually or abruptly and may range from barely noticeable to excruciating, depending on its cause. It usually results from disorders of the teeth, soft tissue, or glands of the mouth or throat or from local trauma or infection. Systemic causes include musculoskeletal, neurologic, cardiovascular, endocrine, immunologic, metabolic, and infectious disorders. Life-threatening disorders, such as myocardial infarction (MI) and tetany, also produce jaw pain, as do certain drugs and dental or surgical procedures.
Jaw pain is seldom a primary indicator of any one disorder; however, some causes are medical emergencies.
Act Now: Ask the patient when the jaw pain began. Did it arise suddenly or gradually? Is it more severe or frequent now than when it first occurred? Sudden severe jaw pain, especially when associated with chest pain, shortness of breath, or arm pain, requires prompt evaluation because it may herald a life-threatening disorder. Perform an electrocardiogram and obtain blood samples for cardiac enzyme levels. Administer oxygen, morphine sulfate, and a vasodilator as indicated.
Begin the patient history by asking the patient to describe the pain’s character, intensity, and frequency. When did he first notice the jaw pain? Where on the jaw does he feel pain? Does the pain radiate to other areas? Sharp or burning pain arises from the skin or subcutaneous tissues. Causalgia, an intense burning sensation, usually results from damage to the fifth cranial, or trigeminal, nerve. This type of superficial pain is easily localized, unlike dull, aching, boring, or throbbing pain, which originates in muscle, bone, or joints. Also ask about aggravating or alleviating factors.
Ask about recent trauma, surgery, or procedures, especially dental work. Ask about associated signs and symptoms, such as joint or chest pain, dyspnea, palpitations, fatigue, headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss. (Keep in mind that jaw pain may accompany more characteristic signs and symptoms of life-threatening disorders, such as chest pain in a patient with an MI.)
Focus your physical examination on the jaw. Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling. Check the TMJs by placing your fingertips just anterior to the external auditory meatus and asking the patient to open and close, and to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.) How wide can the patient open his mouth ? Less than 1⅛" (3 cm) or more than 2⅜" (6 cm) between upper and lower teeth is abnormal. Next, palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
Be alert for nonverbal signs of jaw pain, such as rubbing the affected area or wincing while talking or swallowing. In infants, initial signs of tetany from hypocalcemia include episodes of apnea and generalized jitteriness progressing to facial grimaces and generalized rigidity. Finally, seizures may occur.
Jaw pain in children sometimes stems from disorders uncommon in adults. Mumps, for example, causes unilateral or bilateral swelling from the lower mandible to the zygomatic arch. Parotiditis due to cystic fibrosis also causes jaw pain. When trauma causes jaw pain in children, always consider the possibility of abuse.
Rheumatoid arthritis causes symmetrical pain in all joints (commonly affecting proximal finger joints first), including the jaw. The joints display limited range of motion and are tender, warm, swollen, and stiff after inactivity, especially in the morning. Myalgia is common. Systemic signs and symptoms include fatigue, weight loss, malaise, anorexia, lymphadenopathy, and mild fever. Painless, movable rheumatoid nodules may appear on the elbows, knees, and knuckles. Progressive disease causes deformities, crepitation with joint rotation, muscle weakness and atrophy around the involved joint, and multiple systemic complications.
Many types of head and neck cancer, especially of the oral cavity and nasopharynx, produce aching jaw pain of insidious onset. Other findings include a history of leukoplakia ulcers of the mucous membranes; palpable masses in the jaw, mouth, and neck; dysphagia; bloody discharge; drooling; lymphadenopathy; and trismus.
An acute streptococcal infection of the sublingual and submandibular spaces that produces severe jaw pain in the mandibular area with tongue elevation, sublingual edema, and drooling. Fever is a common sign. Progressive disease produces dysphagia, dysphonia, and stridor and dyspnea due to laryngeal edema and obstruction by an elevated tongue.
Bone infection after trauma, sinus infection, dental injury, or surgery (dental or facial) may produce diffuse, aching jaw pain along with warmth, swelling, tenderness, erythema, and restricted jaw movement. Acute osteomyelitis may also cause tachycardia, sudden fever, nausea, and malaise. Chronic osteomyelitis may recur after minor trauma.
Maxillary sinusitis produces intense boring pain in the maxilla and cheek that may radiate to the eye. This type of sinusitis also causes a feeling of fullness, increased pain on percussion of the first and second molars and, in those with nasal obstruction, the loss of the sense of smell. Sphenoid sinusitis causes scanty nasal discharge and chronic pain at the mandibular ramus and vertex of the head and in the temporal area. Other signs and symptoms of both types of sinusitis include fever, halitosis, headache, malaise, cough, sore throat, and fever.
A rare, acute life-threatening disorder caused by a bacterial toxin, tetanus produces stiffness and pain in the jaw and difficulty opening the mouth. Early nonspecific signs and symptoms (commonly unnoticed or mistaken for influenza) include headache, irritability, restlessness, low-grade fever, and chills. Examination reveals tachycardia, profuse diaphoresis, and hyperreflexia. Progressive disease leads to painful, involuntary muscle spasms that spread to the abdomen, back, or face. The slightest stimulus may produce reflex spasms of any muscle group. Ultimately, laryngospasm, respiratory distress, and seizures may occur.
If the patient is in severe pain, withhold food, liquids, and oral medications until the diagnosis is confirmed. Administer an analgesic. Prepare the patient for diagnostic tests such as jaw X-rays. Apply an ice pack if the jaw is swollen, and discourage the patient from talking or moving his jaw.
Instruct the patient on measures to relieve jaw discomfort depending on the source of the pain. Inform patients of the link between sudden severe jaw pain and cardiac dysfunction and to seek medical assistance immediately.
Read excerpts from these other book chapters related to Jaw swelling:
Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
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Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5 
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