Dentists are in the business of diagnosing dental disease, namely tooth decay, gum disease, and Oral Pathology. Often people come into my office thinking they have dental decay because they have something that feels to them like a toothache. When I tell them their tooth is just fine but their problem is really facial muscle problems they are perplexed as to how this can be. Sometimes the dentist is fooled and so fillings or root canals are performed only to have the problem area still hurt. This is really not good when a good tooth is taken out needlessly.
Here is the answer: Yes, the problem is all in their head. Joking aside, this phenomenon comes about because of anatomy and neurological factors. The 5th cranial nerve innervates the muscles of mastication as well as the teeth. For the most part it has a sensory function, but there are also motor or movement-signaling components to certain branches of this nerve. The sensations of cold or hot on your teeth, along with decay irritation signals, go back to the brain stem before being forwarded to the cerebral cortex of your brain.(your conscious and awareness center). Muscle pain signals from muscles being over worked or injured also go back to the same general area of your brain stem. There they sometime “jump track” and get mixed up because of very little insulating coverage of these pain nerve fibers. The brain then interprets them as coming from a tooth when indeed the problem is really in one of the muscles of mastication. Medically, the process is called “ephapsis,” producing REFERRED pain. So the site and source of the pain are two different places. The toothache feels like it is coming from you lower first molar when it is really coming from the masseter or check muscle. In these circumstances I can often push on the muscle and the tooth will ache. Sometimes the muscle in the temple area of your head, called the temporalis muscle, will make top teeth ache from the back to the front teeth depending on the circumstances. TMJ pain can make your ear ache or feel full. This earache can also come from the deep portion of the chewing or masseter muscle. There are many variations of this anomaly. So if your dentist is puzzled and says let’s just watch it, or take two aspirin and I’ll see you in a week , or worse, “let’s take out that tooth,” it’s time to get another opinion. Preferably, a second opinion should come from a dentist who is verse in the many variations of craniofacial pain. Dull, aching pain is usually of muscle origin. Sharp, electric or severe pain is usually from your teeth.