Face and Jaw Pain

Two muscles in particular affect pain in the face.  These are the temporalis muscle and the lateral pterygoid muscle. The temporalis muscle runs along the entire side of the skull inside the temporal fossa.  It inserts into the mandible and is thus a muscle of mastication.  The lateral pterygoid muscle is in a ninety degree opposition to the temporalis.  It originates on the lateral side of the sphenoid bone (which has the maxillary sinuses) and ends at the neck of the mandibular condyle.  Its function is to shift the mandible in a lateral way. It also facilitates the opening of the mouth.  These two muscles together help in the action of chewing.

Bruxism or teeth grinding is usually treated by a dentist who orders a night guard or splint to keep the teeth from grinding together.  The problem with this is that it doesn’t work in everyone and it may make some people worse.  This is because splints don’t always address the real problem of muscle parafunction.  Bruxism is not a tooth condition but a muscle condition.  Bruxism is, in fact, the clenching of the teeth caused by abnormal muscle tone of the face.  Clenching of the teeth can cause headaches, particularly at night or under stress.  It is the relationship between the movements of the temporal muscle and the lateral pterygoid muscles that determines the presence of bruxism.

In order to treat bruxism, the clenching intensity of the teeth must be diminished.  Splints can, unfortunately, intensify the clenching ability of the temporalis muscle so that the problem actually gets worse.  There is a particular splint that, when worn at night, decreases the clenching of the jaw.  It is called an anterior midline point stop and is available commercially for people with bruxism.  This device, when used for several days, puts the condyle of the jaw in a stable position.  It doesn’t work in everyone but it work in many who use it on a regular basis.  This is a relatively small device, referred to as an AMPS device, that appears better than traditional splints in the management of bruxism, temporomandibular joint disease, and occlusal trauma. 
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