Left Jaw Pain: When to See a Neurologist or Dentist

Sharp pain in the left lower jaw and cheek?

Hello Doctor: For the past two days, I've been experiencing intermittent sharp pain on the left side of my cheek, feeling like someone is poking me with a needle or giving me an electric shock, which is quite uncomfortable.
The pain radiates from my jaw up to my temple, around my eyes, and into my scalp, extending down to my chin.
The frequency can be several sharp pains within a minute or just one sudden pain every few hours.
The pain intensifies when I eat, yawn, turn my head, or talk.
I have experienced similar sharp pains in the past, mostly occurring during colder weather, and I assumed it was just a migraine triggered by temperature changes, as it usually resolved by the next day.
However, this time the pain is more intense and lasts longer.
Initially, I thought it might be a toothache or wisdom teeth issue, so I took some pain relievers and planned to see a dentist later.
However, the pain did not improve after taking the medication.
I researched online and found that these symptoms could potentially indicate trigeminal neuralgia.
I would like to ask the doctor whether I should first consult a neurologist for an examination or determine if it is a dental issue.
Thank you, Doctor.

Ms. Chen, 20~29 year old female. Ask Date: 2022/12/12

Dr. Jiang Junyi reply Neurology

Hello Ms.
Chen,
You mentioned that "the pain extends from the jaw up to the temples, around the eyes, and the scalp, and down to the chin, occurring several times a minute or suddenly once every few hours.
The pain intensifies during activities such as eating, yawning, turning the head, or talking." Your symptoms may suggest an abnormality in the third branch of the trigeminal nerve (mandibular nerve).
There are many causes of trigeminal neuralgia, with approximately 80% attributed to compression of the trigeminal nerve by vascular structures as it exits the brainstem.
Other causes, such as vestibular schwannoma, meningioma, multiple sclerosis, and herpes zoster, can amplify normal sensory signals like touch and temperature into pain signals, leading to trigeminal neuralgia symptoms.
According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), the diagnostic criteria for trigeminal neuralgia are as follows:
- At least three attacks
- Pain occurring in one or more divisions of the trigeminal nerve
- At least three of the following pain characteristics:
- Lasting from a fraction of a second to two minutes, with periodic, paroxysmal attacks
- Severe pain intensity
- Electric shock-like, burning, or sharp pain
- Three or more trigger points in the face
- No other obvious clinical neurological deficits
When there is a relevant medical history and symptoms that meet these criteria, a physician will diagnose through appropriate examinations.
Unlike other types of pain, anti-inflammatory and analgesic medications are not very effective for trigeminal neuralgia.
The primary treatment for trigeminal neuralgia involves anticonvulsant medications, with the most commonly used being carbamazepine (Tegretol), oxcarbazepine (Trileptal), and lamotrigine.
These anticonvulsants have been proven effective in treatment, making pharmacological therapy often the first choice.
However, it is important to use these medications as directed by a physician.
I recommend that you consult a dentist who can provide a referral to an oral and maxillofacial surgeon at a regional hospital for a second opinion.
(Patients with a referral will be prioritized for appointments.) If the oral surgeon rules out structural abnormalities, they will typically refer you to the neurology department of that hospital.
Thank you for your inquiry.
If you have further questions, feel free to discuss them.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Neurology Department, Taoyuan Hospital

Reply Date: 2022/12/12

More Info

Your symptoms of intermittent sharp pain on the left side of your face, which radiates from your jaw to your temple, eye area, and scalp, could indeed be indicative of a few different conditions, including dental issues or neurological disorders such as trigeminal neuralgia. Given the complexity of facial pain, it’s essential to approach this systematically.

Trigeminal neuralgia is characterized by sudden, severe, and brief episodes of facial pain, often described as sharp, stabbing, or electric shock-like sensations. The trigeminal nerve, which is responsible for sensation in the face, can become irritated or compressed, leading to these painful episodes. Triggers can include activities such as chewing, talking, or even light touch, which aligns with your experience of increased pain during eating or yawning.

On the other hand, dental issues, such as problems with teeth or gums, can also cause referred pain that mimics neurological pain. For instance, an abscessed tooth or impacted wisdom tooth can lead to significant discomfort that radiates to the jaw and surrounding areas. However, since you mentioned that over-the-counter pain medications did not alleviate your symptoms, this may suggest that the pain is not primarily dental in nature.

Given the duration and intensity of your symptoms, it would be prudent to consult a healthcare professional. Here are some steps you might consider:
1. Visit a Dentist First: Since you initially suspected dental issues, starting with a dental evaluation can help rule out any underlying problems such as cavities, gum disease, or issues with your wisdom teeth. A dentist can perform X-rays to assess the condition of your teeth and jaw.

2. Consult a Neurologist: If dental evaluations do not reveal any issues, or if your dentist suspects a neurological cause, seeing a neurologist would be the next step. They can conduct a thorough examination and may recommend imaging studies, such as an MRI, to rule out any structural problems affecting the trigeminal nerve or other neurological conditions.

3. Keep a Pain Diary: Documenting your pain episodes, including their frequency, duration, triggers, and any associated symptoms, can provide valuable information for your healthcare provider. This can help in diagnosing the condition more accurately.

4. Consider Other Factors: Since you mentioned that similar symptoms occurred in colder weather, it may be worth considering environmental factors or stress, which can exacerbate nerve pain. Stress management techniques, such as mindfulness or relaxation exercises, may also be beneficial.

5. Explore Treatment Options: If diagnosed with trigeminal neuralgia, treatment options may include medications such as anticonvulsants (e.g., carbamazepine) or muscle relaxants. In some cases, more invasive treatments may be considered if medications are ineffective.

In summary, while your symptoms could be related to either dental or neurological issues, starting with a dental evaluation is a reasonable approach. If dental causes are ruled out, a referral to a neurologist would be appropriate to explore the possibility of trigeminal neuralgia or other neurological conditions. It’s essential to address these symptoms promptly to improve your quality of life and prevent further complications.

Similar Q&A

Understanding Jaw Pain: When Teeth Are Fine but Discomfort Persists

Around the end of July or early August, I started experiencing pain when biting with my left teeth. Later, I also felt pain when opening my jaw on the right side of my temporomandibular joint (TMJ). I visited the hospital on August 23, where I had an X-ray taken. The doctor exami...

Dr. Lin Jiayong reply Dentistry
Hello: Since the dentist at the hospital has already examined your teeth and found no issues, if you are concerned that trigeminal neuralgia may be causing your discomfort, it is recommended that you schedule an appointment with a neurologist for further evaluation and examinatio...

Which Specialist to See for Jaw Pain: Orthopedics or Dentistry?

Hello, doctor. I would like to ask about my cheekbones. For some time now, the tension on the left and right sides has been different. I have experienced a situation where my jaw got stuck after opening and closing my mouth, making it difficult to open and close normally, with on...

Dr. Xiao Yongxun reply Family Medicine
It may be a left temporomandibular joint subluxation or an inflammatory response; of course, there could also be other issues. It is recommended that you see a dentist or first discuss it with your primary care physician for further evaluation before making a decision.

Should I See a Dentist or Neurologist for Jaw and Ear Pain?

Hello Doctor, I have noticed swelling and pain in the gums around my right lower wisdom tooth for the past two days. Additionally, I am experiencing irregular sharp pain in the area of the right ear where the trigeminal nerve is located (each episode lasts about one second but oc...

Dr. Peng Shiwei reply Neurology
Hello, based on your symptoms, I recommend first visiting a dentist to assess your dental condition. If the dentist finds no issues, then you can see a neurologist. Thank you.

Understanding Left Jaw Pain: Symptoms and Specialist Recommendations

Hello, I have not had orthodontic treatment, and previously I had no discomfort in my face, jaw, or mouth. However, two days ago, I woke up feeling discomfort in my left lower jaw, which is tender to the touch. It feels similar to the soreness from a stiff neck, but that area is ...

Dr. Huang Tingfang reply Dentistry
Dear Miss Lin, Hello! As mentioned, if there is no pain in the oral cavity, it may be due to inflammation of the left submandibular gland. You may consider consulting an otolaryngologist or an oral and maxillofacial surgeon. Thank you! Wishing you safety! Sincerely, Dr. Huang...