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If You Feel Pain When Chewing, it May Be Due to Dental Caries, Oral Cancer, TMJ or Inflammation, Say Doctors

Tooth and mouth pain is the worst. Experts share several reasons why it happens.
FACT CHECKED BY Emilia Paluszek

Whether it's biting down on food in excruciating pain, having discomfort while chewing or experiencing a weird sensation on the inside of our cheek or tongue, many of us have felt some sort of mouth soreness. "There can be a multitude of reasons why it hurts to chew food including untreated cavities that have progressed to nerve involvement, abscess of a previously treated tooth, bite/occlusion issues where too much pressure is being placed on one tooth, recession of the gums exposing the root surface to temperature fluctuations and joint issues where an individual's TMJ is flared up or causing pain,"  Dr. Michele Bishop of Ingram Hills Dental tells us. 

While nobody loves visiting the dentist or doctor, preventive measures are always recommended to avoid pain or health issues. Dr. Bishop explains, "Since there could be many reasons with different treatments when a patient feels the first sensation of pain or sensitivity it is advised to see their dentist or doctor as soon as possible to determine the best course of treatment.  When pain is left untreated until it becomes an emergency it usually results in less options and less desirable outcomes for the tooth involved."

As stated, there's several reasons why people can experience an oral aching feeling and Dr. J. Wes Ulm, Harvard and MIT-trained MD, PhD with a background in bioinformatics, gene therapy, genetics, drug discovery, consulting and education tells us, "Pain or discomfort while chewing is a relatively common symptom that can be a marker of underlying issues in the jaw, oral cavity, the muscles of mastication (involved in facial expressions and speech as well as chewing), or associated tissues."

Dr. Ulm continues, " Since these anatomical structures are used frequently in any given day — and given the essential repetitive nature of the motions in chewing food — any associated discomfort, especially if distinctive and recurring, can be a salient indicator of dental or other health concerns. Here are some possible reasons for the symptom, particularly if the pain or discomfort is severe or persistent." As always, please consult your physician or dentist for medical advice. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


Dental Caries

dentist consultation

Dr. Ulm says, "Tooth decay and associated issues (such as a chipped tooth, a loosened filling, gingivitis i.e. gum disease, or a dental abscess — a pus collection — around the root of the tooth) are among the most common causes of pain or significant discomfort while chewing food or other substances like gum or hard candies. They can manifest in a number of specific ways, often entailing a sharp or readily perceived burst of pain upon biting down on a food morsel, and/or a dull lingering soreness that can continue after a meal. There can also be a sensation of pressure or throbbing, marked temperature sensitivity (e.g. to microwaved or oven-cooked meals or ice cream, beyond just temporary discomfort), halitosis (bad breath), fever, headache (including migraines, resulting from irritation of the trigeminal nerve central to sensation in the face and jaw), and swelling. 

Awareness of such symptoms is important since dental caries can steadily progress in severity to involve issues that need immediate medical attention, particularly in the event of a worsening abscess caused by pathogenic bacteria such as strep or staph, which can give rise to life-threatening conditions. Among these are meningitis — an inflammation of the meninges, the membranous layers (dura mater, arachnoid, and pia mater) that line the brain and spinal cord — as well as sepsis, in which the bacteria from a tooth abscess spread systemically into the bloodstream, triggering a maladaptive physiological response that can damage vital organs. Another potentially dangerous condition is Ludwig's angina, named for the 19th-century German physician who discovered it, whereby bacteria from a dental abscess (or another infectious source) disseminate further to cause a cellulitis infection in the floor of the mouth, leading to swelling which can obstruct the airway. Treatment of dental caries involves prompt attention by a dentist or other dental professional — such as an endodontist performing a root canal, if a severe abscess is present — with antibiotics (such as amoxicillin) prescribed as needed."


Oral Cancer

Female dentist examining a patient with tools in dental clinic

Dr. Ulm explains, "Differential diagnoses for a given symptom — the lists of potential causes that doctors and other medical professionals put together — will often be topped with the most common cause on the one hand, and the most concerning on the other, even if relatively rare. While dental caries are among the most common sources of pain or discomfort in chewing, mouth cancer is one of the most serious potential causes, and should be considered especially in those with a history of chewing tobacco (or betel nut), smoking, or heavy alcohol consumption. Such cancers are relatively uncommon but arise with greater frequency particularly in those who chew smokeless tobacco, and can involve the inner cheeks (i.e. the buccal mucosa or oral mucosal lining), floor or roof of the mouth, gums, tongue, or other oral structures. They often manifest as leukoplakia — thick, easily noticeable white spots or patches inside the mouth — but can likewise entail loosening of teeth or disruption of oral structures, which can result in pain or discomfort while chewing. 

Oral cancer is best detected as early as possible, and can be treated with surgery, chemotherapy, and radiation therapy (or a combination thereof) based on the nature and extent of the condition. There are also more recent treatments involving, for example, immunotherapy and various targeted drug therapies — most notably cetuximab, a monoclonal antibody therapy that targets a protein called EGFR (epidermal growth factor receptor), important in many oral cancers — which can be effective."


Temporomandibular Joint Disorders–(TMJ)

man isolated on gray background touching his face and closing eyes with expression of horrible suffer from health problem and aching tooth, showing dissatisfaction

According to Dr. Ulm "Temporomandibular joint disorders — generally abbreviated as TMJ (technically the acronym for the affected joint itself) — are a heterogeneous collection of conditions with variable presentation. They in general result from a malfunctioning of the articulation (linkage between two bones) that connects the lower jawbone (mandible) with a portion of the skull called the temporal bone, at the sides of the head, and/or of the relevant muscles or connective tissues. TMJ is relatively more frequent in women especially between the ages of 20 and 40, and can have many causes and associations including injury (e.g. trauma from an accident or sports), arthritis, bruxism (chronic tooth grinding), stress, fibromyalgia, and misalignment within the oral cavity. 

While symptoms are highly variable, pain or discomfort in the motion of chewing is quite common, alongside head or neck pain, trismus (spasms or tightness of the jaw), facial sagging, or a click-like sound (or pop) in the jaw. TMJ can substantially reduce quality of life and affect broader function, thus prompt recognition and treatment (while ruling out other potential causes) are imperative. Reflecting the disease's heterogeneity, treatment options are also quite varied, so consultation with a physician is indispensable for determining the best options. These can include (but are not limited to) periodic warm compresses (or ice packs on the affected areas), over-the-counter (OTC) analgesics like ibuprofen, dental adjustments or night guards, dietary changes, surgery, or specialized interventions such as trigger-point injections (of anesthetic compounds into affected muscles) or TENS (transcutaneous electrical nerve stimulation)." 


Sinus Congestion or Inflammation

Mature woman feeling strong pain, toothache.

Dr. Ulm says, "Finally, for chewing-associated pain or discomfort involving the upper teeth or jaw, a common cause is not dental or oral at all, but rather an allergic or infectious process involving the paranasal sinuses — the hollow, air-filled pockets that border the nose and nasal cavity. As legions of allergy-sufferers are well aware, reactions to an allergic trigger within the sinuses can lead to overproduction of fluid and blockage of the channels that allow the sinuses to drain into the nasal tubing, in turn causing congestion and unpleasant, persistent pain. Such a sensation is also often present in the midst of a cold or other upper respiratory infection, especially in cases where bacteria also invade the sinus cavities and induce the trademark inflammation of an acute or chronic bacterial sinusitis. As it turns out, the sinuses are innervated by sensory branches of the same nerve — the trigeminal nerve (cranial nerve V) — that also relay sensation from the roots of the upper teeth, and thus register the pain from a toothache. Therefore, irritation of the sinuses by allergies or infections can also entail pain or discomfort in chewing. Nasal and sinus allergies can significantly impact quality of life — impairing sleep and engagement with daily tasks — and so consultation with a general or specialist physician may be helpful if symptoms do not self-resolve or OTC management is insufficient. 

As for cases of infectious sinusitis, most resolve on their own without necessity for further therapy (particularly for viral causes). However, if a bacterial sinusitis persists for more than 10 days, and/or if hallmark symptoms (such as a greenish-yellow discharge, tenderness around the nose on a physical exam, or the aforementioned pain or discomfort on chewing) exacerbate after an initial improvement, then a doctor may prescribe a course of an antibiotic such as amoxicillin or Augmentin.(amoxicillin together with another compound called clavulanate to treat resistant bacteria)."


Cracked Tooth Syndrome

Middle age hispanic man using laptop sitting on the floor at the living room touching mouth with hand with painful expression.

Dr. Gurpreet Sidhu with Lighthouse Dental Centre tells us, "There can be many things that cause pain when chewing food, but one common occurrence is related to what is commonly referred to as cracked tooth syndrome. It can be challenging to diagnose a crack in the enamel of a tooth visually because of the microscopic nature of most cracks. Hence, as dentists, we often rely on objective tests and patient experience. We can use our explorer to track the surface of the tooth to feel the crack; we can use dyes to highlight fractures; we can percuss the tooth to see if pain develops; we can transilluminate the tooth to see a dark line indicating the crack, we can use a bite stick on parts of the tooth to see if it elicits sharp pain or we can use a gum probe to check for infections. 

Dr. Kyle Gernhofer a licensed dentist for 17 years and the co-founder and CEO of DenScore adds, "When a patient experiences pain on chewing, there could be multiple reasons why this is happening but a cracked tooth (cracked tooth syndrome) or an infected tooth (periapical abscess) are the most common causes for this type of discomfort. If the pain is sharp but it doesn't throb or linger, the tooth is likely cracked. As long as the crack hasn't spread into the nerve or within close proximity to the nerve of the tooth, a crown (cap) may be the only treatment that is required. However, in some cases, a root canal will also be necessary if the tooth doesn't respond favorably to the crown.

If the pain is dull and it throbs or lingers, the tooth is probably infected and a root canal would likely be required. If the root canal is done on a tooth in the back of the mouth which is used for chewing (i.e. molar or premolar) or if there is a large cavity on the tooth, a crown will also be required to prevent the tooth from breaking after the root canal. To avoid this type of chewing pain from happening, make sure you're going to a dentist regularly (2x/year) for checkups. A dentist can help identify early signs of dental disease and make appropriate lifestyle changes so you don't experience this type of tooth discomfort."


How to Help Avoid Pain When Chewing

Unhappy mature woman in glasses touching her jaw.

Dr. Selin Kılıç with Vera Clinic Cosmetic Dentistry shares, "It is very common as we get older to encounter pain when biting into harder food such as apples, carrots, or crusty bread. Most people experience pain when they bite down on foods, particularly hard foods or items with extreme temperatures due to tooth sensitivity or dental problems such as cavities and tooth decay. To avoid the pain the easiest thing you can do when eating hard foods is to be more careful about the way you chew. Chew very slowly to avoid causing sharp pain and avoid chewing directly on the affected teeth.

Avoid eating hard foods such as apples, however, if you are then it is best to cut your food into small pieces to make the chewing process easier. Hard foods are even more difficult to chew when you put large pieces of them into your mouth at once.If the persistent pain continues, I would suggest seeing a dentist if your pain is severe or lasts for more than a few days, as you may have tooth decay, a loose filling, or a cracked tooth, all of which need to be handled by a dentist.'

As you get older you may notice your teeth becoming more sensitive and may hurt when biting into certain foods, drinking hot or cold drinks, or even after brushing slightly harder. Everyday wear can take a toll on your teeth after many years of using your teeth. Worn enamel, gum problems, and tooth decay can all make your teeth more sensitive and older people are also more likely to have receding gums, which is a big cause of tooth sensitivity. Therefore, it is important to look after your teeth to prevent these issues from happening."

Heather Newgen
Heather Newgen has two decades of experience reporting and writing about health, fitness, entertainment and travel. Heather currently freelances for several publications. Read more about Heather
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