Can a tooth cause pain in the temple?

In the temple there is skin, a thin layer of muscle and the skull underneath. This muscle is the temporalis, which starts from the temple like a fan and attaches to the projection at the upper front end of the lower jaw's branch (the coronoid process). Its job is to close the jaw and press the teeth together. In other words, every time you clench your teeth, your temple is working too. Most of the bridge that links temple pain to dentistry is this muscle.

Clenching and grinding the teeth at night is called bruxism. Among the symptoms of bruxism, the NHS lists a painful jaw, worn or broken teeth, headaches, earache and disturbed sleep; it writes that the commonest cause is stress and anxiety, and that sleep problems such as snoring and sleep apnoea, some sleep and depression medicines, smoking, and drinking a lot of alcohol and caffeine also go with it. If your temples wake up tight and tender in the morning and ease off during the day, that pattern is worth noticing.

The shared name for problems of the jaw joint and the chewing muscles is temporomandibular disorder (TMD). The NHS lists its symptoms as follows: pain in the jaw, ear and temple, clicking or popping noises when the jaw moves, headaches around the temples, not being able to open the mouth fully, and locking. It adds that the pain gets worse when chewing and at times of stress. Noises and locking in the jaw joint are the subject of a separate page; what matters here is that temple pain can be part of this picture.

This gives a distinction you can apply at home. The internationally used diagnostic criteria for headache attributed to a jaw disorder look for two things: the temple pain changes with jaw movement, chewing or clenching, and the same pain is brought back by pressing on the temporalis muscle or moving the jaw. In 373 headache patients diagnosed with a jaw disorder, reported in Cephalalgia, these two criteria, tested through an examination by a clinician, picked out temple pain coming from the jaw with 89 per cent sensitivity and 87 per cent specificity. These figures belong to a clinician's examination; the test you do at home only gives a clue: press on your temple with your fingertips for a few seconds, then open your mouth wide and close it a few times. If the pain you know comes on, a muscle and joint source becomes more likely; the examination makes the firm distinction.

A study from Denmark shows how closely these two diagnoses overlap. When the records of 671 patients referred to the jaw pain department at Aarhus University were reviewed, 71 of the 73 patients diagnosed with headache attributed to a jaw disorder (97.3 per cent) had also been diagnosed with temporalis muscle pain at the same time. The authors suggest seeing the two as a single picture, and add that the consequences of this need testing in new studies. The practical meaning is this: if your temple pain changes with your jaw, the target of treatment is not your head but your muscle.

The tooth itself can also refer pain to the temple. Because the teeth and the temple area take branches from the same nerve that carries sensation from the face (the trigeminal nerve), the pain of an inflamed upper or lower molar is sometimes felt not in the tooth but at the side of the face, in front of the ear or in the temple. What gives it away in this picture is a single tooth bringing the pain back with cold, with heat or on biting. If pressing on the temple does not change the pain but touching that tooth does, the source is likely to be in the tooth; the tooth's tests and an X-ray give the firm answer.

The two commonest non-dental causes of temple pain are tension headache and migraine. The NHS describes a tension headache as pain on both sides of the head, face or neck that feels like a tight band or pressure; the pain lasts at least 30 minutes and is not made worse by everyday activities. Migraine, on the other hand, is often a throbbing pain on one side of the head that gets worse with movement; the NHS writes that attacks usually last from 4 hours to 3 days and that some people have warning signs beforehand, often visual (aura). When either of them is put down to a tooth, it can lead to unnecessary dental treatment.

One picture must be kept separate: giant cell arteritis, also known as temporal arteritis. It is an inflammation of the arteries in the temple. MSD Manuals writes that the disease typically affects people over 50, most often around the age of 70; a severe, sometimes throbbing headache in the temple or at the back of the head, a scalp that hurts even when the hair is combed, and jaw muscles that tire and ache soon after starting to chew are typical. Because of the jaw tiredness, the patient may come to the dentist. According to MSD, the greatest danger is permanent blindness, which can develop suddenly when the blood supply to the optic nerve is cut off; that is why treatment is often started without waiting for a biopsy.

The list on the left describes how muscle, joint and common headache types behave; these usually ease with simple measures. If even a single item on the list on the right applies to you, do not wait.

The sequence deliberately starts with danger. Before a tooth or a muscle is considered, it is made sure that there is no emergency picture.

1. 1

   Emergency signs first: stop and go to A&E

   If a headache comes with loss of vision, a sudden and extremely severe onset, numbness or weakness in the face or body, difficulty speaking, drowsiness or confusion, a seizure, a very high temperature with a stiff neck, or a head injury in the last 3 months, the assessment happens not in the dental chair but at A&E. Call 112 or ask someone to take you; the NHS advises not driving yourself to A&E and taking the medicines you are on with you.

2. 2

   Age and accompanying symptoms are asked about

   With new temple pain over the age of 50, you are also asked about scalp tenderness, the jaw tiring quickly when chewing, flu-like tiredness, unintended weight loss and stiffness in the shoulders and hips. If this picture is present, you are referred to a doctor without waiting for a dental examination; the NHS asks for people with problems with their sight to be seen by an eye specialist the same day.

3. 3

   How the pain relates to the jaw is tested

   The temporalis muscle and the jaw joint are pressed with a finger, how wide the mouth opens is measured, and the jaw is moved from side to side. If these movements bring on the familiar temple pain, the picture becomes clearer in the direction of headache coming from the jaw and temporalis muscle pain.

4. 4

   The teeth are tested one by one

   With a cold test, light tapping on the tooth and a bite test, a tooth that brings the pain back is looked for. Not only the teeth on the painful side but also those in the opposite jaw are tested; with referred pain, people often feel the source in the wrong place.

5. 5

   The marks clenching leaves in the mouth are looked for

   Flattened biting surfaces, broken fillings and crowns, cracks in the teeth, and tooth marks inside the cheek and along the edge of the tongue are the signs clenching at night leaves in the mouth. If a panoramic X-ray is needed, it is taken at this stage.

6. 6

   Referral according to the source

   If it comes from muscle and joint, a night guard and reducing the load; if it comes from a tooth, treatment of the tooth; if a tension headache or migraine is suspected, your GP or neurology; if giant cell arteritis is suspected, assessment by a doctor the same day.

There is no single treatment for temple pain; what is done depends on where the pain comes from.

The points below are wrong decisions we often come across with this complaint. We are writing them so that you can ask the right questions whichever clinician you see.

The timings vary with the source. The course below applies to temple pain coming from muscle and joint; the plan of the clinician who examines you takes priority.

1. The first few days

   Soft food, giving up chewing gum, reminding yourself to keep your teeth apart during the day, and heat or cold ease the pain. The NHS states that TMD often gets better without treatment.

2. After a night guard has been made

   The guard protects the teeth from the load at night. Tiredness in the temples and jaw in the morning usually eases gradually; if the stress and sleep side does not improve, the pain may not go completely.

3. If the source is a tooth

   After the tooth is treated, the pain spreading to the temple is expected to die down too. If it does not, the diagnosis needs reviewing.

4. If it is still there after a few weeks

   If it continues despite simple measures, see a doctor about causes other than muscle and joint. The NHS writes that you can be referred to a specialist if simple measures have not worked.

We do not give a single figure here, because behind temple pain there may be a tension headache that needs no dental treatment at all, a clenching habit that calls for a night guard, or a tooth that needs root canal treatment. On the dental side, these are the items that determine the scope:

The source of the pain

Muscle and joint, a tooth, or a non-dental headache are entirely different routes and the field of different clinicians.

The type of night guard

A guard made to measure from an impression and a ready-made guard differ in fit and in how long they last.

The damage clenching has done to the teeth

Broken fillings and crowns, cracked teeth and worn surfaces enter the plan as separate items.

The need for imaging

In a picture coming from the muscles, an examination is often enough; if a tooth is suspected an X-ray, and for problems inside the joint more advanced imaging, may be needed.