Jaw pain when chewing: causes, and the warning sign not to miss

Chewing uses the jaw joints in front of each ear and the strong muscles around the cheeks and temples. Any problem with that system tends to show itself when you eat. The NHS describes temporomandibular disorder (TMD) as a condition affecting the movement of the jaw and says the pain may be worse when chewing and when you feel stressed.

A rarer cause lies in the arteries rather than the jaw itself. The NHS lists jaw pain while eating or talking as one of the main symptoms of temporal arteritis, an inflammation of arteries at the side of the head, and it advises an urgent appointment for a headache that comes with jaw pain when eating or a sore or tender scalp.

The two explanations feel quite different in the context of other symptoms, which is the useful way to approach this guide.

The NHS lists the symptoms of TMD as pain around the jaw, ear and temple, clicking, popping or grinding noises when you move the jaw, a headache around the temples, difficulty opening the mouth fully, and the jaw locking when you open it. It can also stop you getting a good night's sleep.

The causes it names are teeth grinding, wear and tear of the joint, a blow to the head or face, stress and an uneven bite. TMD usually gets better without treatment. For self-care the NHS suggests eating soft food such as pasta, omelettes and soup, taking paracetamol or ibuprofen, holding an ice pack or heat pack wrapped in a tea towel to the jaw, massaging the painful muscles and finding ways to relax.

It also lists things to avoid: chewing gum or pen tops, biting food with the front teeth, yawning too wide, nail biting and clenching the teeth, apart from when eating, when the teeth should be kept apart. If these measures do not help, a GP may suggest stronger painkillers, relaxation techniques and ways to improve sleep, and may suggest seeing a dentist, a psychologist or a physiotherapist. The NHS says that if treatments do not help you may be referred to a specialist in joint problems to discuss options such as injections or surgery.

The NHS explains that temporal arteritis, also called giant cell arteritis, is where the arteries, particularly those at the side of the head (the temples), become inflamed. It describes it as serious and needing urgent treatment. The main symptoms it lists are frequent, severe headaches, pain or tenderness at the temples or on the scalp, jaw pain while eating or talking, and vision problems such as double vision or loss of vision in one or both eyes.

More general symptoms are also common, including flu-like symptoms, unintentional weight loss, depression and tiredness, and some people also develop polymyalgia rheumatica, which causes pain and stiffness in the muscles around the shoulders, neck and hips.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you think you might have temporal arteritis, because it can lead to stroke and blindness if not treated quickly. If you have problems with your vision you should have a same-day appointment with an eye specialist at a hospital eye department.

Tests described by the NHS include blood tests, an ultrasound scan of the temples and a biopsy of the temporal artery under local anaesthetic. Treatment is with steroid medicine, usually prednisolone, started before the diagnosis is confirmed because of the risk of vision loss. The NHS stresses not to stop steroids suddenly unless a doctor says so.

The overlap in the NHS lists is striking: both TMD and temporal arteritis can involve pain around the jaw, ear or temple, and the NHS TMD page itself includes, in its urgent advice list, frequent severe headaches, tenderness at the side of the head or scalp, and vision problems, because these can be signs of a serious problem needing urgent treatment. The table sets out features the NHS pages associate with each.

The NHS heart attack page lists chest pain that may feel like crushing or squeezing, with pain that may spread to the arm, neck and jaw, together with shortness of breath, feeling or being sick, sweating and pale or grey skin. It advises calling 999 if you have chest pain that feels tight or like squeezing, or that spreads to the arms, neck or jaw, and not driving yourself to A&E.

A jaw ache that arrives together with chest tightness, breathlessness or sweating is therefore a reason to call 999 rather than to wait. Pain that is clearly tied to chewing, with clicking, popping or locking of the jaw, is the pattern the NHS describes for the jaw joint.

The NHS TMD page lists, under its advice to ask for an urgent GP appointment or get help from NHS 111, being unable to eat or drink, clicking, popping or grinding noises, difficulty opening the mouth fully or the jaw locking, and pain around the jaw, ear or side of the head. The same list includes the warning features above: frequent severe headaches, tenderness at the side of the head or scalp, or vision problems such as double vision or loss of vision in one or both eyes, which it says can be signs of a serious problem needing urgent treatment.

If you have chest pain with jaw pain, call 999. The NHS pages used here do not cover dental causes of jaw pain, so this guide does not go further on them.