Recurrent temporomandibular pain in a patient with scoliosis and reduced cervical lordosis

This de-identified clinical story follows a woman who first visited at age 37 and experienced recurrent pain from 2019 through 2023. The perceived location shifted among a molar, the TMJ, cheek, temple, preauricular area, eye, cheekbone, and forehead.

Scoliosis and reduced cervical lordosis, often called a straight neck, were present as background findings. They were not treated as proof of a direct cause.

In 2023, six outpatient visits and splint therapy were followed by stabilization of the jaw and masticatory muscles and resolution of the reported eye and cheekbone pain.

Why did the pain initially feel like a molar or the jaw joint?

Dental pain may arise from caries, pulp or apical disease, periodontal disease, or a cracked tooth.

When dental examination does not clearly explain the pain and palpation or movement of the TMJ and masticatory muscles reproduces the familiar pain, non-odontogenic tooth pain should also be considered.

Pain from the TMJ or masticatory muscles may be perceived in the molars, cheek, cheekbone, temple, preauricular area, around the eye, or forehead. A past episode of referred pain does not remove the need to check for a new dental disorder whenever tooth pain returns.

Course in 2019

The patient could not clearly tell whether a molar or the TMJ was painful. The pain resolved after one outpatient visit, and care ended because no discomfort remained.

A short response can be a clinical clue that jaw structures contributed, but treatment response alone does not establish the source. Dental findings, jaw movement, and reproduction of the familiar pain must be interpreted together.

Course in 2020

The patient returned with right TMJ and right upper-tooth pain. Possible dental, sinus, neuropathic, headache-related, and masticatory-muscle sources were considered.

The temporalis can refer pain toward the upper teeth, eye, and forehead, while the masseter can refer pain toward the cheek, cheekbone, preauricular region, and molars. The symptoms resolved after four outpatient visits.

Course in February 2021

Non-odontogenic pain was again perceived in the right upper teeth. A new dental cause still had to be excluded rather than assuming that every recurrence had the same origin.

After five TMJ-focused visits, the perceived upper-tooth pain resolved and care ended.

Course in October 2021 and the vaccination timeline

The patient reported that pain across the face and around the right eye, cheekbone, and forehead became prominent after COVID-19 vaccination. The timing was recorded as clinically relevant history, but it did not prove that vaccination caused the facial or TMJ pain.

Possible overlapping factors included transient systemic symptoms, fatigue, sleep change, stress, increased clenching, reactivation of pre-existing jaw-muscle pain, cervical muscle tension, or an unrelated disorder occurring at the same time.

The medically cautious interpretation is that worsening after vaccination remains a temporal possibility, while this single case does not confirm a vaccine adverse effect or direct causal relationship.

Published case reports describe trigeminal neuralgia or neuropathy after vaccination, and reviews describe post-vaccination headache and facial pain. These reports cannot establish incidence or general causality and are not direct evidence that vaccination causes TMD.

An otology study reported new or worsened ear symptoms within four weeks in 61 of 420 vaccinated participants; 1.7% of the full group received a TMD syndrome diagnosis. The study did not establish a mechanistic link between a specific vaccine and those symptoms.

After four TMJ-focused visits, the reported facial, eye, cheekbone, and forehead symptoms resolved. That clinical course does not convert temporal association into proof of causation.

Course in 2022

There was a period of mild jaw and facial discomfort, but it diminished without a visit. TMD and masticatory-muscle pain can fluctuate with sleep, fatigue, clenching, food, prolonged opening, posture, stress, neck and shoulder fatigue, and one-sided chewing.

Course in 2023

The patient returned with right cheek, temple, preauricular, eye, and cheekbone discomfort, pain before sleep, and discomfort on opening. She also reported that a recent COVID-19 infection had delayed her visit.

Because she felt unable to accept injection therapy, care proceeded without forcing injections. Non-injection outpatient care and a splint were selected according to the recurrent course, broader facial symptoms, functional findings, and treatment preference.

Why was a splint added in 2023?

The decision considered repeated episodes over several years, temple and preauricular pain, eye and cheekbone discomfort, opening discomfort, the need for continued stabilization and observation, and the patient's preference to avoid injections.

An oral scan was obtained, followed by a putty-splint stage and fabrication of a TMJ splint. A splint is not required for every patient, does not correct scoliosis or cervical alignment, and does not resolve every form of jaw pain.

What changed during treatment?

At an early follow-up, the patient said the week had been less painful although a numb or tingling feeling remained. Improvement was assessed through intensity, frequency, duration, and opening comfort rather than demanding immediate complete disappearance.

She later reported that discomfort around the eye and cheekbone had decreased. This supports possible involvement of the TMJ and masticatory muscles in this individual, but it does not mean that all eye or cheekbone pain comes from TMD.

The patient also felt pressure on the front teeth while wearing the appliance. Fit and contacts were checked and adjusted. A splint requires follow-up when a tooth feels persistently loaded, the bite remains altered after removal, or oral tissue becomes sore.

The 2023 course comprised six outpatient visits, oral scanning, a putty-splint stage, splint delivery, and adjustment. Injection treatment was not used in that course.

Why can TMD be perceived as tooth pain?

Converging sensory input in the trigeminal system can make pain location difficult to identify. Masticatory-muscle pain may be experienced in upper or lower teeth even when the tooth is not the primary source.

Before irreversible dental treatment, clinicians should compare dental tests and imaging with pain duration, consistency of location, jaw movement, palpation, and response over time.

Why can the eye or cheekbone hurt?

The trigeminal nerve supplies the forehead and eye region, cheek and upper teeth, and jaw and masticatory region through different divisions. Persistent nociceptive input may be perceived broadly or as referred pain.

Temporalis pain can be felt around the temple, forehead, eye, or upper teeth. Masseter pain can be felt in the cheek, cheekbone, preauricular area, or molars.

What must be ruled out with eye or cheek pain?

Eye and cheek pain may also arise from dental disease, sinus disease, ophthalmic disease, migraine or other headache disorders, trigeminal neuralgia, neuropathic pain, infection, inflammation, trauma, or systemic disease.

Urgent or specialty evaluation may be needed for sudden severe or novel headache, visual loss or field change, severe red eye or pain with eye movement, eyelid droop, facial weakness or numbness, speech or limb symptoms, fever, rash, trauma, progressive night pain, or systemic decline.

Upper-tooth pain with cheek pain and purulent nasal symptoms requires consideration of both dental and maxillary-sinus disease. The possibility of referred jaw pain never removes the need to exclude other important causes.

Can temple and forehead headache be related to the jaw?

Clenching and grinding can fatigue the temporalis and masseter. Patients may describe throbbing temples, a heavy forehead, pulling around the eyes, side-of-head pressure, pain after chewing, or morning heaviness of the head and jaw.

If chewing or jaw movement worsens the headache and pressure over the temporalis reproduces the usual pain, jaw-muscle involvement can be assessed. Migraine, tension-type, cluster, cervicogenic, and secondary headaches still require separate consideration.

How should scoliosis and reduced cervical lordosis be interpreted?

The jaw, masticatory muscles, hyoid region, cervical muscles, shoulders, and trunk participate in coordinated function. Reviews report associations between jaw and neck dysfunction, reduced cervical mobility, altered endurance, and sensorimotor changes.

Association is not direct causation. Posture photographs or cervical alignment alone cannot diagnose TMD, and the scoliosis and straight-neck appearance in this patient were not designated as a single cause of recurrent pain.

They may have formed part of a background interacting with head position, asymmetric muscle use, clenching, sleep, fatigue, stress, and prolonged posture.

What does research say about scoliosis and TMD?

Systematic reviews describe possible associations between idiopathic scoliosis and malocclusion, craniofacial asymmetry, masticatory function, head-neck alignment, and TMJ-related findings. Most included studies are observational and heterogeneous.

Small studies have also reported changes in jaw range or deviation alongside changes in mild spinal curvature. These findings do not prove that scoliosis directly causes TMD in an individual.

Can a straight-neck appearance change mouth opening?

A study in patients with myofascial TMD pain reported that craniocervical posture could alter maximal opening and pressure-pain threshold. This supports functional linkage, not a rule that correcting cervical alignment cures jaw pain.

Do not infer that reduced cervical lordosis caused TMD, that a splint corrects scoliosis, that TMD treatment corrects the neck, or that one radiograph confirms the pain source.

Does this case prove a descending syndrome?

Descending syndrome is an explanatory model in which functional changes around the jaw and head may accompany compensation in the neck, shoulders, trunk, or pelvis. An ascending model describes influence in the opposite direction.

It is not an internationally standardized independent TMD diagnosis. In this case, bidirectional interaction among the jaw, cervical region, and spine is more appropriate than claiming a one-way causal chain.

Is there also a neurologic jaw-neck connection?

Trigeminal and upper-cervical sensory information converges functionally in the nervous system. This may help explain overlapping pain in the jaw, temple, ear region, neck, and occiput, but does not prove that all neck pain begins in the jaw or vice versa.

Did recurrence mean that previous care failed?

No. Symptoms had resolved after each earlier episode before care ended. A new episode months or years later can reflect renewed load from sleep, fatigue, clenching, diet, work posture, emotional tension, or neck and shoulder conditions.

For a person with persistent background factors, early reduction of load and management of recurring aggravators may be more realistic than assuming one course must prevent all future pain.

What did stabilization after splint therapy mean?

Temple and preauricular pain decreased, eye and cheekbone discomfort resolved, and opening became comfortable enough for daily life. The appliance was reviewed and adjusted when front-tooth pressure occurred.

Stabilization did not mean that scoliosis or cervical alignment was corrected, that every joint structure returned to an original state, or that recurrence could never happen.

Ways to reduce recurrent load

Keep the upper and lower teeth apart at rest except during chewing and swallowing.

During a flare, temporarily reduce hard or chewy foods, very wide yawning, and prolonged mouth opening.

Change position regularly during computer or phone use instead of holding one ideal posture for a long time.

Check whether tooth pain or discomfort is driving persistent one-sided chewing.

Seek separate orthopedic or rehabilitation assessment for persistent neck or shoulder pain, arm numbness, or weakness.

Reassess any new tooth pain for caries, pulp disease, cracks, periodontal disease, or another dental cause.

Prioritize appropriate medical assessment for visual change, severe new headache, facial weakness or numbness, fever, rash, or progressive symptoms.

Have the splint checked rather than altering it yourself when pressure, persistent bite change, or tissue injury occurs.

What did the long-term course teach?

Jaw and muscle pain can feel like tooth pain, and recurrence may shift location. A changed location does not automatically mean a wholly different disease, while a familiar location should never be accepted without re-examination.

The reduction of eye and cheekbone symptoms during jaw-focused care suggests possible involvement in this patient only. Appropriate differential diagnosis remains essential.

Scoliosis and reduced cervical lordosis were considered background factors, while descending syndrome remained an explanatory concept rather than a confirmed diagnosis.

How does Obokmanse Dental Clinic assess recurrent TMJ pain?

Assessment may include current and prior pain locations, onset and recurrence, opening range and path, joint and muscle tenderness, joint sounds, dental versus non-dental pain, referred facial pain, neck and shoulder function, posture and asymmetry, clenching, sleep, prolonged device use, previous response, new red flags, and the need and fit of an oral appliance.

Cervical or spinal imaging alone is not used to diagnose the source of jaw pain, and symptom improvement after jaw care is not described as treatment of scoliosis or cervical alignment.

Final clinical outcome

From 2019 through 2023, the patient returned with pain perceived in different areas. The 2019 episode resolved after one visit, the 2020 episode after four, the February 2021 episode after five, and the October 2021 episode after four.

In 2023, six non-injection outpatient visits and splint therapy were followed by stabilization of the TMJ and masticatory muscles and resolution of the reported eye and cheekbone pain. Front-tooth pressure from the appliance was checked and adjusted.

The course was interpreted as a multifactorial interaction among jaw function, masticatory muscles, cervical and spinal background, head position, clenching, sleep, fatigue, and daily posture, not as proof that spinal alignment directly caused every symptom.

De-identification and medical information notice

This account was reconstructed from clinical records after removing identifying information. One patient's course does not predict the same response in another person.

Facial, eye, cheekbone, tooth, temple, and jaw pain can arise from dental, sinus, neurologic, ophthalmic, cervical, infectious, inflammatory, headache, or systemic conditions. In-person examination and appropriate tests are required.

References

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How to read this story

The outcome is limited to this de-identified record. It does not prove that scoliosis, reduced cervical lordosis, or vaccination caused the pain, nor does it guarantee that another patient will respond in the same way.