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Left Jaw Pain Near Ear: Causes, Symptoms, and Treatments for TMJ Discomfort

What causes jaw pain near the ear. How to identify TMJ disorders. When should you seek medical attention for jaw discomfort. What are the most effective treatments for TMJ-related pain. How do ear infections relate to jaw pain. Can teeth grinding cause jaw and ear discomfort. What lifestyle changes can help alleviate TMJ symptoms.

Understanding TMJ: The Connection Between Jaw and Ear Pain

The temporomandibular joint (TMJ) plays a crucial role in our daily lives, facilitating essential functions like chewing, talking, and yawning. When this complex joint experiences issues, it can lead to a range of uncomfortable symptoms, including pain that radiates to the ear area. Many people find themselves wondering about the source of their discomfort when they experience pain in both their jaw and ear simultaneously.

The proximity of the TMJ to the ear canal explains why pain in one area can often be mistaken for or associated with pain in the other. Specifically, pain under the ear and behind the jawbone is frequently linked to the temporomandibular joint. Understanding this connection is key to identifying the root cause of your discomfort and seeking appropriate treatment.

Common Causes of Jaw Pain Near the Ear

Several conditions can lead to jaw pain that extends to the ear area. Here are some of the most frequent culprits:

Osteoarthritis of the TMJ

Osteoarthritis is the most common form of arthritis affecting the temporomandibular joint. This condition results from the gradual wear and tear of the cartilage surrounding the joint. As the cartilage deteriorates, it can cause stiffness and pain in the jaw area, often radiating towards the ear.

Rheumatoid and Psoriatic Arthritis

Both rheumatoid arthritis and psoriatic arthritis are autoimmune conditions that can affect the TMJ. These disorders can cause inflammation and pain in various joints throughout the body, including the jaw. When these conditions impact the TMJ, patients may experience pain that extends from the jaw to the ear area.

TMJ Disorders

TMJ disorders encompass a range of conditions affecting the joint and surrounding muscles. These disorders can cause pain, inflammation, and discomfort in the TMJ area. When symptoms persist for more than three months and cannot be attributed to other causes, it may indicate a chronic TMJ disorder or related conditions such as fibromyalgia, sleep apnea, anxiety, or depression.

Ear Infections

While not directly related to the jaw, ear infections can cause pain that may be mistaken for TMJ issues. Infections in the ear can lead to discomfort that extends to the jaw area, especially under the ear and behind the jawbone. In some cases, untreated ear infections can spread to surrounding tissues, causing more severe complications.

Sinusitis

Sinus infections, particularly those stemming from allergies or colds, can cause pain and pressure that extends to the jaw and ear areas. The inflammation of the nasal passages can create discomfort that radiates to nearby structures, including the TMJ.

Teeth Grinding (Bruxism)

Habitual teeth grinding, also known as bruxism, can put excessive strain on the jaw muscles and TMJ. This repetitive action can lead to pain in the jaw, face, and ears, as well as cause damage to the teeth over time.

Identifying TMJ Disorders: Key Symptoms to Watch For

Recognizing the signs of TMJ disorders is crucial for early intervention and effective treatment. Some common symptoms include:

  • Pain or tenderness in the jaw area, especially near the ear
  • Difficulty or discomfort while chewing
  • Clicking or popping sounds when opening or closing the mouth
  • Locking of the jaw joint, making it difficult to open or close the mouth
  • Facial pain that may extend to the neck and shoulders
  • Headaches, particularly in the temple area
  • Earaches or ringing in the ears (tinnitus)

If you experience a combination of these symptoms, particularly if they persist for an extended period, it may be time to consult a healthcare professional specializing in TMJ disorders.

Diagnosing TMJ-Related Jaw and Ear Pain

Proper diagnosis of TMJ disorders and related conditions is essential for developing an effective treatment plan. Healthcare providers typically use a combination of methods to identify the underlying cause of jaw and ear pain:

Physical Examination

A thorough examination of the jaw, face, and neck can help identify areas of tenderness, limited range of motion, or abnormal jaw movements. The healthcare provider may also listen for clicking or popping sounds when the jaw is in motion.

Medical History Review

Discussing your symptoms, medical history, and lifestyle factors can provide valuable insights into potential causes of your jaw and ear pain. Be prepared to share information about any recent injuries, stress levels, and dental procedures.

Imaging Tests

In some cases, imaging tests may be necessary to get a clearer picture of the jaw joint and surrounding structures. These may include:

  • X-rays to examine the bones and joint alignment
  • CT scans for detailed images of the bones in the joint
  • MRI scans to evaluate soft tissues, including the disc within the joint

Dental Examination

A dental professional may examine your teeth, bite alignment, and overall oral health to identify any contributing factors to your TMJ symptoms.

Effective Treatments for TMJ-Related Jaw and Ear Pain

Once a diagnosis has been established, treatment options can range from conservative home remedies to more advanced medical interventions. Here are some common approaches to managing TMJ-related pain:

Conservative Home Treatments

Many cases of TMJ discomfort can be managed with simple, non-invasive methods:

  • Applying ice or heat packs to the affected area
  • Practicing gentle jaw stretches and exercises
  • Eating soft foods to reduce strain on the jaw
  • Avoiding extreme jaw movements, such as wide yawning or gum chewing
  • Using over-the-counter pain relievers and anti-inflammatory medications

Professional Therapies

For more persistent or severe cases, healthcare providers may recommend:

  • Physical therapy to improve jaw strength and flexibility
  • Custom-fitted mouthguards or splints to prevent teeth grinding and reduce jaw tension
  • Cognitive behavioral therapy to address stress and anxiety that may contribute to TMJ symptoms
  • Trigger point injections to relieve muscle tension in the jaw area

Medications

In addition to over-the-counter options, prescription medications may be necessary for some patients:

  • Muscle relaxants to reduce jaw tension
  • Stronger pain relievers for severe discomfort
  • Anti-anxiety medications to address stress-related symptoms

Surgical Interventions

In rare cases where conservative treatments are ineffective, surgical procedures may be considered:

  • Arthrocentesis: A minimally invasive procedure to flush out the joint
  • TMJ arthroscopy: A surgical technique using small instruments to treat joint issues
  • Open-joint surgery: Reserved for the most severe cases of TMJ disorders

Lifestyle Changes to Alleviate TMJ Symptoms

In addition to medical treatments, certain lifestyle modifications can significantly improve TMJ-related discomfort:

Stress Management

Reducing stress levels can help alleviate tension in the jaw muscles. Consider incorporating relaxation techniques such as meditation, deep breathing exercises, or yoga into your daily routine.

Posture Improvement

Poor posture, especially when working at a desk or using mobile devices, can contribute to TMJ pain. Focus on maintaining proper alignment of your head, neck, and spine throughout the day.

Diet Modifications

Opt for softer foods and avoid those that require excessive chewing. This can help reduce strain on the jaw joint and surrounding muscles.

Sleep Habits

Ensure you’re getting adequate rest and consider your sleeping position. Side sleeping with proper pillow support can help alleviate pressure on the jaw.

When to Seek Professional Help for Jaw and Ear Pain

While mild jaw discomfort may resolve on its own, certain situations warrant immediate medical attention:

  • Severe, persistent pain that interferes with daily activities
  • Inability to open or close your mouth fully
  • Sudden changes in your bite alignment
  • Swelling in the jaw or face
  • Fever accompanied by jaw pain, which may indicate an infection
  • Trauma or injury to the jaw area

If you experience any of these symptoms, consult a healthcare provider or TMJ specialist promptly. Early intervention can prevent the progression of TMJ disorders and improve your overall quality of life.

Preventive Measures for TMJ Health

Taking proactive steps to maintain the health of your temporomandibular joint can help prevent the onset or recurrence of TMJ-related issues:

Regular Dental Check-ups

Maintain a schedule of regular dental visits to address any bite issues or teeth grinding habits early on.

Mindful Habits

Be aware of habits that may strain your jaw, such as clenching your teeth, biting nails, or chewing on non-food items. Work on breaking these habits to reduce stress on the TMJ.

Ergonomic Adjustments

Ensure your work environment supports good posture, especially if you spend long hours at a desk or computer. This can help reduce tension in the neck and jaw areas.

Balanced Diet

A diet rich in anti-inflammatory foods may help reduce inflammation in the body, including the TMJ. Consider incorporating foods high in omega-3 fatty acids, such as fish, nuts, and seeds.

By understanding the causes of jaw pain near the ear and implementing appropriate preventive measures and treatments, you can effectively manage TMJ-related discomfort and improve your overall oral health. Remember, persistent or severe symptoms should always be evaluated by a healthcare professional to ensure proper diagnosis and treatment.

Why Does My Jaw Hurt by My Ear? | TMJ


Are you experiencing simultaneous pain in your jaw and ear, on one side or both sides? There could be a multitude of reasons behind the pain. The Temporomandibular Joint (TMJ) is usually the source of pain when it comes to the jaw and ear. That said, it’s important to remember that the jaw and ear are in extremely close proximity which may be why pain in the ear may be confused with pain in the jaw and vice versa. Specifically pain under the ear, behind the jaw bone can be said to be radiating from the temporomandibular joint.

If you are wondering “Why does my jaw hurt by my ear?” you are definitely on the right page. In this article, we will unearth some of the most common causes behind jaw and ear pain including the pain under the ear, behind the jaw bone, and how to remedy them.

Possible Reasons Why Your Jaw Hurts by Your Ear

Osteoarthritis

The most common kind of arthritis in the TMJ is osteoarthritis. Although common, it should still be taken seriously. Osteoarthritis is the result of constant wear and tear of the cartilage enveloping the joint. This triggers stiffness in the joint, eventually resulting in critical pain behind the ear and jaw. So, if you’re thinking “I have an earache and my jaw hurts” then osteoarthritis may be the probable cause.

Rheumatoid or Psoriatic Arthritis

Rheumatoid arthritis is an autoimmune condition that affects healthy joints. It may lead to joint pain at times that may radiate throughout the rest of the body. Some triggers especially cause rheumatoid arthritis pain. Pain in the jaw, under the ear and in the ear could also be a sign of either rheumatoid arthritis or psoriatic arthritis, another autoimmune condition.

TMJ Disorder

Another leading cause of pain under the ear, behind the jaw bone can be a disorder related to the temporomandibular joint (TMJ).

The TMJ is indirectly responsible for many functions such as chewing ad talking as it facilitates movement in the jaw. As such, it includes the jaw joint as well as the nearby muscles that aid in the movement. In cases where patients suffer from symptoms such as, inflammation, discomfort, or pain in the TMJ – that cannot be attributed to any other obvious cause – for more than three months it may be chronic TMJ or other medical conditions like fibromyalgia, sleep apnea, anxiety, or depression. TMJ could be due to wear and tear or another reason.

Ear Infections

Often, ear infections are caused by viruses or bacteria. They can also be caused when water or other fluids build up in and around your ear, leaving you susceptible to earache or jaw, specifically pain under the ear, behind the jaw bone. Also, if you experience a mild to high fever coupled with reduced stamina, that’s a red flag.

In a condition called mastoiditis, undiagnosed ear infections may spread to other parts of the body as well. As the infection spreads, the person might encounter massive swelling and pain near the ear and jaw on one side.

In fact, severe cases of this condition can demand immediate diagnosis as they could be life-threatening.

Sinusitis

Pain under the ear or behind the jaw bone could be the result of sinusitis. But this only happens when you have a precondition of cold allergies. Since it is a virus borne infection, your nasal passage becomes irritated. This could also be accompanied by a runny nose.

Teeth Grinding

How do you know if your teeth are actually grinding? What are the symptoms? If you are experiencing erosion in your teeth or severe strain in your gums or muscles, this could be it.

The tension caused can create pain in the neck, on the front and sides of the face, or in the ears. In some cases, it can cause massive damage to the teeth, ultimately breaking them.

How to Treat Jaw Pain Caused by TMJ

You can try to nurse it from home, which is the least invasive way. Eat soft foods, stretch and massage your jaw, and apply heat and cold alternately to it.

If your symptoms persist, your doctor may recommend any of the following treatments.

Medicines

Some over-the-counter medicines (pain relievers and anti-inflammatories) commonly prescribed for TMJ are Tylenol and ibuprofen.

Therapies

Therapies can include mouthguards to wear while sleeping, as well as physical therapy to get the jaw muscles strong and flexible.

Surgical procedures

Arthrocentesis, corticosteroid injections, TMJ arthroscopy and modified condylotomy are procedures only done in the rarest of cases.

Improve your Quality of Life

Don’t let these issues get in the way of your quality of life. Say Hello to Raleigh TMJ, a leading sleep therapy and TMJ center. It is best known for offering non-surgical therapies and enhancing the quality of your life, painlessly.

Request an appointment right away and bid goodbye to all your TMJ troubles. Additionally, you can check out our other services, which include a cure for headaches, facial pain, snoring, sleep apnea, and more. Why wait? Request an appointment!

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Causes, remedies, and when to see a doctor

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Pain in the ear and jaw can range from a mild ache to intense pain. Numerous conditions can cause ear and jaw pain, including mouth or ear infections, joint injuries, and tooth grinding.

In this article, we discuss the most common causes of ear and jaw pain. We also suggest home remedies to try before seeing a doctor and explain the medical treatment options.

Share on PinterestA problem with the temporomandibular joint may cause ear and jaw pain.

Numerous conditions can cause ear and jaw pain.

It can be difficult for a doctor to diagnose the cause based on these symptoms alone, so they will take into account risk factors and recent history. For example, a person who has not been to the dentist in many years and has a history of tooth pain may have a cavity.

The following are some common causes of ear and jaw pain:

TMJ dysfunction

Problems with the temporomandibular joint (TMJ) can cause a wide range of symptoms, including, most prominently, ear and jaw pain. Some people also get headaches, eye pain, and even sinus pressure. Several conditions and factors can cause TMJ pain, including:

  • grinding the teeth
  • problems with the alignment of the jaw or teeth
  • muscle injuries
  • arthritis

Although TMJ can be painful, home treatment often helps manage or even eliminate symptoms.

Sternocleidomastoid pain

The sternocleidomastoid is a thick muscle that extends from just under the ear down to the collarbone. Injuries to this muscle can cause jaw and ear pain, as well as sinus pain, eye pressure, and other symptoms that a person might mistake for signs of a cold or infection.

When a person has these symptoms but has no injuries and no other signs of infection — such as a fever or runny nose — an injury to the sternocleidomastoid may be the culprit. A doctor can rule out other causes, such as infections of the middle or inner ear, by carrying out a physical examination.

Oral infections

A tooth abscess can sometimes cause pain that radiates to the ear or jaw.

In most cases, a person will also have swelling in the gums or tender spots in and around the teeth. Sometimes, the pain in the teeth disappears and then reappears as pain in the ear or jaw, which may signal that the infection is spreading.

Ear infections

An ear infection can cause intense pain in, around, or behind the ear. Sometimes, this pain radiates to the jaw, sinuses, or teeth.

In most cases, viruses or bacteria cause ear infections. Ear infections can also happen when water or other fluids build up in the ear.

A person with an ear infection may have other symptoms, such as fever, congestion, and low energy. The pain of an ear infection can be intense and may get rapidly worse without treatment.

Untreated ear infections can spread to other parts of the body. Some people develop an infection called mastoiditis, which is an infection in the mastoid bone near the ear. When this happens, a person may experience swelling close to the ear, hearing problems, or a high fever. Severe cases of mastoiditis can be life threatening and require immediate treatment.

Jaw injuries

An injury, such as a broken jaw or a strain or sprain in the surrounding muscles, could cause jaw pain that radiates to the ear. If a person notices ear and jaw pain shortly after a fall, a car accident, or a blow to the head, they may have a jaw injury that needs medical treatment.

Tooth grinding

Grinding the teeth at night places stress on the muscles of the face, neck, and jaw. The tension can cause pain in the jaw, in the ears, and on the front or side of the face. Some people may also damage their teeth, slowly grinding them down or even breaking them.

It is safe to treat ear and jaw pain at home when it is not due to an underlying infection or a serious injury. People can try the following strategies:

  • Sleep with a mouth guard to prevent tooth grinding. Different types of mouth guard are available for purchase online. If the mouth guard helps but does not cure the symptoms, a person might need a custom mouth guard from a dentist.
  • Try applying heat or ice to the injury, as this can ease pain and promote healing. Learn how to make a heating pad here.
  • Gently massage the jaw to reduce muscle tension.
  • Take a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen.
  • Try stretching the sternocleidomastoid by tilting the ear down toward the shoulder and holding it there for 5–10 seconds. Repeat on the other side.
  • Stretch the jaw muscles by opening the mouth and jutting out the lower jaw, then holding this position for 5–10 seconds. Next, try moving the teeth forward and back and from side to side in a circular motion.

Infections almost always require antibiotics. Sometimes, a person needs other medical treatments, particularly in the case of serious infections, such as mastoiditis.

If home remedies fail, medical treatment options include:

  • orthodontic treatment to align the teeth and jaw
  • TMJ surgery to reduce TMJ pain
  • a custom fitted device to prevent tooth grinding
  • mental health treatment, for when a person grinds their teeth because of anxiety
  • prescription medication for arthritis
  • physical therapy to treat jaw injuries or manage arthritis more effectively
  • treatment for cavities, such as fillings, root canals, or crowns
  • stronger pain relievers for TMJ disorders or arthritis

It is best to see a doctor for ear and jaw pain if:

  • there are signs of an infection, such as fever or swelling
  • the pain appears immediately after an injury
  • the gums are swollen or the teeth hurt
  • symptoms do not improve within a few days of home treatment
  • a doctor prescribes antibiotics or other treatment, but treatment does not help
  • ear or jaw pain becomes unbearable
  • a baby or young child with ear and jaw pain does not stop crying

Ear and jaw pain can be extremely unpleasant. Prompt medical treatment can help, even when there is an underlying chronic condition.

If home treatment fails, a person should speak to their doctor. There is no reason to suffer through the pain or delay treatment.

Read the article in Spanish.

Jaw hurts in the ear area, which doctor should I visit? / Dental center “Michurinskiy”

Pain near the right/left ear canal can be constricting or throbbing, burning or aching, sudden or increasing, at rest or when pressed. Sometimes, along with pain, the temperature rises, soft tissues swell. By the nature of the pain, you can first determine its root cause. That is why doctors, only after an in-depth interview, prescribe diagnostic procedures for the patient – X-ray, MRI, complete blood count.

Problems that cause pain in the cheekbones and jaw can be treated by dentists, surgeons, otolaryngologists and other specialized doctors. On the possible causes of discomfort, localized anterior to the ear, we read further.

TMJ dysfunction. Failure of the temporal joint and dysfunction of the masticatory muscles is the most common cause of pain in the jaw near the ear. Pain in this case does not occur spontaneously, but with loads or pressure. Soreness is felt when chewing, yawning and talking. It is even possible to diagnose the disorder by its characteristic features – clicking and crunching in the joint when moving the jaw (in conversation or while chewing food), tinnitus, dizziness. Articular pathology is characterized by a unilateral lesion. The disease develops in the place of localization of pain. That is, if it hurts near the left ear, cheekbones and neck, this means that the destructive process is on the left.

Facial injuries (contusion, dislocation, fracture)

Acute pain attack, swelling and hematoma are the key signs of soft tissue injury even without affecting bone structures. With a sharp opening of the mouth or as a result of a blow to the face, a dislocation of the TMJ may occur, making it difficult for the simplest swallowing and chewing movements. The fracture manifests itself as unbearable pain around the injury, which spreads to the entire facial area.

Bruxism. One of the most common causes of pain in the jaw is grinding teeth at night. Usually discomfort is felt in the morning due to constant clenching of the jaws. With bruxism, the cutting surface of the teeth is abraded, pain in the jaw and ear canal is accompanied by chronic headache, discomfort in the face area, as well as anxiety, depression and insomnia.

After dental treatment. The cause of aching pain in the jaw and cheekbones are often manipulations carried out in the office of an orthopedist or orthodontist. Soreness with inflammation and swelling can occur after poor-quality removal of eights, as well as after caries treatment or dentures. Jaw pain is usually experienced for some time after braces are placed. This is considered a normal response of the jawbone to pressure from the orthodontic appliance.

Infections and inflammations

Osteomyelitis – damage to bones and adjacent tissues by an infection spreading with blood. With jaw osteomyelitis, the TMJ often suffers. Symptoms include jaw pain, swelling of the face, and fever.

Abscess – disease resulting from infection of the pulp during advanced caries. Moving along the root canal, pathogens infect adjacent soft tissues, causing inflammation and jaw pain.

SARS. Persistent ear pain may be felt as a complication of viral infections. The reason for this is inflammation of the joint sac, provoked by the influx of viruses and bacteria.

The cheekbone in the area of ​​the auricle can also hurt with inflammation of the ear canal. However, this case is characterized by intense pain in the ear with a return to the jaw. Inflammation is accompanied by fever (37.5-38C) and general malaise.

Neuralgia. Acute pain syndrome develops with inflammation of the nerves – trigeminal, glossopharyngeal, upper laryngeal. Pain occurs when coughing, hiccups, eating, yawning and pressure.

With jaw pain, they turn to the following specialists:

  • in case of TMJ pathologies, – gnatologist, orthodontist;
  • in case of injuries, diseases and infections of the dental system – to the dentist, maxillofacial surgeon;
  • in case of soft tissue diseases – to the surgeon;
  • in case of inflammatory processes in the teeth or gums – to the dentist;
  • if the pain is a consequence of complications of SARS or occurs with inflammation of the tonsils, larynx, sinuses, ears or lymph nodes – see an otolaryngologist;
  • for neuralgia – to a neurologist.

If the etiology of the pain is unknown, the family doctor or general practitioner should be contacted initially. After examining and identifying a specific cause, the general practitioner will refer you to a narrow-profile specialist. 9Author: Tamara Panterova
Deputy Chief Physician, Candidate of Medical Sciences
Sciences by specialty: dentistry and medical microbiology

What to do if there is pain when opening the mouth and chewing in the area of ​​the jaw and ear, on the left and right sides? How to relieve and cure pain when opening the mouth in Moscow and how much does it cost? Read more…

Symptoms such as severe and sharp pain in the jaw when opening the mouth have several causes. With the exception of injuries and specific pathologies, the most common causes of pain when opening the mouth are diseases of the TMJ and masticatory muscles. As a rule, the tone of the masticatory and mimic muscles first changes, and after a while functional changes occur in the jaw joints.
It must be remembered that the lower jaw has two jaw joints, so pathologies are possible in which there is pain in the jaw both on the right and on the left when opening the mouth, chewing and even talking.

In diseases of the masticatory muscles only, pain in the neck and temple is most characteristic when opening the mouth, as well as when chewing solid food, less often when yawning. This is due to a decrease in the elasticity of muscle fibers as a result of the degeneration of muscle tissue into connective scar tissue and the appearance of muscle scars. More often this can be observed in the example of the masticatory muscles themselves.
Pain near the ear and pain in the joint when opening the mouth suggest that the masticatory muscles and TMJ are also involved in the disease. Pain in the jaw joint when opening the mouth is caused by a change and displacement of the elements of the TMJ. In particular, often gnatologists fix the pathological displacement of the jaw disk forward, and the head of the lower jaw up and back. This combination leads to stretching of the anterior and posterior disc ligaments and pressure on the bilaminar zone of the TMJ, which contains the main pain receptors and the venous plexus.
From the point of view of interdisciplinary dentistry, pain when opening the mouth and chewing is associated not only with the maxillofacial region, but also with such a concept as postural disorders . Neuromuscular dentists and osteopaths in the process of diagnosis take into account the condition of the spine, neck muscles and spatial disturbances in the position of some organs and tissues.

How to properly treat pain in the ear and mandibular joint when opening the mouth?
First of all, it should be understood that the treatment of pain with a wide opening of the mouth, chewing and yawning on your own, at home is unacceptable. This will only lead to a loss of time and increased pain up to the development of migraines and neuralgia of the facial nerves.
To cure pain in the jaw, near the ear, when opening the mouth, this is a matter for qualified dentists and other specialists, respectively, the sooner you see a doctor, the less suffering and complications will fall to your lot.

Briefly, the main points:

  • pain relief with NSAIDs;
  • dissociative night guard;
  • MRI TMJ;
  • electromyography of masticatory muscles and, based on it, TMJ splint therapy;
  • MPI mandibular analysis;
  • performing dental physiotherapy of the temporomandibular joint and masticatory muscles;
  • determination of the “centric” – the central ratio of the jaws and its fixation with the help of ceramic crowns or onlays.

Cost of treatment in Moscow

The most common question of many patients before starting treatment is: “How much does it cost to treat pain when opening the mouth at Partner Med Dentistry?”

In Moscow, the price for fast and high-quality treatment of pain when opening the mouth and chewing depends on the following points:

  • the complexity of each specific case;
  • availability of the required medical equipment, applied methods and methods of treatment;
  • qualifications of doctors;
  • pricing policy.