Why does my jaw hurt by my ear. What causes pain under the ear and behind the jaw bone. How can TMJ disorders affect daily life. What are the most effective treatments for jaw pain near the ear. When should you seek medical attention for jaw and ear pain.

Understanding the Temporomandibular Joint (TMJ)

The temporomandibular joint (TMJ) is a complex structure that connects your jawbone to your skull. It plays a crucial role in various facial movements, including speaking, chewing, and yawning. When issues arise with this joint, it can lead to a range of uncomfortable symptoms, including pain near the ear.

The TMJ is located just in front of the ear on each side of the head. Due to its proximity to the ear, pain originating from the TMJ can often be mistaken for ear pain, and vice versa. This confusion can make it challenging for individuals to pinpoint the exact source of their discomfort.

Key Components of the TMJ

• Mandibular condyle: The rounded end of the lower jawbone
• Articular disc: A cushioning pad between the bones
• Temporal bone: The skull bone that forms the joint’s socket
• Ligaments and muscles: Structures that support and move the joint

Common Causes of Jaw Pain Near the Ear

Jaw pain near the ear can stem from various conditions, some directly related to the TMJ and others affecting nearby structures. Understanding these potential causes can help in seeking appropriate treatment and relief.

TMJ Disorders

TMJ disorders are a group of conditions affecting the jaw joint and surrounding muscles. These disorders can cause pain in the jaw, face, and ear area. Symptoms may include clicking or popping sounds when opening the mouth, difficulty chewing, and limited jaw movement.

Is TMJ disorder always the culprit behind jaw pain near the ear? While TMJ disorders are a common cause, they are not the only potential source of discomfort in this area. Other conditions can mimic TMJ symptoms, making a proper diagnosis crucial.

Osteoarthritis

Osteoarthritis is a degenerative joint disease that can affect the TMJ. It occurs when the cartilage that cushions the joint wears down over time. This wear and tear can lead to pain, stiffness, and reduced range of motion in the jaw.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder that can affect multiple joints in the body, including the TMJ. It causes inflammation and pain in the affected joints, potentially leading to discomfort in the jaw and ear area.

Ear Infections

Ear infections can cause pain that radiates to the jaw area. The close proximity of the ear to the TMJ can make it difficult to distinguish between ear pain and jaw pain. Ear infections may also be accompanied by other symptoms such as fever, reduced hearing, and discharge from the ear.

Teeth Grinding (Bruxism)

Grinding or clenching your teeth, especially during sleep, can put excessive stress on the TMJ and surrounding muscles. This can lead to pain and discomfort in the jaw and ear area. Bruxism can also cause wear on the teeth and contribute to TMJ disorders over time.

Identifying Symptoms of TMJ-Related Jaw Pain

Recognizing the symptoms associated with TMJ-related jaw pain is crucial for seeking appropriate treatment. While symptoms can vary from person to person, there are several common signs to watch for.

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

Can TMJ pain be one-sided? Yes, TMJ pain can affect one or both sides of the face. In some cases, individuals may experience pain primarily on one side, which can lead to confusion about the source of the discomfort.

Diagnosing Jaw Pain Near the Ear

Accurate diagnosis of jaw pain near the ear is essential for effective treatment. Healthcare professionals use various methods to determine the underlying cause of the pain and develop an appropriate treatment plan.

Physical Examination

A thorough physical examination is typically the first step in diagnosing jaw pain. The healthcare provider will assess the jaw’s range of motion, listen for any sounds during movement, and check for areas of tenderness or pain.

Imaging Tests

Imaging tests can provide detailed information about the structure and condition of the TMJ and surrounding tissues. Common imaging techniques include:

• X-rays: To view the bones and check for arthritis or other abnormalities
• CT scans: To create detailed cross-sectional images of the jaw and TMJ
• MRI: To evaluate the soft tissues, including the articular disc

Dental Examination

A dental examination can help identify issues such as misaligned teeth, signs of teeth grinding, or other dental problems that may contribute to jaw pain.

Treatment Options for Jaw Pain Near the Ear

Treatment for jaw pain near the ear depends on the underlying cause and severity of symptoms. Many cases can be managed with conservative approaches, while more severe or persistent cases may require more intensive interventions.

Conservative Treatments

• Rest and lifestyle modifications
• Applying heat or cold packs to the affected area
• Over-the-counter pain relievers and anti-inflammatory medications
• Gentle jaw exercises and stretches
• Stress reduction techniques
• Avoiding hard or chewy foods

Dental Interventions

Dental treatments can be effective for managing jaw pain related to TMJ disorders or teeth grinding. These may include:

• Custom-fitted night guards or splints to prevent teeth grinding
• Orthodontic treatments to correct bite issues
• Dental procedures to address tooth or gum problems

Physical Therapy

Physical therapy can help improve jaw function and reduce pain through targeted exercises, manual therapy, and education on proper jaw mechanics.

Medications

In some cases, prescription medications may be recommended to manage pain and inflammation. These can include:

• Muscle relaxants
• Prescription-strength pain relievers
• Tricyclic antidepressants for chronic pain
• Corticosteroid injections for severe inflammation

Surgical Interventions

Surgery is typically considered a last resort for treating jaw pain near the ear. It may be recommended in severe cases that do not respond to conservative treatments. Surgical options can include:

• Arthrocentesis: A minimally invasive procedure to remove debris from the joint
• Arthroscopy: A procedure using a small camera to diagnose and treat joint problems
• Open joint surgery: More extensive surgery to repair or replace the joint

Preventing Jaw Pain and Promoting TMJ Health

While not all cases of jaw pain can be prevented, there are steps you can take to reduce your risk and promote overall TMJ health.

Maintain Good Posture

Poor posture can contribute to jaw pain by placing additional stress on the TMJ and surrounding muscles. Practice good posture throughout the day, especially when sitting at a desk or using electronic devices.

Manage Stress

Stress can lead to jaw clenching and teeth grinding, which can exacerbate TMJ issues. Incorporate stress-reduction techniques into your daily routine, such as meditation, deep breathing exercises, or regular physical activity.

Practice Proper Chewing Habits

Avoid chewing gum excessively or biting on hard objects like pen caps or fingernails. When eating, take smaller bites and chew food evenly on both sides of your mouth.

Use Proper Technique During Physical Activities

If you participate in activities that involve impact to the face or jaw, such as contact sports, use appropriate protective gear like mouthguards.

When to Seek Medical Attention for Jaw Pain Near the Ear

While mild jaw pain may resolve on its own, there are situations where it’s important to seek medical attention promptly.

Should you always see a doctor for jaw pain near the ear? Not necessarily, but there are certain signs that warrant professional evaluation:

• Severe or persistent pain that interferes with daily activities
• Difficulty opening or closing your mouth fully
• Swelling in the jaw or face
• Fever accompanying jaw pain
• Changes in your bite or the way your teeth fit together
• Pain that spreads to other areas of the face or neck
• Jaw pain accompanied by chest pain or shortness of breath (which could indicate a heart problem)

Seeking timely medical attention can help prevent complications and ensure proper treatment for the underlying cause of your jaw pain.

Living with TMJ Disorders: Coping Strategies and Support

For individuals dealing with chronic TMJ disorders or recurrent jaw pain near the ear, developing effective coping strategies is essential for maintaining quality of life.

Pain Management Techniques

Explore various pain management techniques to find what works best for you. This may include:

• Relaxation exercises
• Mindfulness meditation
• Gentle massage of the jaw and facial muscles
• Applying heat or cold therapy as recommended by your healthcare provider

Dietary Modifications

Adjusting your diet can help reduce stress on the TMJ and alleviate pain. Consider:

• Eating softer foods during flare-ups
• Cutting food into smaller pieces
• Avoiding excessively chewy or hard foods
• Staying hydrated to support joint health

Support Groups and Resources

Connecting with others who experience similar challenges can provide emotional support and practical advice. Look for local or online support groups dedicated to TMJ disorders or chronic pain.

Working with Healthcare Providers

Maintain open communication with your healthcare team. Keep track of your symptoms, triggers, and the effectiveness of treatments to help guide your care plan.

By understanding the complexities of jaw pain near the ear and exploring various treatment options, individuals can take proactive steps toward managing their symptoms and improving their overall quality of life. Remember that each case is unique, and working closely with healthcare professionals is key to developing an effective, personalized approach to addressing jaw pain and TMJ-related issues.

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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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.