When Your Face Hurts but Your Teeth Look Fine | Dr. Bradley Eli on Orofacial Pain & Bruxism
What Orofacial Pain Really Means
Orofacial pain is a specialty that lives in the space between dentistry, neurology, and musculoskeletal medicine. While most people think of dental pain as something you can see on an X-ray—a cavity, an infection, or a cracked tooth—orofacial pain is much broader. It focuses on the complex network of muscles, joints, and nerves in the head, face, and neck, and on how problems in one area can ripple into the others.
Dr. Bradley Eli describes it as “where the systems overlap.” The temporomandibular joints (TMJs), the chewing muscles, the cervical spine, and the trigeminal nerve all share space and signals. If one structure is inflamed or overworked, others can become involved, creating a web of pain that’s hard to untangle. For example, a migraine sufferer may develop jaw tightness and temple soreness. Or someone with long-standing clenching may develop ear pressure and ringing—symptoms they would never connect to their bite.
Because the symptoms cross boundaries between medical disciplines, patients often end up bouncing from one provider to another. A dentist might say the teeth are fine. An ENT might see no sign of ear infection. A neurologist might not find a primary headache disorder. Without a clear specialty home for “my face hurts, but my teeth look fine,” many people are left with no definitive answer.
That’s where orofacial pain specialists come in. Their role is to look at the entire picture, considering the teeth, bite, jaw mechanics, muscle function, nerve pathways, and broader medical context. They’re trained to identify conditions that don’t neatly fit into a single box and to manage pain that isn’t resolved by routine dental or medical treatment.
For many patients, finding an orofacial pain specialist is the first real step toward understanding—and eventually relieving—chronic head, face, and jaw pain.
Conditions an Orofacial Pain Specialist Treats
When most people hear “jaw pain,” they think of TMJ problems or maybe a cracked tooth. But Dr. Bradley Eli’s patient list shows just how wide the spectrum of orofacial pain really is. His cases often reach far beyond what you’d expect a dentist to treat.
Some patients arrive with tension-type headaches—that tight, band-like pressure across the temples—which are often linked to overworked jaw and neck muscles. Others come in with migraines that don’t respond to standard medications, sometimes because muscle overuse or jaw clenching is acting as a trigger. Then there are neuropathic pain cases, where nerves are sending faulty signals, creating sensations like burning, tingling, or sharp “electric” jolts in the face.
Dr. Eli also treats post-surgical pain—discomfort or altered sensation that lingers long after dental or sinus procedures. This can include phantom tooth pain (persistent discomfort where a tooth used to be) or persistent numbness in areas served by branches of the trigeminal nerve. Ear-related complaints are another surprising category: tinnitus (ringing in the ears), ear fullness, or sound sensitivity that actually originate in overactive jaw muscles or joint inflammation.
What unites these conditions is complexity. They rarely respond to a single intervention because the pain system itself has become layered. A patient might start with muscle tension from daytime clenching, which aggravates the TMJ, which in turn irritates the trigeminal nerve, creating a cascade of symptoms.
Dr. Eli refers to this as a “ladder of care” problem. By the time patients reach his office, they’ve often climbed the ladder—seeing a dentist, ENT, neurologist—without relief. His job is to step back, assess the entire chain of events, and create a plan that addresses each contributing factor rather than chasing just one symptom.
The Diagnostic Process: Inclusion vs. Exclusion
In general dentistry, diagnosis often follows a fairly direct path. If you have pain and an X-ray shows a cavity, the problem is clear and the treatment is straightforward. But when it comes to orofacial pain, Dr. Bradley Eli explains, it’s rarely that simple. The symptoms are often vague, overlapping, or misleading, and the problem may not even originate where the pain is felt.
That’s why he uses an exclusion-based approach rather than the typical inclusion-based model. Instead of asking, “Which diagnosis fits these symptoms best?” he begins by systematically ruling out what it’s not. This process can be meticulous. It often involves reviewing dental records, medical imaging, previous test results, and the patient’s own detailed history of when the pain started, how it changes, and what seems to trigger or relieve it.
A key advantage of this method is that it prevents unnecessary or ineffective treatments. For example, if the pain is coming from irritated muscles rather than a damaged tooth, performing dental work won’t help—and may even make matters worse. By narrowing the possibilities, Dr. Eli can focus on what truly fits the patient’s presentation.
The process also includes looking for overlooked connections. Perhaps a patient’s chronic temple headaches coincide with stress-heavy workweeks. Or maybe ear pressure and jaw clicking started after orthodontic treatment altered their bite. Even lifestyle habits—like chewing gum, leaning on one hand, or clenching during workouts—can feed into the pain cycle.
By ruling things out first, Dr. Eli ensures the remaining diagnosis isn’t just a “best guess” but the most probable explanation based on evidence and patient patterns. From there, a treatment plan can be built to target both the source of the pain and any secondary effects that have developed over time.
Headaches, Location Clues, and the Trigeminal Nerve
One of the most powerful tools in diagnosing orofacial pain is location. Dr. Bradley Eli explains that where the pain shows up—and when—can reveal important clues about its origin.
For example, temple pain often points toward muscle tension in the temporalis muscles, commonly linked to jaw clenching. Pain behind the eyes may lean more toward migraine or sinus issues. Forehead discomfort can sometimes trace back to tension in the upper neck muscles, which refer pain forward. Even ear fullness or ringing can stem from inflammation or overactivity in the jaw muscles that share nerve pathways with the ear.
At the center of many of these symptoms is the trigeminal nerve—the main sensory nerve of the face. It branches into three divisions, serving the eyes, cheeks, and jaw. When the trigeminal system is irritated, the brain can misinterpret pain signals, creating sensations in multiple areas at once. This is why someone with jaw inflammation might also feel pressure in their temples or teeth, or why a migraine can be accompanied by jaw soreness.
Dr. Eli describes this as a cascade effect. A trigger—like nighttime grinding—fires up the jaw muscles. Those muscles irritate the joint, which in turn irritates the trigeminal nerve. Once the nerve is sensitized, it can recruit other muscles and amplify the pain response, turning a single source of discomfort into a multi-site problem.
Understanding these patterns helps guide treatment. If headaches reliably occur in the morning, they may be linked to sleep bruxism. If they develop mid-afternoon, daytime clenching during stressful tasks might be the culprit. By pairing headache type, location, and timing with other exam findings, Dr. Eli can more precisely target the root cause instead of only treating the symptom.
Bruxism: The Silent Muscle Habit
- Situational clenchers – People who develop short-term jaw tension in response to a specific event, like recovering from an injury, coping with acute stress, or working through a high-pressure deadline. The habit may fade once the situation resolves.
- Typical bruxers – This largest group clenches lightly, chews tension through the day, or grinds occasionally at night. Dentists may notice mild tooth wear, but the person may have no major pain until stress or other health changes increase the frequency or intensity.
- Pathologic bruxers – Heavy, destructive clenching and grinding that can chip teeth, fracture crowns, or damage implants. Surprisingly, many in this group don’t feel much muscle pain because their chewing system is both strong and efficient at the habit.
Awareness as the First Step to Relief
When you look at the range of conditions Dr. Bradley Eli treats—from migraines and nerve pain to ear symptoms and jaw dysfunction—it’s clear that orofacial pain is rarely a single-issue problem. More often, it’s a network of overlapping systems—muscles, joints, and nerves—feeding into each other. That’s why patients can spend months or years searching for answers.
Bruxism sits at the center of many of these cases. It’s not always the sole cause, but it’s often the spark that lights the fire—irritating muscles, overloading the temporomandibular joints, and agitating the trigeminal nerve. Once that nerve is on high alert, pain can spread in unpredictable ways: temples, eyes, ears, even teeth that are perfectly healthy.
And here’s the challenge: because bruxism is often unconscious, traditional approaches can fall short. A night guard, for example, protects the teeth from wear and fracture. It doesn’t stop the clenching forces, nor does it teach the muscles a new way to rest. If the daytime habit is left unchecked, the muscles remain overactive, the joints continue to bear excessive load, and the nerve system stays sensitized.
This is where awareness-based interventions make the difference. Tools like ClenchAlert bridge the gap between knowing and doing. By giving you a gentle vibration each time you bite down, it trains your brain to recognize the habit in real time and relax before damage is done. Over time, this feedback builds a new reflex: teeth apart, jaw at rest, tongue up, lips closed, nasal breathing.
The process isn’t about perfection—it’s about retraining the default setting of your jaw. Short, focused sessions during the day are often the most effective way to build this awareness. Once your muscles and nervous system have learned the pattern, nighttime symptoms often become easier to manage, even if you still need a night guard for protection.
The bigger message from Dr. Eli’s approach is this: don’t chase one symptom—map the system. If you have headaches, ear pressure, or facial soreness, ask whether bruxism could be part of the picture. Track when the pain starts, where it travels, and what seems to trigger it. Share that with your provider, and if possible, seek out a specialist who understands how muscle tension, joint strain, and nerve irritation work together.
Relief is rarely about one quick fix. It’s about untangling the layers, breaking the habit cycles, and giving your system the chance to calm down. That might mean a combination of protective appliances, posture and breathing adjustments, stress management, and habit awareness training.
For many people, the turning point isn’t the first time they try a new device or therapy—it’s the moment they realize they can influence the habit itself. With the right tools, consistent practice, and a clinician who sees the whole picture, you can move from constant discomfort to a jaw and face that feel like your own again.
Frequently asked Questions
- What is orofacial pain? Orofacial pain refers to discomfort in the head, face, jaw, and neck that can stem from muscles, joints, and nerves working together—or against each other. It often overlaps with dental, neurological, and musculoskeletal conditions.
- How is orofacial pain different from regular dental pain? Regular dental pain often has a clear cause—like a cavity or cracked tooth—visible on an X-ray. Orofacial pain can be more complex, involving muscles, nerves, and joints, and may not show up in standard dental exams.
- What conditions does an orofacial pain specialist treat? They treat TMJ disorders, migraines, tension headaches, neuropathic facial pain, post-surgical discomfort, phantom tooth pain, ear symptoms like tinnitus, and jaw clenching or grinding (bruxism).
- How does an orofacial pain specialist diagnose problems? They use an exclusion-based process, ruling out conditions step-by-step. This involves reviewing past dental work, imaging, symptom history, and lifestyle habits to find the most likely cause.
- What role does the trigeminal nerve play in facial pain? The trigeminal nerve is the main sensory nerve of the face. When it’s irritated—often by jaw muscle overuse—it can cause pain in multiple areas, including teeth, temples, eyes, and ears.
- What is bruxism? Bruxism is the habitual clenching or grinding of teeth, which can occur during the day or at night. It can wear down teeth, strain the TMJ, and irritate nerves, causing headaches and facial pain.
- What’s the difference between daytime and nighttime bruxism? Daytime bruxism often involves sustained clenching while concentrating or under stress. Nighttime bruxism is usually more forceful and may involve grinding motions during sleep.
- How can awareness help treat bruxism? Because bruxism is often unconscious, real-time feedback—like the vibration from a biofeedback device—can train your brain to recognize and stop the habit, reducing strain on muscles and joints.
- What is ClenchAlert? ClenchAlert is a biofeedback dental guard that vibrates when you bite down, helping you become aware of clenching so you can relax your jaw and retrain your muscle patterns.
- How do I know if I need to see an orofacial pain specialist? If you have ongoing headaches, jaw soreness, ear pressure, or facial pain that hasn’t improved with standard dental or medical care, a specialist can assess the full picture and create a tailored treatment plan.
Dr. Bradley Eli, DMD MS, Facial Pain Specialists
Orofacial Pain Specialist and Sleep Disordered Breathing Expert Brad Eli, DMD, MS, is nationally recognized by colleagues in both medicine and dentistry as a leader in pain management and the treatment of sleep disordered breathing. He is one of an elite group of board-certified Orofacial Pain Specialists in the nation with advanced training and experience to diagnose and manage complex orofacial pain conditions.
In his more than 25 years of dedication to the advancement of orofacial pain medicine, Dr. Eli has helped thousands of patients find pain relief and manage their chronic pain conditions. His patient-centered method matches each patient with the best treatment for their symptoms and lifestyle. He is advancing the field of orofacial pain medicine by developing treatment protocols and specialized products that improve care and provide better outcomes for patients with life changing orofacial pain disorders and conditions.
He actively collaborates with peers across the profession. He has been a contributing author to the Journal of the American Dental Association, Pain Medicine and Management, Oral Health Journal, and Dental Economics. He has provided educational courses, webinars, and other orofacial pain and obstructive sleep apnea instruction to dental associations, study clubs, and medical groups.