Severe Causes of Intermittent Right Jaw Pain

Life-Threatening Causes Requiring Urgent Evaluation

The British Journal of Anaesthesia recommends immediate recognition and high-dose corticosteroid therapy to prevent permanent vision loss in patients with giant cell arteritis, which presents with jaw claudication, temporal region pain, scalp tenderness, visual disturbances, fever, malaise, and myalgia 1
Giant cell arteritis is characterized by physical examination findings including absent temporal artery pulse, temporal artery tenderness, and possible cyanosis of the tongue, and laboratory testing shows markedly elevated ESR and C-reactive protein 1
The British Journal of Anaesthesia suggests that temporal artery biopsy must be obtained within 2 weeks of starting treatment, but corticosteroids should not be delayed while awaiting biopsy, with a minimum of 40 mg prednisone daily 1
Vision loss is a devastating complication of untreated giant cell arteritis, occurring from arteritis affecting the ophthalmic artery 1

Trigeminal neuralgia is characterized by paroxysmal attacks of sharp, shooting, electric shock-like pain in the trigeminal distribution, triggered by light touch, washing, cold wind, eating, or brushing teeth, with a refractory period between attacks 1
The British Journal of Anaesthesia recommends MRI to exclude tumors, multiple sclerosis, or neurovascular compression in patients with trigeminal neuralgia, and first-line treatment is anticonvulsants, with surgery reserved for refractory cases 1
Glossopharyngeal neuralgia presents with unilateral pain deep in the ear and/or back of tongue, tonsils, and neck, with paroxysmal attacks similar to trigeminal neuralgia but triggered by swallowing, coughing, or touching the ear 1
Syncope can be provoked in rare cases of glossopharyngeal neuralgia, making this a potentially dangerous condition 1

Tumors of salivary glands can cause intermittent pain, particularly when malignant with perineural invasion, and salivary stones cause intermittent pain characteristically occurring just before eating, with tender salivary gland on palpation 3
The British Journal of Anaesthesia suggests that bimanual palpation may reveal the stone, with slow or absent salivary flow from the affected duct, and ultrasound imaging is useful for diagnosis, with referral to oral/maxillofacial surgery indicated 3

The British Journal of Anaesthesia recommends immediate ESR and CRP testing if age >50 with jaw claudication or systemic symptoms, and MRI with contrast for any suspected neurological cause 1
The British Journal of Anaesthesia suggests that palpation of temporal arteries for tenderness, nodularity, or absent pulse, and cranial nerve examination to document sensory deficits in trigeminal distribution, are essential physical examination components 1
Light touch testing in all three trigeminal divisions to identify trigger zones or sensory abnormalities is also recommended 1, 2