Possible jaw dislocation or dental problem?
 

I am 27 and a few months ago I had a wisdom tooth removed - top right. This, I was told was a very difficult extraction, it took around twenty minutes of serious pulling and a lot of jaw discomfort, as the roots of the tooth were curled over the next tooth.
Since then, I have been experiencing worsening discomfort in the left jaw joint/temple area. It feels like it is in spasm and I find myself clenching constantly - even if I try to relax it won't!!! The last few weeks, it has become very difficult to get comfortable at all, I am unable to sleep - between the pillow feeling like a rock on this jaw, and the clenching waking me... Today however, the muscle of my cheek became very tender to touch, and I feel as though it is becoming increasingly difficult to even hold a conversation - it hurts and just feels like too much effort.
Then the right side began to crack like crazy (I have been able to hear that for a while - but today it became an external sound that all could hear) and suddenly there was this massive crunch which sounded like a bone breaking - my mother heard this and thinks perhaps it is dislocated?!
Since the massive crack, it now sounds like more of a "liquid" noise in the joints.
I do have hypermobility (habitual dislocation) of both shoulders - I don't know whether this could at all be related but thought it was best to mention as the liquid sound is somewhat similar to what I hear in my shoulders.

I have been taking a light anti spasmodic for the pain, in hope that it will loosed this feeling in the joint, but to no avail.
I would also like to know if I should see a GP or a dentist?

Also... Perhaps I should mention that I have en entrapped pudendal nerve - with related pelvic floor myalgia and bladder spasms (for which I have ongoing botox treatments) as well as severe pain and creaking in my left knee - this becomes incredibly stiff if I am sitting properly on a chair with knees bent.
I have also been experiencing severe neck muscle pain for several months - it is absolute murder to touch the deep muscles each side of the nape of my neck... Again, don't know if anything is related or if it helps - just that there seems to be a whole lot of spasms and joint problems going on all at once...

TMJ joint dysfunction
 

Hi HayleyJ,

It sounds like your jaw was opened too widely for too long a period of time and there may have been some movement of the lower jaw in trying to get access to that wisdom tooth. This is a common occurance during surgery to remove wisdom teeth that are "way back" in the jaw and have curved roots, which makes access to get them out difficult.

Your jaw is probably displaced. In your case, the joint is inflammed on the left side and the ligament is stretched tight. This will pull the disk of the TMJ on the right side away from the socket that it usually rests in causing that clicking, cracking and liquid sound that you hear.

It is NOT a good idea to deliberately move your jaw until you hear any of those sounds because that will only cause more inflammtion and cause the disk to wear down. It is imperative to see either an oral surgeon or a TMJ specialist before the problem gets worse or becomes a chronic situation. Most likely they will recommend and anti inflammatory and may suggest making an orthodic appliance to wear until the muscle spasm releases.

In the meantime it is wise NOT to open your mouth too widely. Eat a soft diet that requires minimal chewing, don't chew gum, don't open your mouth widely when you yawn, apply warm moist heat to the left side of your TMJ area for 20 minutes several times a day and take an anti inflammatory like advil or motrin. Some homeopathic remedies that work well as an anti-inflammatories are Arnica and Hypericum.

Please let us know how you are doing!

Bryanna

Thanks
 

Thank you for your advice. I will call and make an appointment today with the dentist and hopefully I can get a referral from there - My tooth was not extracted under anaesthetic, or via surgery - as at the time we were not to know it would be such a difficult extraction, so it does make sense that this is the reason, I am aware of how much pulling and stretching was involved of the jaw!
I will let you know how I get on!

extraction of the wisdom tooth
 

HI HayleyJ,

Glad to be of some help to you! Hope you can get in to see the dentist this week!

You mentioned that your tooth was not extracted under anesthetic or surgery?? Perhaps this needs some clarification as I think you have interpreted this dental treatment as something other than surgery because you were not put to sleep for it. Could that be right?

An extraction of a tooth is definitely oral surgery. Whether or not you were put to sleep, a local anesthetic is always used during extractions and any other type of oral surgery to numb the nerves surrounding the tooth being extracted or the pain would be excruciating. Hope that makes sense to you ~'.'~

Yes, please let us know how you are doing!

Bryanna

Sorry, yes, I had taken surgery to literally mean under a general anaesthetic! Of course I was given appropriate local anaelgesia prior to the extraction.
I have been calling around and I am not going to be able to get into a dentist for a couple of weeks. I stressed the urgency, making note of my stress and inability to sleep, eat, talk properly, and my frustration, to no avail. I was told I could call back if things got worse - I explained as politely as possible that I am already not coping too well, I am just about ready to bawl with exhaustion. Is it possible to get a referral from a GP for an orthodontist? I have a feeling I could get into a GP by tomorrow!

Okay... I have been to the GP, who made a diagnosis of TMJ - She prescribed anti inflammatories and some basic exercises (placing a flat wooden stick between my front teeth), gave advice about foods to avoid and told me see a dentist in 3-4 weeks if there is no improvement. Is this enough action?

treatment for acute TMJ discomfort
 

Hi HayleyJ,

Working in a dental office I know how tightly scheduled things can be, but there is always room for an emergency. Your current situation is considered urgent in that there needs to be some intervention asap. Good that you went to your GP and at least had it looked at.

Anti inflammatories will help alleviate some of the inflammation which helps to reduce the spasm and pressure. The wooden stick between the teeth allows the bite to open in a resting position. But you can't bite on a stick all day! That is why an orthodic appliance would be helpful because it serves the same purpose as the stick, but it's something that can be worn all day and/or all night if necessary. A TMJ specialist, an oral surgeon and some general dentists can make you an orthodic. An orthodontist can make one too, but they look at the bite differently than the rest of the dental profession and can sometimes make TMJ issues worse, depending on their recommended treatment. It is best to be as conservative as possible at this stage!

As for the exercises, I would recommend that take an anti inflammatory and then apply warm moist heat for 20 minutes to the left TMJ area just before you do any deliberate exercises. These will help to loosen up the ligaments so they are willing to move a bit more freely. Otherwise, you would be trying to maneuver a tight ligament that is already in spasm.

It is also very important to be mindful of the way your teeth are positioned. Do not close your teeth tightly together, always leave a slight open gap between your upper and lower teeth. This is the proper resting position for your TMJ joints. When the ligaments are in spasm, we tend to clench our teeth together........ avoid this as much as possible.

Follow the soft diet and the other recommendations I listed as I'm sure the GP suggested similar things. What about getting an appointment with the dentist that pulled the tooth??? He should be able to get you in asap since he contributed to the problem in the first place. That's not to say he was at fault or did something wrong........ this is a common occurance and it just happens. Did you try calling him?

Bryanna

Hi again.
I did phone the same dentist - however, I had seen him as an urgent patient, as I was on the very long waiting list at our local free public clinic, which has a pretty good system which allows you a ten minute assessment appointment to "Triage" you - as I needed urgent attention for the infected wisdom tooth and they were unable to fit me in, they gave me a voucher to visit a participating private dental clinic - up to the value of just over $300 - which was enough to cover the extraction.

I would call that clinic again but I doubt I would be able to pay such high costs myself, and they were unable to quote me beyond the consultation as they are unsure what treatment I will require.

I phoned the public clinic after reading your lastest reply, and stressed my concerns and my needs for immediate attention - giving them the diagnosis from the GP etc. This was a call centre who prioritise appointments - however, the dentist himself phone me back and asked me lots of questions - and I was able to tell him that things are worsening very quickly now - the last three days things have got so bad so quickly, I am now unable to chew at all as the pain over my left temple is excruciating... so he has squeezed me in tomorrow morning for an assessment - hopefully from there I will get a referral - I will request a referral to the TMJ specialist or oral surgeon as opposed to an orthodontist if possible, following your advice.

Thank you again, and I am sorry to be a bother.... I appreciate your advice!

Letting yourself be heard!!
 

Hi HayleyJ,

You are NOT being a bother at all!! I wish I could be of more help to you!! Remember, every time you write here someone learns something... so never stop offering your personal experiences or asking your questions ~'.'~

I am SO glad you made that phone call and make your point clear to them. Of course the dentist is busy, but he can always fit you in within a day or two if there is an urgency........... and in your case there definitely is one!

Please keep us posted on what the dentist says and how you are doing!

Bryanna

Update
 

Hello again
I have some good news. I had my OPG/TMJ view done yesterday, and the dentist has just phoned me now to explain that he is referring me on to the oral surgeon to have an orthodic made and to discuss surgical options - or an injection that may help tighten the tendons? The joint is slightly displacing, and he believes that perhaps it is intermittently mildly dislocating - similar to my shoulders (loose ligaments I expect?).


I will pick up my referral today and hopefully I will be in with the surgeon in no time at all!

suggestion...
 

Many women carry the gene for Marfan's syndrome.

This makes tendons loose, and affects other parts of the body, most importantly the blood vessels.

Have you been evaluated for this? One really needs to know to avoid premature death from stroke, or aortic aneurysms.

A quick screening test is to measure the distance between your extended arms from the middle finger to the other arm. If this is longer than your height, then you may have the gene. But this is only a crude test and you may flub it up so, please consider discussing loose tendons with your medical doctor.

Having children while having this gene, places strain on your aorta. And males who inherit it show more physical signs. Females are often silent, but inside you may have problems you cannot see.

I already have one male child who is almost 6 and does not display any form of growth/joint problems. I certainly would not think that my extended arm would be longer than my body, as everything seems to be in proportion, and I am of average size/height - but I will query the doctor on these concerns as soon as I possibly can. I think it may be worth a visit with my orthopaedic surgeon who I first consulted about my shoulders, as she seemed rather surprised that I would have such symptoms in only those two joints at the time that I visited - without them having been injured.
The only troubles I have had with blood vessels, is last year I had 4 haematomas over my hip/thigh area (2 on each leg, exactly the same place) - and I was tested for many blood disorders at that time - all with negative results. It was recommended that I use a topical cream for this, and increase my Vitamin C intake - this seems to have worked!
I have done as much reading as possible about connective tissue disorders, and thus far, nothing fits, except for the sublaxing or dislocating joints...
Perhaps it is purely coincidence?

I know a family with Marfan's.
 

The gal's sister is clear.

She herself has it (but she is not tall). Her aorta dilated severely with her fourth child, but went back down after. So she was advised not to get pregnant again.

All of her children test positive but only one daughter is tall so far.
This young woman has already had ankle tendon problems and she is in her early 20's. (she is over 6ft tall).

There is a very mixed presentation for it genetically and it remains hidden for many. Anyone with loose tendons, or who are hyper-extendable should be tested just as a precaution.

Right now the gal I know is having mega problems with her knees. She is pretty thin and has no risk factors for OA...but her loose joints/tendons put her in a stress
situation and she has to wear a brace sometimes.

Sometimes a simple thing like your dental work, can be a sign pointing to
something else. I only offer this as a suggestion, so you won't be caught
unawares later.

TMJ treatment options
 

HI HayleyJ,

Glad to hear that you have gotten the referral to the OS.

A word of caution....... before doing any injections in the ligament or TMJ area, try the orthodic appliance first. Sometimes the worse thing to do is inject into a tight ligament. Besides that, the injections are usually some type of steroid or some other toxic medication. If you can get relief without doing the injection, all the better!!

Please continue to let us know how you are doing!

Bryanna ~'.'~

I saw the oral surgeon today - I don't know that I am truly any better off though to be honest. I was not really given specific answers, but I am hoping you may be able to further explain for me?

Firstly, he explained to me that my problem is complex, and has arisen from perhaps a mixture of trauma from the wisdom tooth extraction and the clenching since that time. There is notable asymmetry in my bite.
Secondly, he began to explain that flat spots have been created on the cartilage between the joints, which creates that rough, painful and loud movement and an inability to close smoothly, without some assistance from my hands manoevering the top jaw.

He told me that the only thing he can recommend is for me to rest my jaw as much as is physically possible. He spoke of a night guard, however thought that would not really benefit me, as he thinks that I simply need to undo my behaviour by myself (i.e. clenching)
However, he did recommend that I buy Mercyndol from the pharmacy as it has both relaxation and pain relief benefits.

So, I left and then started realising that I really don't know any more than when I went in, and I still dont really have a solution - except to continue to avoid things I have already began to avoid due to my pain - and hope that it sorts itself out in time... Is it likely that it could fix itself, being that this has been coming on for around 7 months?!

Should I be basically on a fairly liquid diet? (I have made a lot of wholesom home made soups to get through this!!!) Should I seek a second opinion? Will my bite ever realign by itself? (It is to the right by a whole tooth on close, and slips further upon opening) Or, should I just do as he suggests and wait it out a while and rest as much as possible and hope for the best?!
I am rather lost!

Hi HayleyJ,

My interpretation of what you stated your oral surgeon said to you is this>>>

There was trauma to the jaw joint and the ligament during the wisdom tooth extraction. Your clenching habit is aggravating the injury. Your bite is obviously off because he can see that clinically when he checks the movements of your jaw.

However, the flat spots on the cartlidge at the joint occur from long term aggravation on the joint. I seem to recall you writing that you had a TMJ problem in the past. Is that correct? If so, then that is probably what the flat spots are from and the extraction of the wisdom tooth injured the ligament, misaligning the jaw putting more unnatural pressure on the joint.

People can live their entire lifetime with occassional TMJ popping and infrequent tightness but seldom will it cause them pain until there is trauma to the joint and/or ligament. Chronic TMJ issues will wear down the cartlidge and cause the joint and musculature to become weak. Is this your particular case, I could not tell you for sure, but it may be a possibility.

Do I think you should just wait it out?? IMO..... no. I think a bite appliance to place your jaw in a relaxed position may be helpful.... especially if this IS a long term problem which started before the extraction and if you do clench and/or grind your teeth.

Until your jaw relaxes and your bite lines up again, your diet should definitely be limited to foods that do not require alot of chewing. You should be careful not to open your mouth too widely for any reason.

The medication he prescribed mersyndol, is a very strong pain reliever (codeine) which also has an analgesic calmative to induce relaxation. It is generally used for migraine or tension headaches. It may temporarily help in your situation but I still think you would benefit from a bite appliance.

Do I think this problem will resolve on it's own? No because you have a clenching habit which is aggravating the joint and ligament. A bite appliance will allow you to clench into it without causing any harm to the TMJ. You can then find some form of relaxation therapy, like massage and/or biofeedback, to help you stop the clenching.

Those are my personal suggestions for you. I think if you don't do anything but take the meds and eat soft foods, the cartlidge will continue to wear down.

I know this is very hard to deal with and you really need a dentist to be of more help to you. Did you look at the IAOMT site for another dentist?

Keep in touch...... I hope you are feeling some relief soon!!

Bryanna

I would recommend you take an anti inflammatory and then apply warm moist heat for 20 minutes to the left TMJ area just before you do any deliberate exercises.