Make Haste to have Jaw Evaluated

Dear Dr. Mady: I got hit really hard in the face about three years ago while playing soccer. Ever since then, I have had pain in my jaws off and on. Lately it has gotten so bad that it makes noise when I chew. It sometimes locks open and I don't even think that I can open as wide as I used to. At times it is so painful that I just don't know what to do. What do you think the problem is? Joel in Amherstbug

Dear Joel: It sounds as if you have a case of temporomandibular joint disorder (TMJ). It is also called craniomandibular disorder (CMD) and more commonly TMD (temporomandibular disorder).

When an individual is diagnosed with this disorder, it means that they may have any one of a group of conditions that affects the function of their jaw.

This diagnosis does not always indicate that the joint itself is the direct source of the problem, but it often is. You may have a disk problem in your jaw, inflamed jaw muscles, or even arthritis in that location.

The TMJ is located where your lower jaw attaches to your skull. Trauma is often the direct cause of TMJ problems, or at least a contributing factor in most clinical cases.

Other causes include fractures, dislocations, congenital defects, and tension-relieving habits such as bruxing or grinding of the teeth.

Bruxing can lead to muscle spasms and possible dental misalignment. The most common initial sign is facial muscle pain that involves the muscles of mastication or the ones that you use for chewing. It can often later turn into jaw ache, clicking, popping, a grinding noise and even lockjaw. Most cases of TMD are mild but some can turn into chronic pain later if untreated.

Most of the population has at least one sign of abnormal jaw function but five to ten percent will need treatment. Approximately 40 - 60% of the adult population have clicking noises in their TM joints. If pain and other symptoms exist, treatment itself is dependant on the exact diagnosis and cause.

There are some treatments, both surgical and non-invasive for TMJ disorders. It sounds like a consultation with a knowledgeable dentist or specialist is warranted at this point.

Usually the first treatment of choice is the fabrication of a bite splint to wear at night or 24 hours a day if needed. This will not allow you to close your jaws all of the way and will almost force you to relax your jaw muscles. It also puts your joint in a more comfortable position to promote soothing and healing in the socket area.

Images of the joint will most likely be completed, and may include X-rays, an MRI (magnetic resonance imaging) or arthrography (injection of a dye and an X-ray of the area). If your case is severe, you may even require physical therapy or even surgery as a last resort.

Until you can get to your dentist, practice stress control as much as possible to decrease the chances of clenching or grinding.

Avoid hard, chewy foods and if you are a gum chewer, discontinue immediately.

To reduce pain, apply a warm, moist cloth to your TMJ area just in front of your ears and take anti-inflammatory and muscle-relaxing medication that your pharmacist can recommend.

Just remember to be sure you have no allergies to the ingredients in these medications.

It is important to have this condition evaluated even if the pain and symptoms subside. Don't let it go any longer.

This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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