AboutMark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Expert: Mark Bornfeld DDS Date: 7/20/2008 Subject: Severe jaw pain after cleaning and discluder
Question Hello, on Thursday I went in to my dentist for a cleaning and for help with jaw pain. TMJ runs in my family, and I have a history of jaw clicks and locks, but these last couple of months, I thought the pain was muscular, as I have been clenching my jaw. This past Thursday, I went to my dentist, who thought to give me temporary relief with a discluder. It was supposed to bring relief, but instead my jaw felt sore and funny. Then later that night, I was in so much pain I was crying. I called a TMJ/TMD specialty clinic at the local research university; the resident said to take ibuprofen, eat liquids, and call Monday for an emergency appointment if I am still in pain. I am, though it isn't unbearable until after a day of talking and smiling. My question is, why did the discluder make my pain and trouble worse? Everywhere, I've read it is supposed to relax the muscles. I know part of the pain was from the cleaning, but I also feel part of it happened as a result of the discluder.
Answer Dear Aimee,
The precise nature of temporomandibular joint ("TMJ") dysfunction is not fully understood, and the term could properly include a spectrum of different disorders that manifest in similar ways. Some cases of TMJ dysfunction have nothing to do with the joint, and may involve spasm of the muscles as you have intuitively guessed. Muscle spasm may be helped by using a bite splint/night guard/"discluder", but the benefits are inconsistent. Other times, TMJ dysfunction is not the result of muscle spasm, but rather a true derangement inside the joint itself-- for example, displacement of the fibrous disc ("meniscus") that separates the lower jaw from the skull base. In these cases, occlusal appliances are more potentially problematic.
In any case, therapeutic efforts must necessarily be empirical and guided by the results, because the benefits from any one type of treatment are unpredictable. In your case, it may not be immediately obvious just why the discluder made matters worse, but it's sufficient that it did, and it's clear that you should discontinue its use. It would be best to return to your TMJ specialist for further efforts to reduce your symptoms.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
