Dentistry/Tmj pain


QUESTION: Hi, I'm a recent dental grad and seen a patient who is 18 yrs old, 6 months ago, she had four wisdom teeth out under general anesthesia. Ever since achiness in jaws, mostly in right, pops on opening, extremely painful in morning.  Able to open without limitation, cl 1 occlusion in centric,  she has no canine guidance, no contact any teeth when going in left lateral extrusions, posterior interference on lateral extrusion. After post op appointment with oral surgeon, she was uncomfortable to seeing him again and trying to deal with it for past 6 months, thinking it should subside.
Unsure what else I could do, other than night guard , NSAIDs if needed ( she says not helped in past).
Took impressions for night guard, considering a NTI guard, do u have any preference on this guard vs traditional full coverage occlusal guard? How long is it usually before her condition get better? Is there a time frame when her condition should get better, already 6 months? Should she also see an oral surgeon?
What else should I do for her ?
Thank u

ANSWER: Dee - I'm glad to see that you are on top of this problem.  Of course, without examining your patient I cannot be completely sure, but from your description it does sound like she is suffering from spasms of the jaw muscles.  With these spasms, the condyle is often pulled deeper into the fossa and that can create restrictions with lateral excursions.  With these restrictions, the muscle spasms will accentuate.  Examine her and see if she has tenderness in the temple region on palpation.  In addition, placed your fingers "gently" in her ears, facing forward.  Ask her to open and close and see if there is soreness.  If so, this shows the condyle is inflaming the fossa tissue.  

The most important treatment now is to relax those muscles.  A full coverage bite plate, with a completely balanced bite, is best, in my opinion.   Secondly, and even more important, have the patient begin a strict regimen of warm salt water rinses, concentrating the fluids toward the ramus regions.  Have her do it 3-4 minutes, 4-5 times a day.  In addition, I also usually recommend in patients who have had the problem for a while, to place warm moist compresses from the temple region to the bottom of the jaw for 5-10 minutes, 4-5 times a day.  Important that both sides, temple to bottom of the jaw, be done at the same time.  Any improvement will be slow, but there should be a reduction of some pain within 5-7 days.  If not, then have her examined by an oral and maxillofacial surgeon.  If the soreness improves there should be a small change in her bite.  You may need to adjust the guard to keep the bite balanced.  This requires follow up appointment every few days in the beginning and then extend them out if she gets better.

If you have any further questions, do not hesitate and contact me again.

---------- FOLLOW-UP ----------

QUESTION: Thank u very much for your advise, I'm just wondering are the warm salt water rinses for relaxation of muscles like the warm compresses?
Again thanks

Dee - They are actually different in that those muscles such as the interal pterygoid muscle will not actually be affected by warm compresses.  So for a total attempt at relaxation of the jaw muscles, a combination of external and oral warm treatments will more completely relax the muscles of mastication.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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