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Dentistry/I have TMJD and Trismus at same time


QUESTION: After having all 4 of my wisdom teeth removed, i was told to go home and yawn widely to loosen my facial muscles. When i did this, i felt a ripping/pulling near my right jaw joint. I was told the muscles near the TMJ were strained and to take it easy. In a week's time, trismus had set in. A second specialist told me the muscles were strained too and to go home and use tongue depressors to combat the trismus. i did this and my bite, which had only been a little off, went crazy. my teeth were chattering, it was hard to keep them together at all.  Then, all the muscles in my face began hurting.

so, throughout all of this, every time i try to stretch my jaw, even passively, my muscles freak out and my bite begins shifting like crazy, but if i dont stretch, my bite is still off and my opening becomes really restricted.

there seem to be two schools of thought:
A)take it easy on the muscles and they will resume normal functioning, which will correct my bite and ultimately cure my trismus.

Then there's B) the only way to cure my muscle dysfunction and askew bite is to stretch my mouth and get rid of my trismus.

which is the correct line of thinking?


ANSWER: Melanie -  you are being advised by doctor who do not know what they are talking about.  You seem to have developed spasms of the jaw muscles.  When your have a cramping of a leg muscle you do not over walk on it or run on it.  You also do not just leave it alone.  

You need to immediately begin a simple regimen to relax those muscles.  You need to do the following.

1) Begin warm salt water rinses on both sides of the mouth against the jaw back near the wisdom teeth extractions.  Do the rinsing for about 5 minutes, 4-5 times a day.  Do not miss the rinsing.

2) Use a warm moist washcloth placed from the temple to the bottom of the jaw on both sides of the face at the same time(repeatedly keep dipping the washcloths when they get cool).  Do the treatment 4-5 times a day for 5-10 minutes.  

You should notice an improvement within 3-5days.  It will not go away completely in that time and it can often take a couple of weeks of treatment.  If after a week there is minimal to no change, you doctor needs to prescribe a mild muscle relaxer to help the relaxation even more.

So try my suggestions and I think you will begin to notice a change.  If you have other questions, feel free to contact me again.

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

QUESTION: Thank you for your kind and informative response. I just realized I failed to include a timeline of these events, which might change your answer. This all began around Feb. 1 of this year. I saw the first specialist Feb 15, and the second on Feb 30. I have been prescribed muscle relaxers which seemed to work at first, until stretching was advised, at which point my facial muscles all went into distress. I've been in physical therapy since march, which helped reduce muscle tension until we began stretching again. My doctor and PT are just concerned about my limited opening (at 18-20mm) because when I stop stretching it shrinks even more, but stretching only makes my face angrier.

I'm sorry, I should have mentioned the timeline in my original discussion. Please let me know if this changes your advise.

I'm grateful for any clarity you can provide. At the moment, I'm truly lost.

Melanie -  From the length of time without dramatic improvement, the jaw muscles have probably become nonflexible due to internal scarring from a lack of proper usage.  Relaxation of muscles like this is very difficult with the approach that has be used on you.  The warm salt water rinses and washcloths will help to increase the blood flow through those muscles and that can help to relax them and allow the muscles to be more flexible.  You didn't say the type of specialist you have seen, but you definitely need to see a board certified oral and maxillofacial surgeon.  The surgeon might be able to put you to sleep and gradually stretch the jaw muscles while you are asleep. The combination of the stretch and warm salt water rinses is probably the best approach now that it is three months since you have opened.  

I don't know where you live, but if you are unaware of a board certified oral and maxillofacial surgeon skilled in your problem, get back to me, tell me where you live and I will send you names of doctors.  You cannot have this put off any longer.  Waiting might allow the muscles to become solid like bone and you could lose function.

I really wish you well.  If you have additional questions, feel free to contact me again.  


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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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