Dentistry/Left Jaw joint discomfort
QUESTION: Dear Sir,
My age is 56 years, Engineer by profession. Haven't had a great dental health with at least 5 RCs and 1 bridge done so far. The last bridge fixing last year was a repalcement to earlier bridge which was 20 years old.
Problem in my left jaw started a week back. Suddenly while taking my meal, i noticed unusual sound (clicking)every time i opened my jaw and closed it. It neither hampered chewing nor it caused any pain. I continued with it for 3 to 4 days when i started realizing that the left jaw joint requires some medical attention. It started bothering me. Very mild pain feeling, feeling of swelling on the cheek (my wife couldn't see it), fear of getting the jaw locked if opened fully. Since then i am being careful while eating i.e. opening mouth partially, small bites. I am afraid to open the mouth wide enough to insert the tooth brush. Now with such care there is no pain, no feeling of swelling, but the discomfort persists. The moment i move my jaw sideways or open it wide the clicking sound returns (it happens frequently as i can't control it all the time).
Sir, what is wrong with my jaw all of a sudden. Is there any remedy? Is it serious? Whom should i consult?
Pl explain and guide me.
(PS: two years back you had advised in my daughter's case which i found very useful. (you had suggested maxillofacial surgeon and ENT surgeon for the treatment, which i did. My daughter got cured of infection around unerupted wisdom tooth growing in reverse direction and very close to the sinus. First attempt to surgically remove the ttoth was abondoned which had alarmed me and at that time i had taken your advise. Thank you sir.)
ANSWER: Magsood - From your description of what you are experiencing, it sounds like you are suffering from TMJ, temporomandibular joint dysfunction. This situation usually begins with symptoms, like you describe, of clicking, very mild pain and some swelling. The cause for this problem could be a change in your bite from the bridge placed a year ago, chewing on very tough food or even stress in your life. The first symptoms are usually of muscle origin and that could cause some of your initial symptoms. Is the cause your bridge or other potential causes? I don't know, but you need to be examined by a doctor who understands TMJ problems.
I have just looked on the internet and there are specialists in TMJ problems. If your dentist is not trained in it, there are other doctors there who can evaluate you. If for some reason you cannot find one, you can get back to me. Tell me where in India you live and I will try to find an appropriate doctor. If you can find one yourself, good, but if not do not hesitate to get back to me.
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QUESTION: Thanks for your advise. I will first consult the Dentist for any Bridge realated effect.. get it examined. Also will try and find the TMJ specialist in Thane (near Mumbai, India) where i live. Will surely update on the progress.
Thanks and Regards.
ANSWER: Magsood - I hope your dentist can discover the cause of the problem. If you ever have any additional questions, feel free to contact me.
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QUESTION: Dear Sir,
On Friday i got the problem checked by my Dentist. He explained the problem as TMJ. Gave me 'parasetomal based tab for pain and swelling. Incidentally, a TMJ specialist was to visit his clinic on Sunday, he advised me to see him. I saw him on Sunday.
This TMJ specialist (Dr Sanjay Bhavsar, MDS-Bombay,Diplomate: Neuromuscular Dectistry-Europe) based at Nashik, Maharashtra, India.
He examined and explained the TMJ function with the help of a video clip which showed jaw and the joint movement, thin cartiledge type piece between the upper jaw bone and the lower jaw bone. He explained that due to misaligned jaw (over a long period)the cartiledge like piece has worn out and the jaw bones are touching while the jaw opening and closing giving the clicking (kud.. kud) sound and pain.
He noted down the teeth toching points when jaw is closed (with side ways movement of lower jaw)whic he said will be ground off. Further he mentioned about some 'plate' he will put inside my mouth to slowly get the alignment back to centre of the mouth (now the jaw shifts to left side!!! while opening and closing movement. Will take about 12 to 15 seatings and total duration of treatment will be 7 to 8 months (success will be 70 to 75% ?).
I did not feel confident. Must look for another TMJ specialist.
Since i have taken tabs for three days, tehre is no swelling, no pain. With careful / partial jaw movement am able to avoid the Bones touching, slipping. tehre is no sound and pain.
Can i pull on like this for ever? Will the problem get agggravated and land me in a bigger mess? Can you explain on the line of treatment you would recommend vis a vis what i was told by the TMJ specialist? and finally, i will be glad if you can locate any TMJ specilist at Thane (near Mumbai) where i live.
Maqsood - From the description of what the TMJ specialist told you, it seems that the problem appears to be muscularly influenced. This is quite common. The question is why the muscles began to go into spasms and pulling the upper jaw against the cartilage within the temporomandibular joint. This pressure on the cartilage can cause a thinning of the cartilage and eventually wear it out. Once worn out, the bone in the joint become affected and arthritic changes in the joint occur. The arthritis causes pain, but also alters the shape of the bone from the changes in the protective cartilage and that makes the permanent bone changes.
For that reason, what the doctor seems to want to change, is the muscular changes that have altered your jaw alignment, accentuating arthritic changes. So if the doctor did what he was planning to do (I think that he was planning to alter the muscle forces) the pressure on the joint should change and the arthritic changes should calm down.
Now I cannot be sure without speaking with the TMJ specialist, but getting a second opinion is not a bad idea. There seem to be many doctors near you that perform TMJ treatment. I found two doctors who seem to have quite a bit of experience and have many former patients who have been impressed in their treatments.
The doctors are:
Ashwini Bhalerao - Andheri West, Mumbai
Jignesh Kothari - Santacruz West, Mumbai
So I suggest that you have one of the above two to evaluate you and see if they agree with the TMJ specialist you have seen. Let me know how the exams work out.