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What Must Be Done About Jaw Joint Disc Displacement?
Question: Hello Doctor,
My wife (age: 37 years) complained about sensitive teeth (front bottom teeth) couple of weeks back and we consulted a dentist. He recommended tartar removal and we went ahead with the same. After completing the tartar removal, she started getting pain on her right jaw from 2nd day onwards. It becomes severe during evening time and even spreads to right ear as well sometimes. Note that this pain always occurs on the right side. However it is not specific on any tooth or gum area.
We consulted the same dentist again. He took x-ray of the right jaw and could not find any abnormality in teeth/gum. Then he recommended to take an anti-biotic - Mox P 500 (Amoxycilin) along with a pain killer IMOL Plus for 3 days and we completed the same. However the jaw pain is still there with same intensity. It gets to unbearable state and she had to take the pain killer tablet.
The doctor also recommended to rinse mouth with salt water frequently. My wife tried once but she said she is feeling burning sensation throughout the mouth and stopped that procedure.
Need your help to understand what is causing the jaw pain. Can the tartar removal procedure create such severe side effect? Note that the tartar removal was done by a practicing dentist in the main dentist's clinic.
My wife (age: 37 years) complained about sensitive teeth (front bottom teeth) couple of weeks back and we consulted a dentist. He recommended tartar removal and we went ahead with the same. After completing the tartar removal, she started getting pain on her right jaw from 2nd day onwards. It becomes severe during evening time and even spreads to right ear as well sometimes. Note that this pain always occurs on the right side. However it is not specific on any tooth or gum area.
We consulted the same dentist again. He took x-ray of the right jaw and could not find any abnormality in teeth/gum. Then he recommended to take an anti-biotic - Mox P 500 (Amoxycilin) along with a pain killer IMOL Plus for 3 days and we completed the same. However the jaw pain is still there with same intensity. It gets to unbearable state and she had to take the pain killer tablet.
The doctor also recommended to rinse mouth with salt water frequently. My wife tried once but she said she is feeling burning sensation throughout the mouth and stopped that procedure.
Need your help to understand what is causing the jaw pain. Can the tartar removal procedure create such severe side effect? Note that the tartar removal was done by a practicing dentist in the main dentist's clinic.
Brief Answer:
disc displacement, medication, soft diet.
Detailed Answer:
Thanks for your query. I have gone through your query.
As far as the pain in the jaw can because of the disc displacement in the jaw joint secondary to keeping your mouth open for long time. Nothing to be panic. If I am your treating doctor, I would have advised you to take piroxicam(if you are not allergic or asthmatic) tablet 20 mg once daily for 5 days. I would have advised you to take soft diet, do not open your mouth wide, give hot fomentation over the joint and jaw where you have pain.
Before starting this, it is better to consult an oral physician (dentist who is speacialised in oral medicine and radiology)and get it evaluated.
These are the possible causes and treatment plan based on the description of your problem.
If you can upload the images of the x ray I can give better diagnosis.
I hope I have answered your query. If you have any queries reply me back. Take care.
disc displacement, medication, soft diet.
Detailed Answer:
Thanks for your query. I have gone through your query.
As far as the pain in the jaw can because of the disc displacement in the jaw joint secondary to keeping your mouth open for long time. Nothing to be panic. If I am your treating doctor, I would have advised you to take piroxicam(if you are not allergic or asthmatic) tablet 20 mg once daily for 5 days. I would have advised you to take soft diet, do not open your mouth wide, give hot fomentation over the joint and jaw where you have pain.
Before starting this, it is better to consult an oral physician (dentist who is speacialised in oral medicine and radiology)and get it evaluated.
These are the possible causes and treatment plan based on the description of your problem.
If you can upload the images of the x ray I can give better diagnosis.
I hope I have answered your query. If you have any queries reply me back. Take care.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Hello Doctor,
My wife continues to experience jaw pain even after 3 weeks of the dental work (tartar removal). Pls refer to my earlier post for more details. We consulted the dentist (who did the tartar removal) and he recommended muscle relaxant (Mobizox) this time for 3 days. She didn’t experience jaw pain during those 3 days but it came back after she stopped the medicine.
For last 1 week she has been suffering from jaw pain, ear pain and head ache on daily basis and not able to manage without taking the pain killer tablet (IMOL).
Subsequently we consulted an orofacial clinic and their assessment is captured in the attached files (2 files). They are diagnosing ‘internal disc dearrangement with reduction’ and they are recommending DTR procedure. The clinic also did a diagnostic test where she was asked to bite a U shaped device/plate which sensed the biting force from both sides of the jaw and recorded the readings on a computer. I don’t recall the exact name of this test.
I need your help to check whether the direction of treatment is correct. Can you please provide answers to following questions:
* Can the problems she has been facing be caused by some other issue other than TMJ? For e.g, some ENT issue. How can be sure that the root cause is TMJ?
* Is the ‘internal disc dearrangement’ a minor issue or major issue? Could this be muscle related or bone related? Can this be cured by home care/other precautions?
* Is DTR the right procedure to try straight away? As per my understanding this procedure involves grinding away thin layers of relevant teeth to make sure that the jaw/jaw muscle is not strained when the mouth is closed. What are the risks associated with DTR? Is there a possibility of this procedure deteriorating the existing condition?
* Should we try some other procedure (e.g., teeth protector/mouth guard) which does not alter the structure of the teeth (like DTR) before going for DTR?
* For how long we can continue to take the pain killer medication (IMOL)? She has been taking 1 tablet on average for last 3 weeks.
Look forward to your response. Thanks.
Regards
My wife continues to experience jaw pain even after 3 weeks of the dental work (tartar removal). Pls refer to my earlier post for more details. We consulted the dentist (who did the tartar removal) and he recommended muscle relaxant (Mobizox) this time for 3 days. She didn’t experience jaw pain during those 3 days but it came back after she stopped the medicine.
For last 1 week she has been suffering from jaw pain, ear pain and head ache on daily basis and not able to manage without taking the pain killer tablet (IMOL).
Subsequently we consulted an orofacial clinic and their assessment is captured in the attached files (2 files). They are diagnosing ‘internal disc dearrangement with reduction’ and they are recommending DTR procedure. The clinic also did a diagnostic test where she was asked to bite a U shaped device/plate which sensed the biting force from both sides of the jaw and recorded the readings on a computer. I don’t recall the exact name of this test.
I need your help to check whether the direction of treatment is correct. Can you please provide answers to following questions:
* Can the problems she has been facing be caused by some other issue other than TMJ? For e.g, some ENT issue. How can be sure that the root cause is TMJ?
* Is the ‘internal disc dearrangement’ a minor issue or major issue? Could this be muscle related or bone related? Can this be cured by home care/other precautions?
* Is DTR the right procedure to try straight away? As per my understanding this procedure involves grinding away thin layers of relevant teeth to make sure that the jaw/jaw muscle is not strained when the mouth is closed. What are the risks associated with DTR? Is there a possibility of this procedure deteriorating the existing condition?
* Should we try some other procedure (e.g., teeth protector/mouth guard) which does not alter the structure of the teeth (like DTR) before going for DTR?
* For how long we can continue to take the pain killer medication (IMOL)? She has been taking 1 tablet on average for last 3 weeks.
Look forward to your response. Thanks.
Regards
Brief Answer:
Right way of treating, DTR, stop analgesics, splints are temporary solution
Detailed Answer:
Thanks for your reply.
Considering the diagnosis of your jaw issue, The way you are going through is right.
These are my answers for your queries.
Disclusion time reduction(DTR) is the most effective treatment modality in comparison to splints and other medical management. The medications and splints will reduce the symptoms but these will not treat the cause. In case of DTR, the actual cause, that is any high points or deranged occlusion can be corrected by selective grinding of the teeth. The high points can be found out by the help of T Scan. This is what the treatment plan advised to you by your dentists.
Coming to your questions,
The root cause can be a TMJ disc displacement, this can be confirmed based on the clinical findings like, limited mouth opening, clicking noise in the joints, deviation of the jaw, and muscle tenderness. The best modality to confirm the diagnosis is through MRI(Magnetic resonance imaging). It cannot be ENT issue since you have classic features of TMJ disc displacement.
The disc displacement is minor issue, if you left untreated, it can become major issue. It is not a muscle or bone disorder, it is basically a disc disorder that is present between the upper and lower jaw joint.
Yes DTR is the right way of treating the disorder since we will be finding out the exact cause and grinding the high point present in particular teeth. It will not deteriorate the existing problem rather, you will be better within the first week of treatment.
Splints or night guard are temporary solution when compared to DTR.
You cannot take analgesics for long time since it might result in gastritis.
You can stop the medicines and go ahead with the above said treatment.
I hope i have answered your query. If you have any queries rely me back.. Take care. Wish you speedy recovery.
Right way of treating, DTR, stop analgesics, splints are temporary solution
Detailed Answer:
Thanks for your reply.
Considering the diagnosis of your jaw issue, The way you are going through is right.
These are my answers for your queries.
Disclusion time reduction(DTR) is the most effective treatment modality in comparison to splints and other medical management. The medications and splints will reduce the symptoms but these will not treat the cause. In case of DTR, the actual cause, that is any high points or deranged occlusion can be corrected by selective grinding of the teeth. The high points can be found out by the help of T Scan. This is what the treatment plan advised to you by your dentists.
Coming to your questions,
The root cause can be a TMJ disc displacement, this can be confirmed based on the clinical findings like, limited mouth opening, clicking noise in the joints, deviation of the jaw, and muscle tenderness. The best modality to confirm the diagnosis is through MRI(Magnetic resonance imaging). It cannot be ENT issue since you have classic features of TMJ disc displacement.
The disc displacement is minor issue, if you left untreated, it can become major issue. It is not a muscle or bone disorder, it is basically a disc disorder that is present between the upper and lower jaw joint.
Yes DTR is the right way of treating the disorder since we will be finding out the exact cause and grinding the high point present in particular teeth. It will not deteriorate the existing problem rather, you will be better within the first week of treatment.
Splints or night guard are temporary solution when compared to DTR.
You cannot take analgesics for long time since it might result in gastritis.
You can stop the medicines and go ahead with the above said treatment.
I hope i have answered your query. If you have any queries rely me back.. Take care. Wish you speedy recovery.
Above answer was peer-reviewed by :
Dr. Kampana
Hello Doctor,
We visited the hospital for DTR yesterday and following are the outcome:
* The TMJ specialist started with DTR treatment and did grinding of couple of teeth. He reported that he is not able to cure the issue fully using DTR approach. He mentioned that there are structural issues and said that we may have to go for braces. He also wanted to consult the Cons department with X-ray and get back with MRI and CBCT reports. Pls refer to files ‘Presc 3.jpg’ and ‘Presc 4.jpg’ files The doctor wanted these checks to be cleared before he could conclude on the next steps for the treatment.
* We did X-ray of all the teeth (front view) and consulted the other departments. Pls refer to ‘Presc 5.jpg’ and ‘Presc 6.jpg’ files. Note that I am not able to attach the copy of X-ray as it is a physical copy. In Cons department they did cold test and vitality tests and recommended root canal for the teeth located on the bottom side (the same side where she reported jaw pain). Note that this tooth had a filling on top and they claimed that there is a gap below the filling and the tooth is in decayed state. We decided to go ahead with root canal and did the 1st session. We need to visit the hospital again for 2nd and 3rd sessions. The doctor who did the root canal said that the pulp was in inflammation state.
At this point I am confused on whether we are going in the right direction. I was hoping that DTR will help to fix the issue but it didn’t. In addition we heard about more issues. Really need your help to finalize the next steps. Few questions on my side:
* Could the jaw pain+ear pain+headache caused due to the decayed tooth on which the root canal was done? Is there any hope of the jaw pain reducing/going away after the root canal treatment is completed?
* Could the TMJ issue be so severe which requires to go for braces? Note that she never reported about such jaw pain in last 15+ years
* What is your recommendation for the treatment course?
Regards
We visited the hospital for DTR yesterday and following are the outcome:
* The TMJ specialist started with DTR treatment and did grinding of couple of teeth. He reported that he is not able to cure the issue fully using DTR approach. He mentioned that there are structural issues and said that we may have to go for braces. He also wanted to consult the Cons department with X-ray and get back with MRI and CBCT reports. Pls refer to files ‘Presc 3.jpg’ and ‘Presc 4.jpg’ files The doctor wanted these checks to be cleared before he could conclude on the next steps for the treatment.
* We did X-ray of all the teeth (front view) and consulted the other departments. Pls refer to ‘Presc 5.jpg’ and ‘Presc 6.jpg’ files. Note that I am not able to attach the copy of X-ray as it is a physical copy. In Cons department they did cold test and vitality tests and recommended root canal for the teeth located on the bottom side (the same side where she reported jaw pain). Note that this tooth had a filling on top and they claimed that there is a gap below the filling and the tooth is in decayed state. We decided to go ahead with root canal and did the 1st session. We need to visit the hospital again for 2nd and 3rd sessions. The doctor who did the root canal said that the pulp was in inflammation state.
At this point I am confused on whether we are going in the right direction. I was hoping that DTR will help to fix the issue but it didn’t. In addition we heard about more issues. Really need your help to finalize the next steps. Few questions on my side:
* Could the jaw pain+ear pain+headache caused due to the decayed tooth on which the root canal was done? Is there any hope of the jaw pain reducing/going away after the root canal treatment is completed?
* Could the TMJ issue be so severe which requires to go for braces? Note that she never reported about such jaw pain in last 15+ years
* What is your recommendation for the treatment course?
Regards
Brief Answer:
Get the teeth treated along with DTR, Be calm and tension free, Xrays
Detailed Answer:
Thanks for your reply.
The basic etiology or cause for the disc displacement can be secondary to the mal aligned teeth as mentioned in your card (anterior traumatic bite). This will result in abnormal forces to the joint. So this needs to be corrected with the help of braces or orthodontic treatment (Can be done only if the teeth have sufficient bone support).
Regarding the pulpal inflammation and pain originating from the tooth will be severe and aggravates on consuming hot and cold food and during sleep. This pain will radiate to the entire jaw but there will not be symptoms related to TMJ disorders like deviation of the jaw, clicking sound, muscle tenderness. This might be a coincidence. But the treatment of the TMJ disorders will be started after ruling out any other teeth related conditions like pulpitis.
Regarding the problem which has aggravated now, this can get aggravated anytime particularly secondary to stress. DTR will not reduce the symptoms immediately, it takes some weeks.
The mal aligned teeth can be corrected only with the help of braces. Kindly upload the images of the radiographs or X rays so that i can give you better diagnosis. You can ask your Dentist to take a photo of the X rays and upload the images.
I advise you to be calm do not take tension, get the teeth which are in problem treated along with DTR.
Since they have already started with the treatment of the teeth, the symptoms associated with tooth will subside. So hand in hand you can go ahead with the treatment. Stick on to soft diet, do not open your jaw wide, you can give hot fomentation over the joint.
Get the teeth treated along with DTR, Be calm and tension free, Xrays
Detailed Answer:
Thanks for your reply.
The basic etiology or cause for the disc displacement can be secondary to the mal aligned teeth as mentioned in your card (anterior traumatic bite). This will result in abnormal forces to the joint. So this needs to be corrected with the help of braces or orthodontic treatment (Can be done only if the teeth have sufficient bone support).
Regarding the pulpal inflammation and pain originating from the tooth will be severe and aggravates on consuming hot and cold food and during sleep. This pain will radiate to the entire jaw but there will not be symptoms related to TMJ disorders like deviation of the jaw, clicking sound, muscle tenderness. This might be a coincidence. But the treatment of the TMJ disorders will be started after ruling out any other teeth related conditions like pulpitis.
Regarding the problem which has aggravated now, this can get aggravated anytime particularly secondary to stress. DTR will not reduce the symptoms immediately, it takes some weeks.
The mal aligned teeth can be corrected only with the help of braces. Kindly upload the images of the radiographs or X rays so that i can give you better diagnosis. You can ask your Dentist to take a photo of the X rays and upload the images.
I advise you to be calm do not take tension, get the teeth which are in problem treated along with DTR.
Since they have already started with the treatment of the teeth, the symptoms associated with tooth will subside. So hand in hand you can go ahead with the treatment. Stick on to soft diet, do not open your jaw wide, you can give hot fomentation over the joint.
Note: Find out which dental treatment will work best for your teeth. Ask here.
Above answer was peer-reviewed by :
Dr. Kampana
Answered by
Dr. Mahesh Kumar T S
Dentist, Oral and Maxillofacial Surgery
Practicing since :2007
Answered : 3377 Questions
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