Emergency visit involving the Differential Diagnosis of TMJ pain.
Patient and husband visiting from Europe. Wife (the patient) speaks broken English however husband is fluent; he was present throughout visit. Medical History reviewed and discussed – WINL (within normal limits) except as noted: ok.
Dental History reviewed and discussed: check up and x-rays w/ her current dentist only a few weeks ago. No recent dentistry was performed. All wisdom teeth removed over 8 years ago. Head and Neck exam – WINL except as noted: pain focused on left ascending ramus. Otherwise winl.
Chief Complaint: above. Pain upon rising in a.m. and drinking hot tea – not lying down to sleep at night.
Diagnosis: Decay present #12 M and #20 M but not identfied by pt as location of pain. Gingival inflammation and some BOP (bleeding upon probing) w/ poor OH (oral hygiene) but pocketing winl. Percussion testing #12 – 21 winl. Cold testing #12 – 21 winl. Pt does wear a bite guard for grinding but left it at hotel. Occlusal test appear winl; no tooth feels or looks high. No obvious PARL (periapical radiolucency) but multiple large restorations. Recommendations: PANORAMIC x-ray and Oral Surgeon consult first. Pt informed need to treat decay, and seek Periodontist and Endodontist consults upon her return home in five days. Agreed. Pt informed risk of neglect. Next Visit: Pt scheduled later same day for Pan and OS consult. Part 1 of 2

Emergency visit involving the Differential Diagnosis of TMJ pain.
PANORAMIC x-ray taken. Oral Surgeon Consultation: Pt complaining of TMJ pain in left mandible radiating up the ascending ramus. Panoramic Radiograph reviewed without obvious causes. Pt has maxillary (upper jaw) bite plate.
Palpation of the left sternocleidomastoid muscle gave positive response to pain approximately 5 on the scale of 1 to 10. Palpation of left internal pterygoid, and the inferior insertion of the temporalis, gave a similar response. Pt indicated these areas as the origin of her pain. Pt exhibits a mild click and deviation to the left upon opening. Impression: Rule out left TMJ dysfunction. Rx: Flexeril 10 mg TID and Vicoprofen 5 mg QID for pain. Pt will see her current dentist when she returns home in five days for follow-up for TMJ treatment. Conclusion: Don’t rush to treat teeth without a clear indication it is needed. Part 2 of 2.

Dental Reconstruction of a phobic Wall Street executive. Total treatment time was about nine hours in two visits during one business week: Monday (four hours) and Friday (five hours). This patient hid his dental condition for over a decade by never smiling.

In the first row of photos, note that the teeth bite was over-closed due to a prior history of an eating disorder, now controlled, and a current severe teeth clenching grinding habit. This patient suffered from anxiety and stress and was informed about the need to control his bruxism habit to avoid TMJ pain and damage to his natural teeth and dentistry.

An Oral Surgeon consultation with panoramic x-ray (second row) was performed prior to treatment to evaluate opening the teeth bite occlusion and to examine the current condition of the TMJ, the temporomandibular joint.

The third row shows x-rays taken after the Endodontist completed root canal therapy on eight teeth on the first day on teeth #’s: 6 – 11 and 14, 15.

The fourth row shows the lab-processed 11 teeth temporary provisional dental bridge and the cast gold post and cores for the root canal treated teeth.

The fifth row shows the cast gold post and cores after insertion with dental cement.

The sixth row shows the lab-processed temporary teeth bridge in place after oral surgery extraction of teeth #’s: 3 – 5 and 12, crown lengthening gum surgery was performed on teeth #’s: 6 – 11, and a distal wedge was performed on #15.

The patient will have a final porcelain-metal bridge made after the gums heal. Dental implants may also be placed in the upper right posterior. A bite plate occlusal guard is also necessary to try to mitigate the force of teeth grinding clenching. Referral for pharmacological management of anxiety is also recommended.

These photos show how to make a mandibular stabilization appliance with a braided brass lingual reinforcement, occlusal stainless steel mesh and ball clasps. This is used to treat myalgia-myositis secondary to bruxism – teeth grinding. Note the extension up the lingual aspect of the anterior teeth without incisor coverage. ALSO SEE: BRUXISM SECTION.

These pictures show how to check the fit of a mandibular stabilization appliance. Note the cuspid rise to obtain disocclusion during lateral excursions. This is worthwhile treatment for jaw pain associated with bruxism – teeth grinding clenching.

Left and right lateral intra oral photos of the mandibular stabilization appliance. Note the cuspid rise to obtain disocclusion during lateral excursions. This can be an effective treatment for mouth or jaw pain associated with bruxism teeth grinding.