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Medical Forum / General / Dentistry / November 2004limited mouth opening after injection
Hi, I've searched the archives of this group and found a few cases similar to mine, but none that seem to be so protracted. I have now been referred by my dentist to an oral surgeon - my appointment is next Tuesday. the history is this: I had a cracked filling replaced in a lower molar (left side, 3rd from the front). The injection was quite uncomfortable (which surprised me since I normally hardly feel them, other than when I had my wisdom teeth removed). I noticed that the dentist inserted the needle twice. As the anaesthetic wore off, the whole of the left side of my lower jaw became extremely painful, and I had restricted opening of my mouth (I could get just 2 fingers between my front teeth). My dentist told me it was probably bruising from the injection (which was into the muscle at the back of the mouth) and that it would clear in a couple of days. After 1 week there was no change in jaw function and the pain was worse so I attended the hospital. Jaw was x-rayed, I was told by general doctor that there was no dislocation, but the muscles were in spasm and they would settle down in time. I was given stronger painkillers. My dentist disputes that the muscles are in spasm and insists it is just bruising. However, it is more than 5 weeks since the treatment and althought he general pain has subsided, my jaw opening is still limited to 1 finger despite doing the stretching excercises and twice weekly accupuncture from my Chinese doctor. Finally I have been referred to an oral surgeon, my appointment will be 6 weeks after the initial treatment. The pain on opening is concentrated behind my teeth in the area between the upper and lower jaw. If I try harder the pain moves to the area just in front of my ear and spreads to the upper jaw, with all the teeth on that side feeling rather sensitive. The sensation is that there is something quite solid preventing my jaw from opening properly. Could bruising or muscle spasm really be the cause of my problem (given that it's now 5 weeks and no improvement)? Is it feasible that the disc could have slipped out of position? IS there anything particular that I should expect the oral surgeon to check? I should point out that I have seen in other posts the suggestion that TMD problem could lead to muscle bruising from injection, but as far as I am aware I don't have any TMD problems, and no grinding, jaw clenching etc. Having been sharing meals with my 16 month daughter for the past 5 weeks, I really do need to get this sorted, so any comments or suggestions would be gratefully received. Dave You either have a muscle spasm or fluid build up in the muscle (inflammation of the muscle). I doubt very much the joint is dislocated or fractured, based on your description. Sometimes, when we insert a needle to get teeth numb, we hit a blood vessel. It is just part of doing this work. Rarely, hitting the vessel results in bleeding into the tissues. This can pool in one area and prevent normal jaw opening until the fluid is absorbed by the body. This happened to one of my patients about 2-3 months ago. Usually it goes away in 1-3 weeks. Air embolisms can occur. This is where air is forced into the spaces in stead of fluid. This happens during surgery or during root canal treatments. Again, it only happens rarely, and is easy to prevent. Muscle spasm is the result of heavy clenching (especially during sleep). No one can tell what their muscles are doing during sleep. A sleep partner cannot tell if the other person is clenching. You can only tell by the signs and symptoms resulting from the activity. The fact that your problem is out to 5 weeks, makes me very suspicious of a muscle spasm. If this is correct, the only predictable way to treat this (that I know of) is to wear an NTI device for 5-8 weeks--minimum. What ever you do,,,,,,,,,,,,,, do NOT consent to surgery on the joint unless you have at least three separate opinions from three different offices which all agree and can tell you that there is some anatomical problem (besides a displaced disc).  Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Hi, > [quoted text clipped - 49 lines] > > Dave >You either have a muscle spasm or fluid build up in the muscle (inflammation >of the muscle). I doubt very much the joint is dislocated or fractured, [quoted text clipped - 13 lines] >this is correct, the only predictable way to treat this (that I know of) is >to wear an NTI device for 5-8 weeks--minimum. I was thinking parafunction ....... (how am I doing?) >What ever you do,,,,,,,,,,,,,, do NOT consent to surgery on the joint unless >you have at least three separate opinions from three different offices which >all agree and can tell you that there is some anatomical problem (besides a >displaced disc). >You either have a muscle spasm or fluid build up in the muscle (inflammation >of the muscle). I doubt very much the joint is dislocated or fractured, [quoted text clipped - 18 lines] >all agree and can tell you that there is some anatomical problem (besides a >displaced disc). Steve, thanks very much for your very clear explanation. it does seem that a spasm is likely. will talk to the surgeon tomorrow about this possibility and also about NTI devices. I'd not heard of them before reading the archives of this group, so I'm not sure if they as widely used here in the Uk as in the US. DOn't worry - I won;t be consenting to surgery in a hurry - in any case these things don;t happen that quickly over here, so I would have plenty of time to reflect/get other opinions. WIll post again after seeing the surgeon. Thanks again Dave SignatureDavid Shepherd ENV Skip the surgeon. go to www.headacheprevention.com and go to the link where you can find a provider near you. There is a listing for the UK. Go get an NTI and try it for a month before doing invasive and expensive treatments. DO NOT CONSENT TO SURGERY OF TMJ UNLESS YOU HAVE BROKEN BONES, CANCER, etc. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > >>You either have a muscle spasm or fluid build up in the muscle [quoted text clipped - 42 lines] > WIll post again after seeing the surgeon. Thanks again > Dave >Skip the surgeon. go to www.headacheprevention.com and go to the link where >you can find a provider near you. There is a listing for the UK. Go get an >NTI and try it for a month before doing invasive and expensive treatments. > >DO NOT CONSENT TO SURGERY OF TMJ UNLESS YOU HAVE BROKEN BONES, CANCER, etc. I say this is a case of "Parafunction." Needs treatment ..... Would the surgery be NHS approved or is this a private insurance sort of thing? Just wondering how NHS affords unnecessary TMJ surgery ... TW > Skip the surgeon. go to www.headacheprevention.com and go to the link where > you can find a provider near you. There is a listing for the UK. Go get an [quoted text clipped - 47 lines] > > WIll post again after seeing the surgeon. Thanks again > > Dave >Hi, Hi. >I've searched the archives of this group and found a few cases similar >to mine, but none that seem to be so protracted. I have now been [quoted text clipped - 16 lines] >spasm and they would settle down in time. I was given stronger >painkillers. >My dentist disputes that the muscles are in spasm and insists it is >just bruising. However, it is more than 5 weeks since the treatment [quoted text clipped - 3 lines] >referred to an oral surgeon, my appointment will be 6 weeks after the >initial treatment. avoid surgery. >The pain on opening is concentrated behind my teeth in the area >between the upper and lower jaw. If I try harder the pain moves to the >area just in front of my ear and spreads to the upper jaw, with all >the teeth on that side feeling rather sensitive. The sensation is that >there is something quite solid preventing my jaw from opening >properly. here is something simple and harmless to try.. if you have not already.. you did not give specifics about what kind of stretching exercises you have done how about applying heat (hot towel or cloth) to the affected side covering the area from the front of the ear to the mandible for say, 15-20 minutes twice a day. After applying heat, move the mandible (move the chin) very carefully, slowly downward, then forward, jutting the chin forward. - Don't move the chin back, or side to side. all this very easy. first slightly downward as far as you can comfortably, then slightly forward, jutting the chin forward, after appying heat, very easy (in the shape of a "J" if you can imagine) Try this for a few days and see if there is any change. >Could bruising or muscle spasm really be the cause of my problem >(given that it's now 5 weeks and no improvement)? Is it feasible that [quoted text clipped - 9 lines] >weeks, I really do need to get this sorted, so any comments or >suggestions would be gratefully received. Hope this works. >Dave >here is something simple and harmless to try.. if you have not >already.. you did not give specifics about what kind of [quoted text clipped - 10 lines] >can imagine) >Try this for a few days and see if there is any change. Hi Dora, these are basically the excercises I have been doing. I find that I can open ok, but when I push the jaw forward, it moves sideways (towards the injured side). The dentist told me no to let that happen, ie only to mobilise the joint within the range that I can keep it straight. Unfortunately it doesn;t seem to have had any noticable effect. Thanks for your help though, and I'll report back after seeing the surgeon tomorrow, and no, I won;t be consenting to surgery! Dave SignatureDavid Shepherd ENV |
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