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Question:
Dental Treatment caused jaw to lock open: My dentist was doing a filling, I was tense and nervous and when he asked me to bite, my jaw was stuck and I felt two big bones and I couldn't close my mouth.
I was in a lot of pain. The dentist told me that it looks like my jaw has been misplaced and he tried to place it back and forth. My mouth would not close and I couldn't speak.
After he asked me to sit back and relax, his fellow dentist suggested that I try to open my mouth even more and close and close it fast, which i did. My mouth went back to its place.
Now I am fine however my smile slightly changed since then. Even my husband noticed. How do I fix this?
Answer:
I think what happened to you was a subluxation of the temporomandibular joint (TMJ).
You had your mouth open for a long time, you were tense, and your muscles that open and close the lower jaw became spastic.
In anatomical terms, the head of the condyle of your lower jaw (put your fingers in front of your ears and open and close your mouth - the moving part in front of your ear attached to your lower jaw is the head of the condyle) traveled too far forward and slipped out of the joint space in front of your ear and got stuck under the articular eminence behind the joint space. These were the 2 bones you felt.
I will try to show you this in a picture: http://www.rad.washington.edu/anatomy/modules/TMJ/images/NormMeniscus.MOV
If you can't see this picture, google "TMJ anatomy" to see it. In the animation, the lower "thumb-like" bone is the head of the condyle and the downward bump on the upper image to the left is the articular eminence. The lower bone went up the slope to the farthest left and got stuck; therefore your mouth was locked open.
The common treatment for this is to have the patient sit in a straight chair with her head in front of a wall. The dentist should stabilize your head against the wall and pull the lower jaw back and downward to allow the head of the condyle to snap back in place.
Once subluxation has happened to you, it may happen again because the ligaments that hold the mandible in place could be stretched. If you try this at home, be sure to not have anybody put fingers over the lower teeth because they could be caught as the jaw snaps back into place.
The second dentist released the bones by having you open wider and the condylar head of the mandible was able to go under the articular eminence and snap back into the joint.
I would guess that your muscles are still a bit spastic and that is why your smile is different; your lower jaw may not be in the proper place in the joint.
I would recommend that you see a dentist who is very knowledgeable about TMJ. This could be a general dentist who has extra training in occlusion and TMJ disorders. I would probably get you on a low dose of a muscle relaxant at bedtime for about 2 weeks (2 mg. valium is my favorite) and get you in a nightguard or NTI appliance.
If your jaw is not in the proper position, you are probably grinding your teeth at night which would make this worse. The NTI device is a small, clear, taco shell-shaped appliance that fits over the upper two front teeth. Attached on the incisal edges of the taco shell is a bump or a bar that extends anteriorally and posteriorally to provide the point stop.
NTI stands for Nociceptive Trigeminal Inhibition. This is a technical way of saying the jaw opening is a reflex, and this device provides a way to suppress the elevating muscles of mastication (your spastic muscles).
I would also recommend that you take a muscle relaxant prior to future dental appointments, find a dentist who uses a bite block (small wedge to hold your mouth open so your muscles are not so tense), and provides rest times during long procedures. You will need to warn a future dentist that this has happened to you.
Hope this helps.
Corinne Scalzitti, DMD, MAGD
Austin Reconstructive Implant Dentistry
3900 RR 620 South
Austin, Texas TX 78738
(512) 263-3330
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