UNCOMMON JAW JOINT PROBLEMS

The conditions described in this section are much more rare but as a maxillofacial surgeon, Mr Hodges has experience in diagnosing and treating them all.


Dislocation of the jaw joint

When the jaw joint dislocates, it effectively ‘unhinges’ and the bottom jaw gets stuck in a forward position. It is quite rare but when it happens, you certainly know immediately that something is wrong. Your bottom teeth are pushed forward in front of the upper teeth, making eating and speaking difficult.

A dislocated jaw usually arises through injury, most commonly having your mouth opened very wide for a long period of time, as happens during a procedure at the dentist or during surgery when you have a general anaesthetic and are intubated. It is possible to dislocate your jaw by yawning but it is very rare for that to happen.

Once dislocated, the joint needs manipulation to set it back into the right place.

Mr Hodges has treated many jaw dislocations and his favoured technique is to use local anaesthetic to numb the muscles around the jaw joint and then ease the jaw back into position.

Gout

Gout causes uric acid crystals to build up in the joints and this type of deposition can affect the jaw joint, causing inflammation, stiffness and pain.

Psoriatic arthritis

Psoriasis is a skin condition but in some people it also affects the joints. Although it is quite rare, psoriatic arthritis can cause problems with the jaw joint.

Infective arthritis

The jaw joint can become infected and inflamed if there is a widespread infection in the body. The most serious problem is that bacteria have entered the blood but once in recovery, patients can experience joint problems, including jaw joint stiffness and pain.

Diagnosing and treating jaw joint problems

When you come for an initial consultation, Mr Hodges will talk to you in detail about your condition and symptoms and will perform a thorough examination of the jaw joint and surrounding structures. At this stage you will probably need to have X-rays, CT scans or an MRI so that we have as much information as possible about what is happening in the joint.

All of the information is collected together and Mr Hodges will discuss your diagnosis. Most people are helped just by being reassured that the symptoms they have been experiencing are not due to a more serious condition.

Your treatment options

“For the vast majority of jaw joint problems, we keep things simple. There is no point rushing in with invasive treatments such as injections or even planning surgery if the problem responds to lifestyle changes, pain killers, rest and heat…” advises Mr Hodges.

Treatment strategies

  • Explaining the problem – once we have identified what is causing the problem with the jaw joint, explaining what has happened can be tremendously reassuring. Knowing that there are straightforward things that you can do yourself to improve your symptoms is also a big relief.
  • Giving you reassurance – being reassured that you don’t have anything sinister such as cancer may reduce your anxiety and this in itself will stop you doing things like tensing your jaw.
  • Resting your jaw – just as you would rest a sprained ankle, you need to rest your jaw joint. This allows the joint to settle down and for natural healing processes to get going. This involves only eating soft foods for a while and not opening your mouth wide to take big bites – no hard baguettes or crunchy apples for example. Mr Hodges also advises that you don’t visit your dentist for work that will involve having your mouth opened wide for significant periods of time. You may also need to be quieter and definitely avoid clenching your teeth or jaw.
  • Relaxation techniques – if you are a teeth clencher, it’s a habit that can be difficult to let go of. Any sort of stress tends to make this behaviour worse. Some patients find treatments such as yoga, meditation, mindfulness and acupuncture have a positive impact on their jaw joint problems.
  • Using local heat – when the jaw joint is painful, using a heat pad to gently warm the area can bring great relief.
  • Painkillers – over the counter painkillers such as paracetamol or ibuprofen can be used in the early stages of treatment, just for a few days. They can relieve pain and help reduce inflammation but you should not take them as a long-term treatment.
  • Other medications – there are other medications that may be appropriate in certain situations. Mr Hodges will advise as appropriate.
  • Bite raising appliance – a bite splint, or mouth guard, that fits over the teeth may be of benefit for some temporomandibular joint problems.
  • Steroid injections – injecting steroid into the jaw joint can help with pain in certain conditions. This is used mainly in degenerative conditions, such as osteo-arthritis.
  • Arthrocentesis – washing the jaw joint out may be effective in some patients.

“Its also really important to identify some habits that you don’t even think about but that are contributing to the problem. I see many people who chew gum for many hours of the day and have aching jaw joints and muscles as a result. I think of this like someone running a marathon wondering why their thighs and knees ache. Once you realize that something you do is irritating the jaw joint, not doing it for a while is usually enough to show you that it’s a habit you need to ditch!”