Tag Archives: temporomandibular joint syndrome

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Dental, Head/Eyes/Ears/Nose/Throat, Cardiology/Heart, , , , , , , , , ,

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Reacting to Broken or Dislocated Jaws

Dental, Trauma, Head/Eyes/Ears/Nose/Throat, , , , , , , ,

broken-jaw-photos-1

Should you ever suffer the misfortune of getting hit or falling onto your jaw, would you know what to do?
Trauma to the jaw is more dangerous than you might imagine. The risk for bleeding or subsequent breathing difficulties is such that immediate medical attention is a must in the presence of either.

jawfracturejaw dislocation

Once you get past bruises, there are two main considerations to jaw injuries: fractures and dislocations. Jaw fractures are simply broken jaws. A dislocated jaw is one in which the lower portion of the jaw bone (the mandible) has moved from its normal position (i.e., out of the joint connecting it to the skull). It’s not likely that you’ll know which has occurred, which is another big reason why you should be sure to get medical attention instead of attempting to do much yourself. There are significant differences in the medical management of the two conditions.
There are two main considerations I want you to learn from this post: what to do (and not to do) in the case of a jaw injury and what can happen if you don’t.

jaw fx bandages

Things for you to do

  • While traveling to the emergency room, you should hold the jaw and any other injured portion of the face gently in place.
  • If you have access to a bandage, loosely wrap it over the top of your head and under your jaw. It needs to be rather loose in the event you need to remove it so you can vomit, which is likely after a head injury.

What you should not do

  • Do not attempt to move, relocate or otherwise manipulate the jaw after an injury. Your doing so without knowing the extent of the injuries could have devastating consequences.

What can happen if you don’t get the situation addressed

  • Bleeding from a facial fracture is a pretty big deal. Blood can go into the lungs and block your airway at different levels. Similarly any food that might have been in your mouth (e.g., during a car crash) can have the same outcome.
  • Displacement of a broken or dislocated jaw can cause difficulty eating or speaking and can cause problems aligning the teeth over the long-term.
  • Depending on the mechanism, the jaw and/or other parts of the face can become infected. With the facial structures being packed so tightly in a relatively small space, many different types of complications can occur.
  • Anyone with TMJ syndrome (temporomandibular joint) appreciates the pain this condition can bring. Untreated or mistreated injuries to the jaw and/or jaw joint can produce chronic pain in these areas.

jaw protector

Of course it shouldn’t have to be said that the better course of action is to avoid such injuries, but some of us refuse to wear helmets during sporting events, and some of us find ourselves in bar fights and motor vehicle crashes. If you can’t avoid these situations, then the next best course of action is to respond appropriately. Take care not to ruin your beautiful faces and smiles.
I welcome any questions you may have.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: TMJ (Temporomandibular Joint) Syndrome

Trauma, Head/Eyes/Ears/Nose/Throat, , , , , , ,

TMJ pain

TMJ. Those of you have TMJ syndrome are likely already shaking your head in understanding. Those of you who don’t, be thankful. Take the advice of those who do and read this post to appreciate steps you can take to avoid developing it.
TMJ (temporomandibular joint) syndrome/disorders refer to symptoms developed in the chewing muscles and joints connecting your lower jaw to your skull. In other words, you’re having problems with your jaw joint. Given that the TMJ closes your mouth, and you’re using it all day to talk and chew, having this poses a lot of problems.
To understand various causes of TMJ, start by appreciating that most anything affecting all the various structures connecting the joint can contribute to the disorder. This includes problems with the joint itself or to its surrounding muscles, tendons and bones. Therefore, there isn’t just one cause. Many things you do or have done can contribute to difficulties with the joint. Here are some examples:

  • Arthritis (degenerative joint disease)
  • Having a bad (poorly aligned) bite
  • Having to wear braces
  • Lack of sleep (insufficient rest and recuperation for overworked muscles)
  • Poor diet
  • Poor posture (e.g., holding the head forward while looking at a computer all day, straining the muscles of the face and neck)
  • Stress and grinding your teeth
  • Trauma to the jaw resulting in fractures or dislocations

tmj_2

Knowing this makes prevention easy.

  • Limit or avoid hard foods and excessively chewing gum. Although you don’t think about it much, you can wear out the joints in your mouth just as you can a hip or a knee.
  • Learn to reduce your overall levels of stress and muscle tension.
  • Practice and maintain good posture of your head and neck.
  • Use protective measures when engaged in activities that can produce jaw fractures and dislocations.

It’s pretty easy to figure out the symptoms you may have if there is a problem with your jaw or TMJ.
TMJ sx

  • Aching facial pain
  • Clicking, popping or grating of the mouth when opening or closing it
  • Difficulty opening and/or closing the mouth
  • Difficulty/pain biting or chewing
  • Earache
  • Headache
  • Jaw pain or tenderness
  • Locking of the jaw

Treatment strategies vary widely based on severity and cause of the joint issues. Many patients get by with over the counter medications, relaxation techniques, heat or ice to the face and prevention of additional damage. More complicated measures may include use of prescription pain medicines, muscle relaxants, corticosteroids or antidepressants. Bite guards (aka splints, mouth guards/appliances) may be recommended if you have problems with teeth grinding. Your physician will make appropriate recommendations based on your individual circumstances.
The good news is for many patients symptoms come and go, and they are reasonably well treated with minor interventions. The bad news is if you go unidentified or untreated, you may suffer chronic facial pain and/or headache, and this is not a pleasant experience. Therefore, if you discover yourself having difficulty opening and closing your mouth or eating, please address it early and see your doctor or dentist right away. You really don’t want to deal with the consequences of inaction.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: When Your Jaw Pain Could Be a Heart Attack

Head/Eyes/Ears/Nose/Throat, Cardiology/Heart, , , , , , , , , ,

Several Straight, No Chaser posts have addressed jaw pain. We’ve separately discussed jaw trauma and TMJ syndrome. Unfortunately, that’s not the most important story of jaw pain. As an emergency physician, those causes aren’t close to my first consideration when you tell me you have jaw pain.

 jaw referred pain

Previously, we have discussed heart attack recognition. It is important to appreciate that because of the distribution of certain nerves, heart pain can be transmitted (i.e., referred) up to the left jaw (particularly the lower aspects). In the context of someone at high risk for a heart attack or otherwise presenting with symptoms of a heart attack, jaw pain becomes a very important clue.
Before you overreact to that toothache that’s causing jaw pain, here are some important considerations about when jaw pain might or might not be part of a heart attack or other illness related to the heart.

  • If your jaw pain is worsened or reproduced by pressing a specific place on the face (known as a trigger point), it is not likely due to the heart.
  • If your jaw pain is worsened by chewing, grinding your teeth or other motions of the jaw, it is not likely due to the heart.

jaw-pain

Here’s a group of considerations that in the presence of jaw pain could indicate heart pain.

  • If exertion exacerbates the pain, this makes the heart more likely as a cause.
  • If rest does not relieve the discomfort, this makes the heart more likely as a cause.
  • Any presence of shortness of breath during the episode of chest discomfort makes the heart more likely as a cause. (Pain during breathing is not the heart as shortness of breath, which describes the subjective inability to get enough air or difficulty breathing.)
  • Any presence of nausea, vomiting, sweating, blackouts or racing/fluttering of the heart makes the heart more likely as a cause, without or without the presence of jaw pain. 

If simple motions of the arm, shoulder, or jaw make things worse, it is probably not due to the heart. If rotating the muscles of your trunk (twisting from side to side) make things worse, it is not likely to be due to a heart problem. If pressing on a trigger point causes exquisite discomfort, it is also not likely a heart problem. If taking a deep breath makes things worse, it is not likely that a heart attack is the problem.
On the other hand, if walking fast aggravates the issue or causes shortness of breath, I would be concerned. If the discomfort persists even when lying quietly, I would be concerned. If you are getting short of breath for any reason, I would be concerned.

 heart-symptoms

You really should know the risk factors and typical signs of a heart attack. If you have a moderate to high-risk profile, don’t take these things lightly. Get in and get evaluated. If the worse thing you discover from your jaw pain is you have TMJ syndrome, that would be a good day, because even that needs to be addressed.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Reacting to Broken or Dislocated Jaws

Dental, Trauma, Head/Eyes/Ears/Nose/Throat, , , , , , , ,

broken-jaw-photos-1

Should you ever suffer the misfortune of getting hit or falling onto your jaw, would you know what to do?
Trauma to the jaw is more dangerous than you might imagine. The risk for bleeding or subsequent breathing difficulties is such that immediate medical attention is a must in the presence of either.

jawfracturejaw dislocation

Once you get past bruises, there are two main considerations to jaw injuries: fractures and dislocations. Jaw fractures are simply broken jaws. A dislocated jaw is one in which the lower portion of the jaw bone (the mandible) has moved from its normal position (i.e., out of the joint connecting it to the skull). It’s not likely that you’ll know which has occurred, which is another big reason why you should be sure to get medical attention instead of attempting to do much yourself. There are significant differences in the medical management of the two conditions.
There are two main considerations I want you to learn from this post: what to do (and not to do) in the case of a jaw injury and what can happen if you don’t.

jaw fx bandages

Things for you to do

  • While traveling to the emergency room, you should hold the jaw and any other injured portion of the face gently in place.
  • If you have access to a bandage, loosely wrap it over the top of your head and under your jaw. It needs to be rather loose in the event you need to remove it so you can vomit, which is likely after a head injury.

What you should not do

  • Do not attempt to move, relocate or otherwise manipulate the jaw after an injury. Your doing so without knowing the extent of the injuries could have devastating consequences.

What can happen if you don’t get the situation addressed

  • Bleeding from a facial fracture is a pretty big deal. Blood can go into the lungs and block your airway at different levels. Similarly any food that might have been in your mouth (e.g., during a car crash) can have the same outcome.
  • Displacement of a broken or dislocated jaw can cause difficulty eating or speaking and can cause problems aligning the teeth over the long term.
  • Depending on the mechanism, the jaw and/or other parts of the face can become infected. With the facial structures being packed so tightly in a relatively small space, many different types of complications can occur.
  • Anyone with TMJ syndrome (temporomandibular joint) appreciates the pain this condition can bring. Untreated or mistreated injuries to the jaw and/or jaw joint can produce chronic pain in these areas.

jaw protector

Of course it shouldn’t have to be said that the better course of action is to avoid such injuries, but some of us refuse to wear helmets during sporting events, and some of us find ourselves in bar fights and motor vehicle crashes. If you can’t avoid these situations, then the next best course of action is to respond appropriately. Take care not to ruin your beautiful faces and smiles.
I welcome any questions you may have.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: TMJ (Temporomandibular Joint) Syndrome

Trauma, Head/Eyes/Ears/Nose/Throat, , , , , , ,

TMJ pain

TMJ. Those of you have TMJ syndrome are likely already shaking your head in understanding. Those of you who don’t, be thankful. Take the advice of those who do and read this post to appreciate steps you can take to avoid developing it.
TMJ (temporomandibular joint) syndrome/disorders refer to symptoms developed in the chewing muscles and joints connecting your lower jaw to your skull. In other words, you’re having problems with your jaw joint. Given that the TMJ closes your mouth, and you’re using it all day to talk and chew, having this poses a lot of problems.
To understand various causes of TMJ, start by appreciating that most anything affecting all the various structures connecting the joint can contribute to the disorder. This includes problems with the joint itself or to its surrounding muscles, tendons and bones. Therefore, there isn’t just one cause. Many things you do or have done can contribute to difficulties with the joint. Here are some examples:

  • Arthritis (degenerative joint disease)
  • Having a bad (poorly aligned) bite
  • Having to wear braces
  • Lack of sleep (insufficient rest and recuperation for overworked muscles)
  • Poor diet
  • Poor posture (e.g., holding the head forward while looking at a computer all day, straining the muscles of the face and neck)
  • Stress and grinding your teeth
  • Trauma to the jaw resulting in fractures or dislocations

tmj_2

Knowing this makes prevention easy.

  • Limit or avoid hard foods and excessively chewing gum. Although you don’t think about it much, you can wear out the joints in your mouth just as you can a hip or a knee.
  • Learn to reduce your overall levels of stress and muscle tension.
  • Practice and maintain good posture of your head and neck.
  • Use protective measures when engaged in activities that can produce jaw fractures and dislocations.

It’s pretty easy to figure out the symptoms you may have if there is a problem with your jaw or TMJ.
TMJ sx

  • Aching facial pain
  • Clicking, popping or grating of the mouth when opening or closing it
  • Difficulty opening and/or closing the mouth
  • Difficulty/pain biting or chewing
  • Earache
  • Headache
  • Jaw pain or tenderness
  • Locking of the jaw

Treatment strategies vary widely based on severity and cause of the joint issues. Many patients get by with over the counter medications, relaxation techniques, heat or ice to the face and prevention of additional damage. More complicated measures may include use of prescription pain medicines, muscle relaxants, corticosteroids or antidepressants. Bite guards (aka splints, mouth guards/appliances) may be recommended if you have problems with teeth grinding. Your physician will make appropriate recommendations based on your individual circumstances.
The good news is for many patients symptoms come and go, and they are reasonably well treated with minor interventions. The bad news is if you go unidentified or untreated, you may suffer chronic facial pain and/or headache, and this is not a pleasant experience. Therefore, if you discover yourself having difficulty opening and closing your mouth or eating, please address it early and see your doctor or dentist right away. You really don’t want to deal with the consequences of inaction.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.