I was in the office the other day seeing a patient yesterday. His dentist had sent him to me and explained that he was in need of immediate help. The patient had recently had a routine cleaning followed by a temporary crown procedure.
When I saw him the problem was rather obvious.
He couldn’t open his mouth!
And he had pain. He looked fairly easy going, but he told me in no uncertain terms that if he didn’t take an Advil every 6 hours his mouth felt like it was ready to blow!
His jaw only opened 15mm. However he had full side to side motion (laterotrusion) and protrusion. This indicated to me that he didn’t have an actual TMJ “joint” problem. A wonderful “catch-all” term nowadays for generalized jaw pain.
What he did have- was a trismus problem!
aka- a jaw “muscle” problem.
This patient fit the typical trismus profile to a “T”. Despite what appeared to be his casual nature, he confided that work had made him a stress case the last 2 years. He did realize that he had a habit of clenching & grinding his teeth from time to time. He worked on a computer for 7-10 hours a day. As he sat and demonstrated his work posture he somewhat resembled an ostrich with swayback. It wasn’t pretty. It was obvious that there was a build up of both physical & emotional tension.
Now imagine taking this ball of tension, injecting into that area with a needle a few times and then having it keep its jaw open for two and a half hours. Guess what happened next?
BOOM!!!
The master muscle seized up into a spasmodic knot. And the next thing he knew he was sitting in my office mumbling his story to me the best he could through his narrowed occlusion.
Now here’s the biggest problem for the dentist-
Take one guess who this patient will blame for their problem…?
Yep, you guessed it- their dentist.
Which is unfortunate because truly the patient was living a lifestyle and profile that was just begging for this to happen. It wasn’t the dentist’s fault.
Here’s the thing though, if it could be avoided, that would be ideal for everyone- both the patient and the dentist. The dentist doesn’t risk losing her patient, her well-earned reputation or worst of all (-but I’ve seen it) expose himself to the mind-numbing headache that never seems to go away- a lawsuit.
Beyond all that, I find it amazing how quickly one strong complaint or one really poor review can quickly shift public perception nowadays- whether deserved or not.
So here’s the good news is, if you’re alert to the warnings signs, there’s more than a decent chance that these seemingly unavoidable situations can actually be avoided.
In case you missed them, here they are-
- Poor sitting posture
- Forward Head, Scoliosis
- Prolonged Daily Sitting/Computer work > 4 hours day
- History of Oral Parafunctional Habits- Gum Chewing, Nail-biting, Clenching or Grinding Teeth
- History of Neck Stiffness or Pain
- Prolonged Mouth Opening
- Palpation of Jaw & Neck Musculature including Masseter, Sternocleidomastoid, Temporalis, Trapezius, etc.
- History of Headaches
- Poor Sleep
- Increased Stress
- Painful or Limited Opening with/without a Click
- History of Jaw Clicking or Locking
- Women (Ouch. Sorry, ladies, women are 3-5 times more likely to have TMJ issues. I know, SO not fair!)
In the next few posts, I will talk more about each of these. But here’s my recommendation… have yourself and your staff on the look out for these things!
If you do become more aware of these considerations, I promise you that those occasional “problem patients” will grow fewer and fewer.
Here’s 2 quick take-home tips
for once you & your staff do begin to recognize these patients…
Tension in the jaw can rapidly accumulate and this is the time that patient is most at risk. So, tip #1…
- Give these patient more breaks during their dental work- especially if it involves a longer procedure. And for the dental procedures that can be broken up into more than one visit, definitely consider doing so. And then explain the reason why to your patient.
Then for the patients that are most at risk, such as the patients that have a history of headaches, neck pain or stiffness, tender facial muscles or jaw discomfort, here is tip #2…
- These are the patients that should be referred to your orofacial physical therapist
An orofacial physical therapist with a CCTT (a Certified Cervical & Temporomandibular Therapist) credential that specializes in these problems. In my experience, your patient will be very very appreciative! Most of these patients been dealing with these problems unhappily for years. They’ve usually seen multiple people- massage therapists, chiropractors and doctors with no luck and unfortunately have come to assume they’re a hopeless mess! And that there’s nothing that can be done to help them. So not true!!
My patients have always been grateful to their dentists that helped them find me. They’ve often actually been frustrated that no one helped them find me sooner! And on the flip side, for the patients that find me on their own- they often tell me who their dentist was that “caused” the problem and didn’t direct them to a helpful solution.
- -So talk with your staff and begin identifying these potential “problem patients” early.
- -Have a plan to adjust their care accordingly when they’re in your chair.
- -And finally, have a CCTT that you can trust to help you with these patients.
Let me know if y'all have any thoughts below…
Thanks!~
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