Suggest Remedies For Severe Jaw Pain Post An Injury

Posted on Sat, 10 Sep 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 10 Sep 2016 Answered on

Tue, 4 Oct 2016 Last reviewed on

Question : Hi, I'm writing on behalf of a friend now since I get frurstrated just by hearing about her problem. She was kicked by a horse on her jaw four years ago and has been in pain ever since (has trouble eating). She has been to doctors, pain specialists and dentists but they all tell her she is a hard case or even impossible. The latest is they want to send her to a dentist again, but the last time she went they could not examine her properly because she was in so much pain. Now she just wants medicine to deal with the pain, but this is no way to live?! So do you have any idea how to go forward with this? I would ve glad to tell her since she is now asking for advice.. Her diagnoses are prolonged pain (neuropathic), myalgia, depression, add and anxiety... Oh, and she is born 1996.

Answered by Dr. Dr. Matt Wachsman (1 hour later)

Brief Answer:
Cannot say for certain without seeing her.

Detailed Answer:
But you'd really wonder about dental or TEMPORAL MANDIBULAR SYNDROME in someone with jaw pain after trauma.

Diagnosis is tricky.
http://www.oprah.com/health/Do-You-Have-TMJ-Take-the-Home-Test
http://www.mayoclinic.org/diseases-conditions/tmj/diagnosis-treatment/diagnosis/dxc-0000
http://www.ncbi.nlm.nih.gov/books/NBK271/

The shape of the mouth and how far it can be opened is a somewhat good test.
The pain elicitation is bunk
http://schaferselfdefense.blogspot.com/2009/09/using-pressure-points.html
see honorable mentions 1 and 2.
Everyone is exquisitely painful there. So.....everyone has TMJ and everyone needs Lots and Lots of Narcotics? I can get thousands of people to agree with that statement. They are, however, addicts.

So, nerve pain responds well to nerve pills that are NOT addictive substances like anti-epileptic medicine. All my TMJ patients love them. They are extremely cheap and not controlled substances.

Aspirin worked absolutely fabulous when I had this. When it wore off it was like a siren went off in my jaw. Til I took another. Mouth guard fixed it in a few days.

So, if she doesn't have limitations on jaw opening, she doesn't have TMJ. IF she does, then the nerve pills are a good place to start. Pain maangement has a huge number of minor surgical options for it.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Matt Wachsman (14 hours later)

Thank you for yor reply, this is helpful information!

She definitely has limitations on jaw opening. She also says that she is sensitive to hot and cold weather in the area. The cheek turns red and swollen. She has been taking pills with ibuprofen and paracetamol, but she should take acetylsalicylic acid pills instead? She has now heard trigeminal neuralgia as an alternative diagnosis, what do you think about that? Is it the same principle with the medication? What are some other (mild but effective) medication options?

She can't wear a mouth guard since she feels it makes the pain worse...

Answered by Dr. Dr. Matt Wachsman (5 hours later)

Brief Answer:
well.. there it is....

Detailed Answer:
So, deformity, also nerves control motion, sensation and circulation tone. If an area's circulation is 'funny'...going real red or blue or cold and white then the circulatin is funnny and if it is very spastic, it is likely to be from a nerve.

Trigeminal neuralgia is if the trigeminal nerve at the base of the brain is irritated. This can occur from ANYWHERE along it's path. Sinusitis, or other causes both to START the process and to TRIGGER the process.
http://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/basics/causes/con-0000

so, yeah, fine, trigeminal neuralgia....but if there is deformity, then there is deformity underlying it.

Still... that's a nerve and nerve pills are good.

Acetylsalicylate is worthless. Pharmacologists like me, but not your other doctors, would know that ACETYL-salicylate has to get to the liver to have the ACETYL taken off before it will do anything. Trisalycylate-Choline (trilosate), on the other hand, just has to be swished around in the mouth for the choline to fall off and be totally active... about 15 seconds.

But the nerve pills are a better bet in nerve pain.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Matt Wachsman (2 days later)

Hi again!! So I took your information and turned to a swedish neurologist in her area (she lives far away from me) and asked if they could treat her (but also happened to explain that she does not have much money since they dont have any prices in their site), but he said that he could not see that this would be a neurological problem! So do you think she should go to the dentist or do you think this will pass with the right rest, mindset,exercises, maby some nutritional changes and supplements??

Answered by Dr. Dr. Matt Wachsman (4 hours later)

Brief Answer:
Some thoughts

Detailed Answer:
Sorry for the lateness. My response I wrote and then closed the tab.

Neurologists would not normally be doing any pain managment. For simple, non-controlled nerve pills a regular doctor of Internal Medicine doing primary care would generally do that. Pain management does nerve procedures but generally would not be prescribing the nerve pills.

Dentists or better, ORAL SURGEONS, can evaluate for TMJ.

Seems random to suggest it will change after this amount of time unless something is really done. On nutritional changes, it isn't a question of some vitamin helping it, but in TMJ many foods that involve a lot of chewing aggravate it.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar