Gum Swelling and Pain After Tooth Extraction and TMJ Issues

Q: Gum Swelling and Pain After Tooth Extraction and TMJ Issues

Hello Ms. <br>Li： If you have temporomandibular joint (TMJ) disorder, you may experience soreness in the muscles around your ear and cheek when biting down. <br>If you feel pain in your molars while chewing, it could be due to a deep cavity that is close to the nerve, causing pul

Gum swelling and pain during occlusion?

Hello, doctor.
I have been diagnosed with temporomandibular joint disorder (TMJ).
After undergoing extraction of a molar and treatment for cavities, my condition has worsened.
Currently, I have a sensation of swelling in the gums of my upper jaw, but visually, the gums do not appear red.
When I touch the gums with my tongue or apply pressure to the occlusal surface, I also feel some pain.
The doctor reviewed my X-rays and indicated that there are no cavities, and the pain does not feel like the typical throbbing associated with cavities.
I am unsure if this is related to my TMJ or nighttime bruxism.
Since the extraction of my right molar, my left upper molar has become the primary tooth for chewing, and the pain when biting down makes it difficult for me to eat; I have been on a liquid diet for nearly two weeks.
Additionally, that tooth has not undergone root canal treatment but has been filled, and the filling has been in place for over ten years.
I would appreciate your guidance.
My TMJ inflammation has slightly improved recently, but the oral pain is really troubling me.
Thank you, doctor, for your assistance.

Li, 30~39 year old female. Ask Date: 2023/09/07

Dr. Zeng Guanghui reply Dentistry

Hello Ms.
Li: If you have temporomandibular joint (TMJ) disorder, you may experience soreness in the muscles around your ear and cheek when biting down.
If you feel pain in your molars while chewing, it could be due to a deep cavity that is close to the nerve, causing pulpitis.
If the symptoms persist, you might consider undergoing root canal treatment.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/09/07

More Info

Hello,
Thank you for reaching out with your concerns regarding gum swelling and pain following tooth extraction, particularly in the context of your existing temporomandibular joint (TMJ) issues. It sounds like you are experiencing a complex interplay of dental and jaw-related symptoms, which can indeed be quite distressing.

Firstly, it's important to understand that after a tooth extraction, especially of a molar, the surrounding tissues can undergo significant changes. Swelling and discomfort in the gums can be a normal part of the healing process, but persistent or severe pain, especially if it is localized and not accompanied by visible signs of inflammation (like redness or swelling), may indicate other underlying issues.

Given your history of TMJ disorders, it is plausible that your symptoms could be related. TMJ disorders can lead to muscle tension and pain in the jaw, which may exacerbate discomfort in the surrounding areas, including the gums. Additionally, if you have been grinding your teeth at night (a condition known as bruxism), this can put additional strain on your teeth and gums, potentially leading to pain or sensitivity, especially in the teeth that are now bearing more load after the extraction of your right molar.

The fact that you are experiencing pain when biting down on your left upper molar could suggest that this tooth is now taking on a greater functional load, which may not be ideal if it has not been treated recently. You mentioned that this tooth has not undergone root canal treatment but has been filled for over ten years. Over time, dental restorations can wear down or become compromised, leading to sensitivity or pain, particularly under increased stress from chewing.

Since your X-rays did not reveal any cavities, it is essential to consider other factors. The sensation of swelling without visible inflammation could be due to a few reasons:
1. Post-Extraction Healing: The area where the tooth was removed may still be healing, and the surrounding gums can be sensitive as they adjust to the absence of the tooth.

2. Referred Pain: Pain from the TMJ or from the muscles around the jaw can sometimes be felt in the teeth and gums, leading to confusion about the source of the pain.

3. Occlusal Issues: After losing a tooth, the bite can change, leading to uneven pressure on the remaining teeth. This can cause discomfort, especially if the opposing tooth is not aligned properly.

4. Gum Disease: Even if there are no visible signs, underlying gum disease can cause discomfort and swelling. It might be worth discussing with your dentist the possibility of a thorough periodontal evaluation.

Given your situation, I recommend the following steps:
- Follow-Up with Your Dentist: It’s crucial to communicate your ongoing symptoms to your dentist. They may want to reassess the bite and ensure that the remaining teeth are not under undue stress.

- Consider a TMJ Specialist: Since you have a history of TMJ issues, consulting with a specialist who can address both your dental and jaw concerns may provide a more comprehensive approach to your pain.

- Pain Management: In the meantime, over-the-counter pain relievers may help manage your discomfort. Applying a warm compress to the jaw can also alleviate muscle tension.

- Dietary Adjustments: Since you have been on a liquid diet, try to gradually introduce soft foods that require minimal chewing, which can help reduce strain on your teeth and gums.

- Monitor Symptoms: Keep track of your symptoms, noting any changes or patterns, which can be helpful for your healthcare provider in determining the best course of action.

In summary, your symptoms could be multifactorial, involving both dental and TMJ-related issues. A collaborative approach involving your dentist and possibly a TMJ specialist will likely yield the best outcomes. Please ensure that you continue to seek professional advice tailored to your specific situation.

Take care, and I hope you find relief soon!

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