TMJ Disorders After Facial Injury: Symptoms and Solutions

I have developed temporomandibular joint disorder due to an impact injury?

Hello Doctor,
On December 6, 2023, I was playing basketball and someone accidentally hit my left cheek (possibly near the jaw area).
Since then, I have experienced a clicking sensation when I open my mouth wide, almost like a two-part feeling.
Later, I noticed that my jaw joint makes a sound when chewing, but it’s not very loud, more like a "pop" or bubbling noise.
There is no pain in the joint.
Due to my anxious nature, I am worried that I might develop temporomandibular joint disorder (TMJ) which could lead to difficulties in opening my mouth and chewing.
Therefore, on December 21, 2023, I consulted Dr.
Tsai Chih-Meng at the TMJ department of National Taiwan University Hospital, hoping to address any potential issues promptly for optimal recovery.
On that day, the doctor explained that the sound I hear is due to cartilage displacement.
However, since I do not experience pain and have no significant difficulty opening my mouth, he mentioned that the body has a self-healing ability, but it requires time.
The doctor concluded that I should return for a follow-up on January 11, 2024, and advised me to observe my condition, avoid opening my mouth too wide, and refrain from foods that require prolonged chewing to allow the joint to rest.
He also mentioned that if I did not have any other discomfort before the next appointment, I could call to cancel.
I followed the doctor's instructions as best as I could, but I still felt uneasy.
It is quite difficult to make an appointment due to high demand, so I decided to return for a follow-up.
During the second visit, my condition had not worsened; I still had no pain and no significant difficulty opening my mouth.
The doctor asked me to remove my mask and open my mouth wide, stating that it looked much better! He also mentioned that males tend to be more resilient and recover quickly from injuries.
He reassured me that I did not need a bite splint or any other treatment, and I should continue to let the joint rest and avoid forcing my mouth open.
This second visit eased my worries significantly.
However, I became anxious again after having my lower left wisdom tooth extracted on January 8, 2024.
Starting January 12, I began to feel pain in my left ear, which made me wonder if this discomfort was related to the tooth extraction or if my TMJ was starting to show more obvious symptoms.
The pain persisted from January 12 to January 16, during which I took one painkiller daily to manage the discomfort, as it affected my ability to work.
As of today (January 17), the pain has decreased significantly (without taking painkillers), but I have started experiencing tinnitus in my left ear.
Since TMJ disorders can also present with this symptom, I find myself feeling helpless again.

I found online that some people experience ear pain after wisdom tooth extraction, which can radiate along the jaw to the lower front teeth.
However, I also read that TMJ disorders can have similar symptoms.
I plan to return to the dental clinic next Thursday (January 25) to address a cavity in my lower teeth, and the dentist will check if the ear pain is related to the tooth extraction.
Recently, I have noticed that after I finish speaking, there is a "pop" sound in my ear, similar to the sound we hear when yawning and equalizing pressure.
I wonder if this is related to my TMJ, as I have seen others online report the same symptom.
Additional notes:
1.
I took painkillers prescribed by the dentist from the day of the extraction until January 11.
Is it normal to experience ear pain after wisdom tooth extraction? I only started feeling it on January 12, possibly due to the painkillers masking the pain initially?
2.
As of today (January 17), I do not feel significant pain when gently pressing on the joint.
I would like to ask:
1.
If the TMJ disorder is caused by external force, how significant does that force need to be? (I had no visible injuries on the day of impact, and most online cases of TMJ issues due to external force involve car accidents, which makes me question if my incident could have caused such problems.
Is the joint really that fragile?)
2.
The doctor at my second follow-up visit indicated that my condition is not severe and advised me not to overthink it, suggesting I live normally.
If I were to experience any unfortunate issues in the future, what symptoms should prompt me to seek medical attention?
3.
Are there any side effects associated with using a bite splint for treatment? Can they be avoided, such as causing an open bite?
4.
If TMJ disorders are difficult to heal and can only be managed, what steps can I take to prevent worsening? I still want to enjoy a variety of foods and I love talking; I don’t want to have difficulties speaking in the future.

Thank you for your patience in reading this, and I appreciate your understanding of my anxious nature.
I am grateful for this channel to seek professional guidance in finding the right direction for my health concerns!

Awei, 20~29 year old female. Ask Date: 2024/01/17

Dr. Zeng Guanghui reply Dentistry

Dear Mr.
Avi,
1.
Any external force that can cause displacement of the temporomandibular joint (TMJ) cartilage, or even tearing of the joint head, can lead to inflammation and pain in the TMJ.
2.
If you experience difficulty opening or closing your mouth, or if you feel pain in front of your ear while chewing, a follow-up examination is necessary.
3.
If the pain in the TMJ cannot be alleviated, it is usually recommended to use an occlusal splint to relieve the pain; however, the thickness of the splint will not cause an open bite.
4.
Avoid frequently chewing hard objects or developing a habit of chewing on one side.
Sincerely,
Director Tseng Guang-Hui, Dental Department, Nantou Hospital

Reply Date: 2024/01/17

More Info

TMJ (temporomandibular joint) disorders can arise from various causes, including trauma to the jaw or face, as you experienced during your basketball incident. The symptoms you describe, such as a clicking sound when opening your mouth and a sensation of the jaw getting stuck, are common indicators of TMJ dysfunction. It's important to understand that while these symptoms can be concerning, they do not always indicate a severe underlying issue.

Understanding TMJ Disorders
1. Symptoms: TMJ disorders can manifest through a variety of symptoms, including:
- Clicking or popping sounds when moving the jaw.

- Limited range of motion or difficulty opening the mouth fully.

- Pain or discomfort in the jaw, neck, or shoulders.

- Ear pain or a sensation of fullness in the ear.

- Headaches or facial pain.

2. Causes: The causes of TMJ disorders can include:
- Trauma or injury to the jaw or face.

- Teeth grinding (bruxism) or jaw clenching.

- Arthritis or other inflammatory conditions.

- Misalignment of the teeth or jaw.

3. Diagnosis: A thorough examination by a healthcare professional, such as a dentist or an oral and maxillofacial specialist, is crucial for diagnosing TMJ disorders. They may perform imaging tests like X-rays or MRIs to assess the joint's condition.

Treatment Options
1. Conservative Management: Most TMJ disorders can be managed with conservative treatments, including:
- Rest: Avoiding activities that strain the jaw, such as chewing gum or eating hard foods.

- Heat and Cold Therapy: Applying heat or cold packs to the jaw can help reduce pain and swelling.

- Pain Relief: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate discomfort.

- Physical Therapy: Exercises to strengthen jaw muscles and improve flexibility can be beneficial.

2. Behavioral Modifications: Reducing stress and anxiety can help minimize jaw clenching and grinding. Techniques such as mindfulness, meditation, and relaxation exercises may be effective.

3. Dental Appliances: In some cases, a dentist may recommend a bite guard or splint to help prevent teeth grinding and alleviate pressure on the TMJ.

4. Surgical Options: Surgery is typically considered a last resort and is only recommended for severe cases where conservative treatments have failed.

Addressing Your Concerns
1. Ears and Jaw Connection: The symptoms you describe, such as ear pain and a popping sound after speaking, can indeed be related to TMJ disorders. The TMJ is located near the ear, and dysfunction can lead to referred pain or sensations in that area.

2. Impact of Wisdom Tooth Extraction: It is not uncommon for patients to experience ear pain following wisdom tooth extraction, especially if the extraction was complicated or if there was swelling. This pain can sometimes mimic TMJ symptoms.

3. Monitoring Symptoms: If your symptoms persist or worsen, or if you experience new symptoms such as severe pain, difficulty opening your mouth, or persistent ear issues, it is essential to follow up with your healthcare provider. They can reassess your condition and determine if further intervention is necessary.

4. Preventive Measures: To prevent worsening of TMJ disorders, focus on maintaining good posture, avoiding excessive jaw movements, and managing stress. Regular follow-ups with your healthcare provider can help monitor your condition.

5. Long-term Management: While TMJ disorders can be chronic, many individuals find relief through a combination of treatments and lifestyle adjustments. Staying proactive about your oral health and addressing any concerns promptly can help you maintain a good quality of life.

In summary, while your symptoms may be concerning, they are not uncommon in TMJ disorders. Following your doctor's advice, practicing self-care, and monitoring your symptoms will be key to managing your condition effectively. If you have any further questions or concerns, don't hesitate to reach out to your healthcare provider for guidance.

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