I recently received a e-mail from a patient with the following complaint:
intense jaw pain on left side, swollen jaw and cheek, no dental issues per dentist and endodontist...tmj or trigeminal neuralgia?
The question TMJ or Trigeminal Neuralgia is very limited. 95% of all pain that patients experience is muscle pain. Many patients have severe or even excruciating pain but their TM Joints are normal. These are neuromuscular problems and may have many contributing factors. Trigeminal Neuralgia is rarely the cause of pain and when it is there is usually very specific triggers. The pain usually comes and goes going from normal to intense pain after stimulating trigger.
KI have seen patients with similar symptoms that are later tracked back to cracked toooth syndrome that was not evident early on. Vacumn sinusits can also give similar symptoms.
That said, the most common cause of pain is myofascial pain acute muscle spasm, myositis or other pain of muscular orgin.
A simple test that all general dentists and/or endodontists should know is how to do trigger point deactivation with a vapocoolant and stretch that can often give instanyt pain relief. Use of a diagnostic block to the muscle can also correct these problems when used to make a differential diagnosis.
The patient did not describe whether the pain was affected by jaw movement, if there was limited opening, or many other vital facts to know if there was joint involvement.
The correct approach is to make an accurate diagnosis. This involves a thorough evaluation of the jaw musclesand (TMJ) joints but also the head and neck musculature.
The best route is to seek out a neuromuscular dentist who is trained to evaluate and correct these problems.
I frequently see patients in Chicago who have not found help locally.
Diagnosis is the key to successful treatment. Treatment should be reversible until significant pain relief is accomplished and both the patient and the doctor are comfortable with primary and secondary diagnosis.
