intense jaw pain on left side, swollen jaw and cheek, no dental issues per dentist and endodontist...tmj or trigeminal neuralgia?

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.

Trigger point injections are an essential part of TMD, Migraine and Headache treatment for many patients

The importance of this study though extremely limited is that it explains why understanding Myofascial Pain and Dysfunction is essential when chronic pain problems including neck pain, headache and TMD disorders. In this study a single injection in the trapezius muscle (shoulder) gave significant reduction in pain in the masseter region along with reduction in EMG values.

There are hundreds of trigger point areas. It is essential to see a physiian or dentist who understands Myofascial Pain and knows how to preform trigger point injections as well as trigger point deactivation with vapocoolants.

Treating patients with drugs and not addressing underlying causes of pain is like painting your ceiling every time it rains instead of fixing where your roof leaks. Neuromuscular Dentistry is used to create a healthy environment where trigger points do not return.

Pain. 1993 Dec;55(3):397-400.
Reduction of pain and EMG activity in the masseter region by trapezius trigger point injection.
Carlson CR, Okeson JP, Falace DA, Nitz AJ, Lindroth JE.

Department of Psychology, College of Dentistry, University of Kentucky, Lexington 40536.
Abstract
In this open, uncontrolled trial, 20 patients with upper trapezius muscle trigger point pain and ipsilateral masseter muscle pain received a single trigger point injection of 2% lidocaine solution (without epinephrine) in the upper trapezius muscle. Following the trapezius injection, there was a significant (P < 0.001) reduction in pain intensity ratings for pain in the masseter region. In addition, there was a significant (P < 0.03) reduction in EMG activity in the masseter muscle. Overall, however, a significant relationship between EMG activity in the masseter and the self-report of pain was not found with the present data set. These clinical findings support the contention that sources of deep pain can produce heterotopic sensory and motor changes in distant anatomical regions.

PMID: 8121703 [PubMed - indexed for MEDLINE]