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Dental Anesthesia

Stiffness in jaw after dentist visit/shot

01/09/2009

Question:

Hi, I`m 48, no medical problems, allergic to sulfa drugs, and recently visited the dentist. The first visit was to replace a crown that was too "big" so they gave me shots and all was fine. I left with the temporary and that night experienced very severe pain. It was localized to that area and definitely tied to the tooth. More than a week passed (due to Christmas) and the pain was severe enough to wake me up from my sleep unless I took 600 mg of ibuprofin every eight hours.

Two days ago I went back and they took the temporary off and replaced it using a more "soothing" material to attach it. That seemed to help.

But before taking it off, the dentist numbed my jaw and I felt a sharp pain from the site to the front of my jaw and tasted metal or something funny. The epi in the shot made my heart race like nothing I`ve ever experienced before -- I was lightheaded and felt the same as I did right before going "out cold" in surgery. But I didn`t however I couldn`t catch my breath or talk for a few minutes.

The dentist told me it was the adrenaline and explained its purpose, and I`ve read tonight about it so I understand that part.

However, before I left the dentist office and still two days later, the jaw muscles on that side are very stiff -- not any real pain but there is some pain when I open my mouth and there is swelling and you can feel a large knot when I open my mouth (in the muscle area between the upper jaw and lower jaw).

It`s that stiffness/pain that I`m concerned about. I am allergic to sulfa drugs but nothing else. Any thoughts?

Thank you.

Answer:

As you probably read, the dentist injects in the area of the nerve to the lower jaw, where I assume this injection was given based on your history. The injection is into the general area but if the dentist gets it perfectly, it is right where the nerve enters the jaw, and there is a blood vessel associated with the nerve in the same area. It sounds like some of the anesthetic with epinephrine got into the blood vessel as the needle pierced the vessel. No doubt, some small amount of bleeding occurred in that area where the blood vessel was contacted. This accounts for the stiffness and should resolve in a few weeks.

Gentle jaw stretching can speed this up, but you don't want to be too aggressive early on. The jaw function will return to normal.

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Response by:

Steven I Ganzberg, SB, DMD, MS Steven I Ganzberg, SB, DMD, MS
Formerly, Clinical Professor of Dentistry
College of Dentistry
The Ohio State University