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Dental Anesthesia

Jaw Pain Weeks after Dental Anesthetic

09/23/2009

Question:

Today`s date: 9-21-09 On 8-26-09 had a temporary crown installed, lower lefthand side. STILL HAVE some pain in jaw when I open mouth to eat.

Someone in the same dental office examined the situation on 9-9-09 (and made minor adjustment to the temp crown - the adjustment was not related to the problem I`m having).

His findings - that (forgive my layman`s terminology) there was something like a tissue/muscle spasm in the UPPER left side of the gum or cheek, that would be slow to heal.

I think it is improving...but so slowly there are moments of doubt about that point. And as I`m sure you understand, when one opens the mouth to put food in, and experiences a shot of pain in the jaw area, the joy or solace of eating, even a comfort food, is lost...and replaced by distress that it is perhaps a semi-permanent problem.

In your experience and from your knowledge, how long do you feel such a situation can last? Thinking back, I feel it was triggered when a second inection of anasthetic was made...and the problem took some days awhile to surface. I am takng every precaution to guard against any infection and reduce inflammation.

Very much appreciate your help...any thoughts you might have about this siutaion.

Thank you!

Answer:

This could be a number of things. The diagnosis is difficult without clinical examination and correlation with a careful history. I do appreciate your detail, but it is not complete from a diagnostic standpoint.

I will comment on your thought about the injection, however, being associated with your current symptoms. This could have been needle trauma where a blood vessel was pierced, causing bleeding into the deep tissue and muscle where the injection occurred. This can lead to a myositis which presents with limited mouth opening and pain. This usually resolves with gentle stretching after a period of rest and anti-inflammatories, but it can be slow to get back to normal mouth opening. Usually, there is significant improvement in 4 - 6 weeks. There can be pain with chewing, especially if this is done on the same side as the apparent injury.

This could also be a lingering needle tract infection, I think this should be seriously considered as the symptoms are persistent. This is an infection from the injection - rare, but it occurs and can present as you describe.

This could also be a problem with the jaw joint itself or a completely unrelated problem, such as Trigeminal neuralgia, a painful condition of the nerves to the jaw and face.

As an initial option, I would consult with the dentist but if no diagnosis is clear, perhaps consult with an oral surgeon, or with a dentist that specialized in facial pain. This latter group is diverse and benefits from a specific referral.

Good luck!

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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