Open lock == the condyle gets stuck out in front eminence and cannot return to socket. The mouth is stuck wide open and will not close. Most panic and force jaw closed with tearing lateral ligament & severe pain.
Some joints in body are known for subluxation (ball coming out of socket). The shoulder joint can sublux a persona Mel Gibson used in series w/ Danny Glover called Lethal Weapon. The TMD or jaw joint can subluxation when the mouth gets stuck wide open.
??? PLACE OPEN LOCK PICTURE from Power point #563 & 565 ????
The Emergency room & Urgent Care do not understand anatomy of TMD; therefore, do not know the technique for reduction of subluxation of TMD.
Besides, Medicare (government medical insurance of old) does not act like the jaw joint is part of body; therefore, would not cover for the reduction of subluxation of TMD. Don't shoot messenger, this makes no sense to me when I found out 25 years ago and still makes no sense. If you do not believe me call them and ask, if they cover TMD services.
OPEN LOCK: 1) subluxation 2) Hypermobility of TMD 3) Urgent reduction required 4) Longer lock more tearing lateral ligament 5) Forced closing tears more ligament 6) Reduction = ball back in socket 7) Pain on trying to close w/o proper reduction
REDUCTION: 1) Ball returned to socket 2) Prevent locking 3) Promote healing in joint
move this picture up, put open lock picture here
TEARING LATERAL LIGAMENT: 1) condyle gets stuck in front eminence 2) Stretches lateral ligament (side joint, like bucket handles) 3) Stretches retrodiscal tissue (rear joint made up elastic) 4) Holding disc on top condyle 5) Stuck way out in front socket. 6) Forced reduction causes more tearing
GOALS OF CARE: 1) Open lock begs for help, but seems no one listening 2) ERs, Urgent Care, PCP, or Dentists are not train in reduction 3) Call RFPC for same day reduction, 919-781-6600, Dr. Yount 4) After emergency visit, a detailed exam is scheduled to prevent
FACTS KNOW: 1) Quicker open lock is reduced, less tearing 2) Urgent referral for reduction 3) Orofacial pain specialist trained reduce 4) Same day reduction is available 5) Same cost as ER visit w/ little no help form insurance 6) Prevent future Open Locks 7) Learn reduction Open Lock
OROFACIAL PAIN SPECIALIST 1) Board certified and residency trained 2) Blend medical and dental 3) Specializes malfunction of chewing system
Open Lock Reduction:
- Reduction is to press mandible downward
- Place index finger on bone outside 2nd molar lower
- With leverage far back as possible on buccal plate
- Have patient relax
- Press down firmly on index finger,
- Thumbs used as leverage/support on anterior mandible
- Almost in backward & downward C
- Brace mandible to not forceably spring back up into socket
- Alternative to relaxing: a) Inject auriculotemporal nerve b) IV sedation in ER, c) Preop with 5 mg valium
You had open locked reduced, now what ?
Expect Orofacial Pain Specialist who just perform the reduction to recommend: 1) Prescribe muscle relaxant and anit-inflammatory 2) Recruit Physical therapy and Biofeedback 3) Take impression for orthotic
Three levels of subluxation prevention: 1) HABIT TRAINING: Conservative 2) TETHERING: moderate technique 3) SURGERY: Rarely used
TEARING LATERAL LIGAMENT: (move this up to previous block) 1) Open lock itself cause tearing 2) Panic & forced closure causes more tearing 3) Incorrect reduction technique cause tearing
Panic causes a person to forcibly try to close the ball back into the socket, but the anterior bone of the socket is in the way, which does not allow the ball to return to the socket. This pits the ligaments against bone and the ligaments lose the battle.
PROMOTE HEALING 1) Research subluxation joints 2. Recruit orthopedic team 3. Expedite all healing tools 4. Stop looking for quick fixes there are none 5. Pray healing
Guidelines to Emergency: 1) Do not to panic, stay calm. 2) There is a painlessly reduction. 3) Urgently call Orofacial pain specialist , 4) He will see you today, 5) Being an emergency expect cost 6) Have hope doctor will see you immediately 7) Expect follow up care for healing and prevention.
Confusion Jaw joint Dysfunctions:
Open Lock = mouth is stuck wide open at 4 fingers + Close lock = mouth is stuck & cannot open more 1 finger
What's big deal of tearing lateral ligament with open locking. If it only tears some ligament fibers each time, I don't see point-need-concern ? Well, if the only tearing of lateral ligament was from open lock, I would agree, but there are the hidden or somewhat hidden tearing from clench-grind, tension in muscles, and trauma. If your jaw joint locks up (closed lock) from all the years of tearing lateral ligament will you be concern then ???
Raleigh Facial Pain Center Providing Relief for Subluxation
To prevent future tearing to discal ligaments of TMD, it is important that your chewing system structures are free from any subluxations. Board certified and residency trained, Orofacial Pain Specialist, Dr. Keith A. Yount, and the team of specialist utilized to promote healing in chewing structures. Reach out to us today at (919) 781-6600 or contact us online to make an appointment.
