Surprise Pain “Party”:

1. The surprise phone call that my jaw is restricted or moderate jaw pain insued after “your” crown or surgery can be unsettling.
2. By urgent referral to orofacial pain, you provide patient with
3. understanding the situation,
4. shows your care and concern for patient,
5. allows for least suffering
6. provide science of chronic pain.
7. This not time to rely on conservative therapy like soft diet, hot paks, and Ibuprofen
8. Hope it goes away, that is formula for patient anger, dentist frustration.
9. Pain is a beacon for hidden moderate damage in jaw joint, just like fire alarm is to fire in building.
10. Please care enough for your patients to refer orofacial pain specialist as urgent referral.
11. Please stay in contact with Dr. Yount to access progress patient makes so you can support their efforts in healing.

Post op jaw pain:

1. Prolong open mouth procedures
2. Entubation

Types post operative pain

• Increase in jaw pain
• Restricted opening

Frequency of post-operative pain or restricted opening is less 5%.

Reasons for post operative pain:

1. Hidden jaw jointdamage
2. Instability Jaw Joint
3. TMD on verge of complete disc displacement
4. Hidden osteoarthritis

Confusion averted:

Open mouth procedure is final insult fragile TMD

Straw broke camels back

Unrevealed history:

1. Frequent Tension Headache
2. History jaw restricted opening
3. History chewing pain
4. High pain threshold
5. Destructive parafunction
6. High anxiety, panic attacks, PTSD, emotional hijacking, negative, non-trust
7. History atypical toothache, earache, or unexplained face pain
8. Multiple traumas to head or neck
9. History open locking or hypermobility

Frequency of post-operative moderate pain or restricted opening is less 5% of all dental care.

The cases of post-operative moderate pain or restricted opening occur in undiscovered or hidden fragility of disc condylar system (unstable TMD). Either on verge of complete disc displacement or osteoarthritis enough for final insult of open mouth procedure.

Dentist should be measuring openings at recall

1. Preop (hygiene)
2. Post op (post op pain)

Restricted Opening: based on fingers: measure at post op

1. Restricted           ½ to 1 finger
2. Limited                2 fingers       
3. Normal                3 fingers       

Managing post op discomfort or muscle spasm:

1. Return dentist for exam with day
2. Mild pain, limited opening but can open all way tx conservatively
3. PA, percussion, bite, cold, probe, EPT
4. Moderate jaw pain or restricted opening refer
5. Review hints stress-anxiety-negative
6. Review parafunctional hints
7. Main reason refer is preventing chronic pain

Conservative therapies:

1. Hot pak
2. Low chew diet
3. Avoid yawn-open wide-gum
4. Isometric exercises
5. Advil 600 mg &Tylenol 325 mg tid
6. Trial muscle relaxant