Post operative Pain in dentistry related to Orofacial Pain Specialist = Unexpected Jaw pain or restricted opening after dental procedure.

HIDDEN FRAGILE TMD: 1) Dentist does not pick up hints TMD 2) Hints TMD are in all 4 structures 3) Dentist see what they are trained to see, teeth 4) Patient does not tell dentist of hints TMD 5) Patient doesn't know what are hint's TMD 6) Traumas are difficult to remember

POST OP JAW PAIN or RESTRICTED OPENING:

1. The surprise phone call during supper "My jaw is restricted or moderate jaw pain after “your” crown, surgery, implant, fillings, or even cleaning"
2. First, next day appointment to check out treatment reassure patient care was flawless
3. Urgent referral to orofacial pain, if disc displaced need recapture is timely and urgent
4. Patient understanding the hidden fragility joint
5. Shows your care and concern for patient by calling Orofacial Pain Specialist
6. Emphasizing to patient need for referral to allows for least suffering
7. Provide some of science of chronic pain
8. This not time to rely on conservative therapy like soft diet, hot paks, and Ibuprofen
9. Hope it goes away is formula for patient anger, dentist frustration
10. Do not recommend stretching of restricted opening or other unproven techniques from guru's
11. Pain is a beacon for hidden damage in jaw joint, just like fire alarm is to fire in building.
12. Please care enough for your patients to refer orofacial pain specialist as urgently
13. Please stay in contact with Dr. Yount to access progress patient makes so you can support their efforts in healing

Post operative JAW PAIN or RESTRICTED OPENING comes from 1) Prolong open mouth procedure or 2) Entubation

Types post operative pain: 1) Moderate to severe chewing pain, 2) Restricted Opening will not reduce, 3) Episodic Restricted opening, 4) Daily Tension Headache, 5) Bite changes

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

Reasons for post operative pain:

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

Confusion averted: 1) Open mouth procedure is final insult fragile TMD, 2) Straw broke camels back, 3) Partial displaced disc was driven off condyle becoming a complete displaced disc 4) Dentist did not cause displaced disc, open mouth procedure contributed to it

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, atypical earache, or ongoing unexplained face pain
8. Multiple traumas to head or neck
9. History open locking or hypermobility or multiple bites

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

The cases of post-operative moderate pain or RO 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.

At recall, Dentist or hygienist should be measuring: 1) Changes openings & lateral excursions 2) Looking for deviations on opening 3) Sudden Bite changes 4) Facial asymmetries changes 5) History of limited opening even w/o pain 6) Remember pain and damage are usually connected but not always

Restricted Opening: based on fingers: measure at post op

1. Restricted           ½ to 1 finger
2. Limited                2 fingers       
3. Normal                3 fingers
4. California 4 fingers       

Managing post op discomfort or muscle spasm:

1. Return dentist for exam within next day
2. Mild pain & can open all way = tx conservatively
3. PA, percussion, bite, cold, probe, EPT are inconclusive
4. Moderate jaw pain or restricted opening refer OFP
5. Review hints stress-anxiety-negative-emotional hyjacking
6. Review parafunctional-tension muscles-trauma-other pains
7. Reasons Urgent referral: 1) preventing chronic pain, 2) Recapture in Restricted opening

Conservative therapies:

1. Hot pack
2. Low chew diet
3. Avoid yawn-open wide-gum
4. Advil 600 mg &Tylenol 325 mg
5. Trial muscle relaxant or anti-inflammatory