KyleR Asked :
I was constantly having problems with one of my upper molars on the right side and after repeated problems with fillings, I asked my dentist to remove it. He had explained that the tooth was still strong and he would put in a new type of filling and this should settle down the issue. About 3 weeks later the problem started up again and I went to another dentist. I told him about my history with this tooth and insisted that he remove it because I could not take these toothache episodes any longer. This dentist agreed and I had the extraction.
He said that the tooth was still strong and the elevator tool could not get it out. He repeatedly tried and at one time even rested his knee on the dental chair. I could actually feel the force that he was applying. Anyway, he eventually got it out and I was quite happy. He told me to give the area about 6 weeks to settle down before he would take impressions to get a dental bridge made up.
About 2 days later my right cheek was swollen and there was some pain. He told me that I had an infection or an abscess and prescribed antibiotics and painkillers. The pain went down in about 3 days and the swelling eased drastically but not completely. I then started to notice that my TMJ joint on the other side (left side) was paining. About a month later the TMJ pain was still there but now it also felt like my jaw was locking at times and at other times it would click loudly.
I never went back to the dentist who removed my tooth because I was unhappy with the way the procedure was done. Since he had to cut my two other teeth on either side to fit in this bridge, I was worried if he was going to do it properly. It’s now about 3 months later and I am not in the financial position to pay for a bridge. The missing tooth is quite far back so it does not show if I don’t smile too broadly.
My clicking jaw has not stopped although the jaw pain is rare and only occurs when I bite down on something hard. The swelling on my right cheek, where the tooth was removed, is still there and while it is not massive, it is noticeable to others.
I am quite concerned about what is going on? Did the dentist damage my TMJ joint when removing the tooth? Will this jaw pain and clicking ever go away? Will my cheek swelling go away eventually?
This question was posted under the Clicking Jaw, Jaw Pain and TMJ Dysfunction article.
Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.
Dr. Chris Answered :
Overt trauma to the temporomandibular joint (TMJ) during a dental procedure is possible but in the hands of a skilled dentist, it is unlikely. However, with that said, a difficulty procedure can be trying even for the most skilled practitioner. It is more likely that you had a slight TMJ dysfunction prior to this procedure. It may have been very slight and the symptoms were probably mild, or virtually non-existent and you had not noticed it. This dental procedure may have therefore exacerbated a pre-existing problem.
Swelling of the cheek is a common feature of an infection and even though the infection resolved, there may have been other factors contributing to this swelling. Firstly, the change in bite now that one tooth is missing may have caused swelling due to overuse. While this would have been expected on the opposite side from where the tooth was removed, given your TMJ discomfort on the left, it is possible that you have started applying more force on the right side.
There is also the possibility that since you now lack one tooth on the right side, you may have altered the bite significantly by chewing more towards the front than the back. This may further exacerbate any muscle strain – your muscles will slowly adapt over time and enlarge (hypertrophy). Another common occurrence in patients with a missing tooth or even mild tooth pain is that they tend to bite down on that area.
Alternatively, the cheek muscles on the left side may have slightly shrunk (atrophy) since you are not using it as much as a result of the TMJ discomfort. This may be giving a distorted perception in that it may not be the right side that is swollen, but rather the left side which is now slightly smaller giving the appearance that the right side is swollen. A dentist who has your dental records over the years will be able to assess any change in bite based on dental impressions. This usually causes slight erosion of teeth that were previously unaffected.
Lastly, there is a possibility, although unlikely, that you may be allergic to the ‘new’ filling used in other tooth cavities or even the anesthetic at the time of the dental procedure. The latter should not contribute to swelling over such a long time. It would be advisable to speak to a dentist as the dental bridge would be necessary to restore your bite and prevent your other teeth from ‘drifting’. Your jaw pain and the ‘locking’ may indicate some swelling of the TMJ and possibly even a slight dislocation so you would need to have this attended to as well. An experienced dentist would be able to help you with both these complaints or refer you to a specialist to assist accordingly.
Please note that there may be other reasons for the TMJ dysfunction and cheek swelling and it is therefore important to consult with a medical professional.