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Jaw pain
COMMENTARIES
and Adjunct Clinical Assistant Professor of Surgery Emory University Atlanta, GA Roger A. Meyer, DDS, MS, MD Georgia Oral and Facial Reconstructive Surgery Marietta, GA and Director Maxillofacial Consultations Greensboro, GA and Department of Surgery Northside Hospital Atlanta, GA and Clinical Assistant Professor Department of Oral and Maxillofacial Surgery Georgia Regents University Augusta, GA
In presenting the clinical problem section, the author failed to include a transitory change in the usual chewing pattern, which may result in opposing teeth striking a portion of the contacting surface that normally is not in contact during mastication; a prematurity. This can happen in centric occlusion, but it often is discovered when checking eccentric occlusal patterns as well. Often, one will discover a singletooth crossbite or complete arch crossbite, resulting in an inability to achieve lateral jaw excursion.
http://dx.doi.org/10.1016/j.adaj.2014.11.004 Copyright ª 2015 American Dental Association. All rights reserved.
http://dx.doi.org/10.1016/j.adaj.2014.11.005
1. Hillerup S. Injection injuries of the trigeminal nerve. In: Miloro M, ed. Trigeminal Nerve Injuries. New York, NY: Springer; 2013:63-72. 2. Pogrel MA, Schmidt BL. Trigeminal nerve chemical neurotrauma from injectable materials. Oral Maxillofac Surg Clin N Am 2001;13(2): 247-253. 3. Meyer RA, Bagheri SC. Etiology and prevention of nerve injuries. In: Miloro M, ed. Trigeminal Nerve Injuries. New York, NY: Springer; 2013:27-61. 4. Harn SD, Durham TM. Incidence of lingual nerve trauma and postinjection complications in conventional mandibular block anesthesia. JADA 1990;121(4):519-523. 5. Pogrel MA. Permanent nerve damage from inferior alveolar nerve blocks: a current update. J Calif Dent Assoc 2012;40(10):795-797.
JAW PAIN
My thanks to JADA for Dr. Harold F. Menchel’s June Pain Update, “Acute Posttraumatic Jaw Pain” (JADA 2014;145[6]:578-579).
8 JADA 146(1) http://jada.ada.org
Michael H. Dyer, DDS, MS Belleville, IL
Copyright ª 2015 American Dental Association. All rights reserved.
Author’s response: My thanks to Dr. Dyer for his comments. I am not aware of any transitory change in chewing pattern in this type of patient. The chewing pattern is controlled by the central pattern generator in the rostral trigeminal nucleus and brainstem reticular formation, and there is no evidence that I know of that shows there is a change with an inflamed temporomandibular joint.1 With any introduced anterior or posterior interference, however, there can be occasional temporary change of closing pattern. This is not permanent in most cases.2
January 2015
Dr. Dyer is correct that tooth contact changes, as indicated in the figures included in my article. There is a decrease in overbite, increased anterior contact, posterior open bite on the ipsilateral side, and midline shift to the contralateral side. Some of this is due to acute joint inflammation, and the rest is due to ipsilateral lateral pterygoid protective co-contraction.3,4 Dr. Dyer also is correct that these tooth contact changes will occur both in centric occlusion (maximum intercuspation) and in eccentric movement. I don’t find either single-tooth or full crossbite with these cases. Crossbites would occur only in a gross inflammation and severe ipsilateral lateral pterygoid contraction. Harold F. Menchel, DMD Coral Springs, FL
http://dx.doi.org/10.1016/j.adaj.2014.11.006 Copyright ª 2015 American Dental Association. All rights reserved.
1. Morquette P, Lavoie R, Fhima MD, Lamoureux X, Verdier D, Kolta A. Generation of the masticatory central pattern and its modulation by sensory feedback. Prog Neurobiol. 2012;96(3):340-355. 2. Clark GT, Tsukiyama Y, Baba K, Watanabe T. Sixty-eight years of experimental occlusal interference studies: what have we learned? J Prosthet Dent. 1999;82(6):704-713. 3. Jarabak JR. An electromyographic analysis of muscular and temporomandibular joint disturbances due to imbalances in occlusion. Angle Orthodont. 1956;26(3):170-190. 4. Karlsson S, Cho SA, Carlsson GE. Changes in mandibular masticatory movements after insertion of nonworking-side interference. J Craniomandib Disord. 1992;6(3):177-183.
and Adjunct Clinical Assistant Professor of Surgery Emory University Atlanta, GA Roger A. Meyer, DDS, MS, MD Georgia Oral and Facial Reconstructive Surgery Marietta, GA and Director Maxillofacial Consultations Greensboro, GA and Department of Surgery Northside Hospital Atlanta, GA and Clinical Assistant Professor Department of Oral and Maxillofacial Surgery Georgia Regents University Augusta, GA
In presenting the clinical problem section, the author failed to include a transitory change in the usual chewing pattern, which may result in opposing teeth striking a portion of the contacting surface that normally is not in contact during mastication; a prematurity. This can happen in centric occlusion, but it often is discovered when checking eccentric occlusal patterns as well. Often, one will discover a singletooth crossbite or complete arch crossbite, resulting in an inability to achieve lateral jaw excursion.
http://dx.doi.org/10.1016/j.adaj.2014.11.004 Copyright ª 2015 American Dental Association. All rights reserved.
http://dx.doi.org/10.1016/j.adaj.2014.11.005
1. Hillerup S. Injection injuries of the trigeminal nerve. In: Miloro M, ed. Trigeminal Nerve Injuries. New York, NY: Springer; 2013:63-72. 2. Pogrel MA, Schmidt BL. Trigeminal nerve chemical neurotrauma from injectable materials. Oral Maxillofac Surg Clin N Am 2001;13(2): 247-253. 3. Meyer RA, Bagheri SC. Etiology and prevention of nerve injuries. In: Miloro M, ed. Trigeminal Nerve Injuries. New York, NY: Springer; 2013:27-61. 4. Harn SD, Durham TM. Incidence of lingual nerve trauma and postinjection complications in conventional mandibular block anesthesia. JADA 1990;121(4):519-523. 5. Pogrel MA. Permanent nerve damage from inferior alveolar nerve blocks: a current update. J Calif Dent Assoc 2012;40(10):795-797.
JAW PAIN
My thanks to JADA for Dr. Harold F. Menchel’s June Pain Update, “Acute Posttraumatic Jaw Pain” (JADA 2014;145[6]:578-579).
8 JADA 146(1) http://jada.ada.org
Michael H. Dyer, DDS, MS Belleville, IL
Copyright ª 2015 American Dental Association. All rights reserved.
Author’s response: My thanks to Dr. Dyer for his comments. I am not aware of any transitory change in chewing pattern in this type of patient. The chewing pattern is controlled by the central pattern generator in the rostral trigeminal nucleus and brainstem reticular formation, and there is no evidence that I know of that shows there is a change with an inflamed temporomandibular joint.1 With any introduced anterior or posterior interference, however, there can be occasional temporary change of closing pattern. This is not permanent in most cases.2
January 2015
Dr. Dyer is correct that tooth contact changes, as indicated in the figures included in my article. There is a decrease in overbite, increased anterior contact, posterior open bite on the ipsilateral side, and midline shift to the contralateral side. Some of this is due to acute joint inflammation, and the rest is due to ipsilateral lateral pterygoid protective co-contraction.3,4 Dr. Dyer also is correct that these tooth contact changes will occur both in centric occlusion (maximum intercuspation) and in eccentric movement. I don’t find either single-tooth or full crossbite with these cases. Crossbites would occur only in a gross inflammation and severe ipsilateral lateral pterygoid contraction. Harold F. Menchel, DMD Coral Springs, FL
http://dx.doi.org/10.1016/j.adaj.2014.11.006 Copyright ª 2015 American Dental Association. All rights reserved.
1. Morquette P, Lavoie R, Fhima MD, Lamoureux X, Verdier D, Kolta A. Generation of the masticatory central pattern and its modulation by sensory feedback. Prog Neurobiol. 2012;96(3):340-355. 2. Clark GT, Tsukiyama Y, Baba K, Watanabe T. Sixty-eight years of experimental occlusal interference studies: what have we learned? J Prosthet Dent. 1999;82(6):704-713. 3. Jarabak JR. An electromyographic analysis of muscular and temporomandibular joint disturbances due to imbalances in occlusion. Angle Orthodont. 1956;26(3):170-190. 4. Karlsson S, Cho SA, Carlsson GE. Changes in mandibular masticatory movements after insertion of nonworking-side interference. J Craniomandib Disord. 1992;6(3):177-183.