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Dental Anesthesia

Jaw Pain Weeks after Dental Anesthetic

09/23/2009

Question:

Today`s date: 9-21-09 On 8-26-09 had a temporary crown installed, lower lefthand side. STILL HAVE some pain in jaw when I open mouth to eat.

Someone in the same dental office examined the situation on 9-9-09 (and made minor adjustment to the temp crown - the adjustment was not related to the problem I`m having).

His findings - that (forgive my layman`s terminology) there was something like a tissue/muscle spasm in the UPPER left side of the gum or cheek, that would be slow to heal.

I think it is improving...but so slowly there are moments of doubt about that point. And as I`m sure you understand, when one opens the mouth to put food in, and experiences a shot of pain in the jaw area, the joy or solace of eating, even a comfort food, is lost...and replaced by distress that it is perhaps a semi-permanent problem.

In your experience and from your knowledge, how long do you feel such a situation can last? Thinking back, I feel it was triggered when a second inection of anasthetic was made...and the problem took some days awhile to surface. I am takng every precaution to guard against any infection and reduce inflammation.

Very much appreciate your help...any thoughts you might have about this siutaion.

Thank you!

Answer:

This could be a number of things. The diagnosis is difficult without clinical examination and correlation with a careful history. I do appreciate your detail, but it is not complete from a diagnostic standpoint.

I will comment on your thought about the injection, however, being associated with your current symptoms. This could have been needle trauma where a blood vessel was pierced, causing bleeding into the deep tissue and muscle where the injection occurred. This can lead to a myositis which presents with limited mouth opening and pain. This usually resolves with gentle stretching after a period of rest and anti-inflammatories, but it can be slow to get back to normal mouth opening. Usually, there is significant improvement in 4 - 6 weeks. There can be pain with chewing, especially if this is done on the same side as the apparent injury.

This could also be a lingering needle tract infection, I think this should be seriously considered as the symptoms are persistent. This is an infection from the injection - rare, but it occurs and can present as you describe.

This could also be a problem with the jaw joint itself or a completely unrelated problem, such as Trigeminal neuralgia, a painful condition of the nerves to the jaw and face.

As an initial option, I would consult with the dentist but if no diagnosis is clear, perhaps consult with an oral surgeon, or with a dentist that specialized in facial pain. This latter group is diverse and benefits from a specific referral.

Good luck!

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Response by:

The Ohio State University Steven I. Ganzberg, SB, DMD, MS
Chief of Dental Anesthesiology
Clinical Professor
Section of Dental Anesthesiology
College of Dentistry
Nationwide Children's Hospital
The Ohio State University
Steven I. Ganzberg, SB,  DMD, MS