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  • Why have I got jaw joint problems?

    The cartilage in the jaw joint is thought to slip forward because of
    overuse of the muscles surrounding the jaw. This overuse commonly produces tightening of the muscles and may occur as a result of chewing habits, such as grinding or clenching the teeth when under stress, or at night.

    Nail biting or holding things between the teeth can also cause jaw joint problems.

    Less commonly, missing back teeth, an uneven bite, or an injury to the jaw, can lead to the problem.

    Often no obvious cause is found.

  • What causes jaw joint problems?

    Pain is caused by the muscles in and around the jaw joint tightening up.

    Joint noises occur if the disc of cartilage moves out of its normal position between the bones of the jaw joint. Most commonly, the cartilage slips forward and a noise is made when it returns to its normal position in between the bones of the jaw joint. The noises sound louder to some patients than others because the joint is just in front of the ear.

    The ligaments and muscles surrounding the joint can, in turn, go into spasm, producing pain and limited mouth opening.

  • Background information

    The temporomandibular joint (jaw joint) is located in front of the ear, where the skull and lower jaw meet. The joint allows the lower jaw (mandible) to move and function.

    The joint itself is made up of two bones that are separated by a disc of cartilage. Ligaments and muscles surround the joint.

    Problems with the jaw joint are very common, but typically only last a few months before getting better. In some instances, only the muscles are affected (myofacial pain dysfunction), whereas in others the cartilage and ligaments may also be at fault (internal derangement of the temporomandibular joint).

    The most common symptoms are:

    • Joint noise, such as clicking, cracking, crunching, grating or
      popping
    • Pain, usually a dull ache in and around the ear. The pain may
      radiate, i.e. move forward along the cheekbone or downwards
      into the neck
    • Headache
    • Limited mouth opening

    Most jaw joint problems are made worse by chewing and are aggravated at times of stress.

  • What are the complications associated with this procedure?

    This is usually a very safe procedure, which is carried out by specially trained staff who are very experienced.

    Complications with this type of surgery are, fortunately, rare and may not apply to you, but it is important that you are aware of them.

    Bleeding

    Although there may be a little bleeding at the time if extraction, this usually stops very quickly and is unlikely to be a problem if the wound is stitched.

    Should the area bleed again when you get home this can usually be stopped by applying pressure over the area for at least 10 minutes with a rolled-up handkerchief or swab.

    If the bleeding does not stop, please contact us for further help and advice or if out of hours then call 111.


    Numbness

    There are 2 nerves that lie very close to the roots of the lower wisdom teeth. One of these nerves supplies feeling to your lower lip, chin and lower teeth. The other supplies feeling to your tongue and helps with taste. Sometimes these nerves may be bruised when a wisdom tooth is taken out. This can cause tingling or numbness in your lower lip, chin or tongue, and (more rarely) altered taste.

    About one in 10 people will have some tingling or numbness that can last for several weeks. Less than one in 100 people will have problems that last more than a year. These risks may be higher if your teeth are in a difficult position. Your surgeon will tell you if you are considered to be an increased risk. 

    Infection

    It is important to keep your mouth clean and to reduce or cut down your smoking following the removal of your wisdom teeth to prevent infection.

    Antibiotics are not routinely prescribed after surgery, but your surgeon may prescribe antibiotics for particular cases.

    Other risks

    • Pain
    • Swelling
    • Bleeding
    • Infection
    • Temporary/permanent risk of numbness
    • Risk of the roots retained or further surgery may be needed.

    There may also be associated pain, swelling and stiffness of your jaw.

  • Do I need to take any time off work?

    Usually it will be necessary to take a few days off work and avoid strenuous exercise for this time. Depending on the type of anaesthetic used, you may not be able to drive (24 hours after intravenous sedation or after a general anaesthetic).

    Immediately following a general anaesthetic, you may feel tired, dizzy or weak. You must have somebody to collect you and stay with you for the first 24 hours.

    During the first 24 hours you must not drive or operate any motorised vehicles or electrical equipment, sign any legal documents, make any important decisions or drink any alcohol.

  • Is there anything else I need to do after the extractions?

    It is important to keep the extraction sites as clean as possible for the first few weeks after surgery.

    It may be difficult to clean your teeth around sites of the extraction because it is sore. If this is the case is it best to keep the area free from debris by gentle rinsing with a mouthwash or warm salt water (dissolve a flat teaspoon of kitchen salt in a cup of warm water), starting on the day after surgery.

  • What anaesthetic will be used?

    A number of options are available and depend on how difficult the wisdom tooth is to remove.

    • Local anaesthetic – this is an injection into the gums surrounding the wisdom tooth, rather similar to that you may have had at your dentist for a filling. The injection takes a couple of minutes to numb the area and means that you feel no pain while the wisdom tooth is removed. This is the best option for wisdom teeth that are simple to remove.

    • Local anaesthetic and intravenous sedation – in addition to a local anaesthetic injection you can be given an injection in your arm. This makes you feel relaxed and less aware of the procedure.

    • General anaesthetic – it is usually possible to remove wisdom teeth under a ‘day case’ general anaesthetic, i.e. although you are put to sleep completely, you will be able to go home on the same day as surgery.

    If you are having day surgery with sedation or under a general anaesthetic, you need to ensure that a responsible adult is with you for the first 24 hours after surgery and that they can escort you home as well.

    You will need to make our own transport arrangements for your discharge unless arranged by the hospital in advance.

    If arrangements are not in place your surgery will be cancelled.

  • What does the treatment involve?

    Because the wisdom tooth has not fully erupted into the mouth, it is often necessary to make a cut in the gum over the mouth.

    Sometimes it is also necessary to remove some bone surrounding the crown of the wisdom tooth. Rarely the tooth needs to be cut into 2 or 3 pieces to remove it.

    Once the wisdom tooth has been removed, the gum is put back into place with stitches. In the majority of cases these stiches are dissolvable and take around two weeks to disappear.

  • Why do I need treatment?

    An impacted wisdom tooth can cause a number of problems that mean the tooth is best removed. Most commonly these are:

    • Repeated attacks of infection in the gums surrounding the tooth. This leads to pain and swelling
    • Food packing which causes decay in either the wisdom tooth or the tooth in front.
    • Cysts can form around the wisdom tooth if it does not come into the mouth properly. A cyst occurs when fluid fills the sack that normally surrounds a developing wisdom tooth.
    • Removal to facilitate other forms of maxillofacial surgery.
  • The problem with wisdom teeth

    The wisdom tooth (or 3rd molar) is usually the last tooth to erupt into the mouth, any time after 16 years of age.

    Frequently there is not enough room to accommodate wisdom teeth and as such they do not come into the mouth normally. When this happens, the wisdom teeth are said to be ‘impacted’.

    Wisdom teeth are usually either impacted forwards into the tooth in front, or backwards into the lower jaw bone.

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    Nicholas Lee: Oral & Maxillofacial Surgeon, Sheffield UK