Management of Acute Dental Problems

Brief description of condition

Acute disorders of the temporomandibular joint, which connects the lower jaw to the skull (e.g. dislocated or locked jaw or problems involving muscles around the joint).

Key signs and symptoms

• Pain
• Swelling
• Joint noises, e.g. pop, clicks and grating associated with movement
• Limited opening of mouth
• Headaches
• Earache
• Tinnitus.

For dislocated jaw:

• Unable to move jaw
• Jaw is displaced in open position

Initial management

If the jaw is dislocated::

• Send the patient to emergency care via NHS 24
• Recommend optimal analgesia .

For other temporomandibular joint conditions:

• Recommend optimal analgesic/anti-inflammatory drugs.
• Consider both the benefits and potential harms of prescribing a short course of diazepam to relax muscles (for adults only).
• Advise the patient to use local heat packs or ice packs to relieve the symptoms.
• Advise the patient to have a soft diet, to avoid chewing gum and to rest their jaw.
• Advise the patient to seek non-urgent dental care.

Subsequent Care

Consider making an occlusal splint for the patient.

Monitor symptoms in follow-up appointment(s).

Consider referring the patient for specialist opinion if the above measures do not improve symptoms.

.

References

1. Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny AM. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002778. DOI: 10.1002/14651858.CD002778.pub2.
2. Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004973. DOI: 10.1002/14651858.CD004973.pub2.
3. Koh H, Robinson P. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003812. DOI: 10.1002/14651858.CD003812.
4. Mujakperuo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological interventions for pain in patients with temporomandibular disorders. JCochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD004715. DOI: 10.1002/14651858.CD004715.pub2.
5. SDCEP. Drug prescribing for dentistry: dental clinical guidance, 2nd edition. Dundee: Scottish Dental Clinical Effectiveness Programme, 2011.