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Facial pain due to inflammation of TM Joint.

Resolved Question:

I have had severe facial pain (upper/lower teeth left hand side) for 5 days, I saw my dentist who said there was no dental problem and he prescribed antibiotics in case of infection (not evident on x-ray), I am on the third day of treatment and pain has moved away from teeth but the jaw line and gum area is very painful, throbbing pain. There are no sinus symptoms, no fever, no headache.


Category: Family Physician-GP

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello and thankyou for approaching DoctorSpring with your query.
Since you have ruled out any dental cause, from what you have described your pain can either be referred from your ear, or referred pain from your temperomandibular joint (TMJ) which is the jaw joint,
In case of stress you could be clenching your teeth during your sleep or eating and munching on one side unconsciously, resulting in inflammation of the TMJ. This pain is usually referred to the jaw.
Are you having any ear pain or discharge or itching in your ear? or difficulty in hearing?
Is there any redness around the jaw swelling?

Right now I would advise you to take tablet Ibuprofen 400 mg 3 times a day after a meal for 3 days, to take care of the referred pain. Continue your antibiotics.
And let me know if you are having any ear symptoms.

You can reply as a follow up.

Thankyou.



Patient replied :

No real ear problems at the moment. The concern I have is the swelling which has been progressing all day; inside the mouth the gum line of the left side is dramatically inflamed, outside the month the swelling is not red but the swelling in face and neck is very pronounced. I am finding it difficult to swallow normally.


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,

The possibilities are : Parotitis, Gingivitis and a caries teeth (probably missed by your dentist). The redness, pain and spreading swelling is suggestive of an infection. This could be a bacterial infection.

As of now for pain relief you can take Ibuprofen. This is your best shot. If the symptoms peristis you will need furhter evaluation in form of a complete blood count, ESR, physical examination. If an infective cause is diagnosed you will require a course of antibiotics.

Is it possible for you to send me the picture of the swelling ? You can reply as a followup

Thank you


Patient replied :

Thank you for coming back to me. I can't send photos I'm afraid. The ibuprofen I took an hour ago has provided some relief. If things haven't improved in a couple of says, will see doctor. Thanks again for your help.


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Glad that your pain is bit relieved.
Feel free to get back to me any time.
Good luck
Thank you


Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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