Jaw slips out
I have a rather odd problem. For the past several years, I have noticed that when I open my mouth wide to yawn or take a bite out of a sandwich, the right condyle of my jawbone slips laterally from the temporomandibular joint, making it difficult, and at times, painful, to close my mouth. I basically have to slip the condyle back into the socket; otherwise, it slips in by itself, which is what causes the pain.
Other than being inconvenient, this has not adversely affected me in any way that I can tell, except that I am now careful not to open my mouth completely when I yawn. I am reluctant to see a doctor about this because I cannot reproduce the situation at will, and don't know if the problem can be diagnosed or detected unless the doctor actually sees the condyle slip out.
Also, any time I have gone to Health Services, it seems that whatever the problem, they just send me home with a jar full of ibuprofen. What do you think is wrong? Is this problem serious? Does it deserve immediate attention? What type of doctor would I need to see and could I get a referral from Health Services?
The jaw is complex and amazing. The temporomandibular (TM) joints, located on either side of the head just in front of the ear, connect the lower jaw to the upper jaw. One of the more versatile joints in the body, the TM joint is able to open and close like a hinge, but also able to move back and forth and side to side, which allows for chewing. Several things can go wrong with this system, however. Formally called TMJ, temporomandibular disorders are caused by problems with the muscles, joints, or the fibrous disk situated between the two bones. These disorders can be caused by tension or stress in the muscles, which can stem from jaw-clenching or teeth-grinding (especially in one's sleep). Yawning can also cause it and so can visits to the dentist where your mouth must be held open wide. One common form of this disorder is called internal joint derangement, which usually causes a clicking sound in the joint when the mouth opens wide or the jaw shifts from side to side. In many people, these joint pops are the only symptoms. Some people, however, experience pain and/or difficulty opening their mouth wide. Depending on the jaw trouble, treatment may involve the doctor popping the disk or joint back into place. Other treatments may include pain relievers, muscle relaxers, or splints.
It sounds as though you've read a lot about your jaw-popping already. A medical provider or a dentist could likely make a diagnosis, based on the history you describe and a physical examination. The issue seems to be, however, that you aren't satisfied with the advice you've already been given. You've sought professional advice from your school's health services, but are still unsatisfied and have unanswered questions. So, the real issue here is what to do next??
The first step may be to communicate with the health professional you saw at your school's health services. Take your own research in with you and show it to the provider. Let her or him know that you need more information about your jaw, that you are concerned, and that you still have questions about your ongoing problem. Let her or him know that you don't understand the causes of the problem, nor the treatment prescribed. Then, if you don't like the information you receive, tell the provider that you'd like a second opinion and ask if she or he could refer you to another provider or dentist who could provide you with more thorough information. If you still feel dissatisfied and if your finances allow it, you can seek an opinion from another health practitioner not employed by your school's health services. If you regularly see a dentist, maybe this would be the person to see.
It may be frustrating trying to get a diagnosis in this way, but don't give up until you are satisfied that you understand your problem and what can be done about it.
Hope this helps,
Originally published May 01, 1994
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