Treatment of articular disc displacement without accompanying reduction

No one is immune from jaw displacement. Dislocation of the lower jaw can occur either as a result of a blow or when the mouth is suddenly opened. But there are a number of factors that provoke the occurrence of such situations. How to behave if jaw displacement occurs? How soon can it be put back in place, and where should one go if the lower jaw is dislocated? Experts answer these questions.

Dislocation of the lower jaw is a situation when the articular head of the temporomandibular joint is displaced. Dislocation can only affect the lower jaw, since the upper jaw is immobile. The mandible is connected to the temporal bone by the TMJ, which helps the mandible move.

Why does dislocation of the lower jaw occur?

Mandibular displacement can occur because:

• the patient suddenly opened his mouth during a conversation or yawned;
• the man dropped his jaw sharply;
• the patient suffers from certain diseases that have weakened the skeletal system and articular ligaments. Among the most common diseases that provoke dislocation of the lower jaw are osteomyelitis, rheumatism, arthritis, etc.;
• a person has a habit of opening bottles with his teeth;
• the temporomandibular joint was affected due to improper distribution of the load on the teeth (for example, if on one side there are no chewing teeth, but on the other side they are there and do more work).

Causes

The causes of displacement of the jaw joints are most often external influences. Each person has different anatomical features and the strength of fixation of the joints in the bursa. Therefore, in some people, even a minor bruise can cause subluxation. This is usually caused by weak bone tension and weakened ligaments. But also the causes of the disease are:

• rheumatism;
• epilepsy;
• arthritis (advanced stage);
• consequences of encephalitis;
• convulsions;
• joint deformation, osteomyelitis.

Factors that increase the risk of subluxation are also separately identified:

• mechanical injuries, strong impacts;
• congenital deformities, pathologies of the articular cavity;
• opening the mouth too much when biting or yawning;
• bad habits (opening bottles with teeth, habits of gnawing nuts and seeds).

How to understand that a dislocation of the lower jaw has occurred?

The symptoms of dislocation of the lower jaw are quite clear:

• it becomes impossible to open your mouth;
• pain is felt in the projection of the jaw, as well as in the area of ​​the temporal bone;
• after dislocation of the lower jaw there may be speech impairments;
• redness may be observed in the area of ​​the temporomandibular joint;
• the lower jaw is pushed forward or shifted to the side;
• against the background of joint dislocation, uncontrolled salivation occurs.

As a rule, a person immediately understands that something is wrong with the lower jaw. Visually, the displacement of the lower jaw is also visible. If you notice similar symptoms of dislocation, you should urgently seek help from a doctor.

Symptoms and signs

The universal symptoms noted with any form of subluxation include:

• Painful sensations of varying severity, intensifying when trying to move the lower jaw;
• Deterioration of TMJ mobility, interfering with the usual way of life;
• Excessive salivation caused by impaired swallowing function.

Clinical cases characterized by bilateral lesions of the frontal zone are characterized by:

• Severe violation of occlusion, forcing you to keep your mouth open constantly;
• Headaches, swelling of tissues in the ear area, as well as impaired speech function.

With unilateral subluxation, similar symptoms are observed, but the patient has the opportunity to at least partially close the jaws, reducing the level of discomfort. But in the case of a posterior bilateral dislocation, the opposite situation arises - it becomes extremely difficult to open the jaws, since the lower section is pressed into the laryngeal region.

What types of dislocations of the lower jaw are there?

Depending on the side of displacement of the articular head, there are:

• posterior dislocation of the lower jaw (when the jaw moves back);
• anterior dislocation of the lower jaw (when the jaw is pushed forward).

Based on the nature of the injury, we can distinguish:

• complex dislocation of the jaw, when soft and hard tissues are affected, and an open wound is visible;
• simple or closed dislocation of the lower jaw, when the displacement of the jaw bones is not visualized.

Based on the number of affected joints (and there are two of them) in articular dislocation of the lower jaw, the following are distinguished:

• bilateral dislocation of the lower jaw is a complex diagnosis in which the jaw “pops out” of both joints and is therefore pushed forward, the mouth remains slightly open, the jaw moves forward, the person is drooling, and there are problems with speech;
• unilateral articular dislocation of the lower jaw, when one temporomandibular joint is involved, while the chin shifts towards the unaffected joint.

If, when the lower jaw is dislocated, the tips of the bones do not touch each other, a complete dislocation of the lower jaw is diagnosed. If the ends of the bones partially touch, most likely the patient has articular subluxation of the lower jaw.

Structure

The formation of the mandibular region is the result of the evolution of the human body. In the process of development, the entire structure became mobile and autonomous, gaining the ability to move freely and perform the basic functions necessary for a person. The temporal joint is localized in the fossa, connecting to the bony part.

When a subluxation occurs, the head of the joint partially comes out of the fossa, succumbing to the influence of external factors. As a rule, this phenomenon becomes a consequence of a general weakening of the ligaments or disturbances in the articular cavity. If you have the proper skills and practical experience, you can restore the original position of the jaw yourself, but the systematic occurrence of such a problem is the basis for complex treatment.

How can you determine that a dislocation of the lower jaw has occurred?

As we said above, based on the symptoms, the patient immediately understands that something is wrong with his lower jaw. A doctor will be able to make an accurate diagnosis based on the following diagnostic steps:

• general examination;
• radiography of the jaw;
• computed tomography or MRI of the joint.

The specialist must also make sure that the dislocation or subluxation does not hide a fracture of the jaw, which is much more serious and requires surgical intervention.

It is important! If a person has a dislocation of the lower jaw as a result of injury or an accident, he should be given first aid - apply a tight bandage to the jaw and take him to a medical facility.

Diagnostics

In order to make a diagnosis, the doctor conducts an examination according to the following scheme:

• Questioning the patient. Of interest to the specialist are complaints, conditions for the appearance of unpleasant symptoms, duration of the disease, previous treatment and its effectiveness.
• External examination and palpation. The gnathologist examines the patient’s face, paying attention to the area where the TMJ is located. By feeling the joints, you can get an idea of ​​its structure and the state of its tissues.
• Dental examination. Anomalies of occlusion and the degree of their severity are identified.
• X-ray examination. The photographs show the bone formations that form the joint. By their relative position one can determine the presence of dislocations and subluxations, and by the thickness of the joint space one can judge the condition of the cartilaginous disc.

Treatment of lower jaw dislocation

To solve the problem of dislocation of the lower jaw, the jaw should be moved back into place. This should be done exclusively by an orthopedic traumatologist or orthopedic dentist. Adjusting bones yourself after a dislocation is fraught with complications - do not try to repeat the same thing at home, contact a professional.

The procedure for realigning a patient's jaw consists of 5 main steps:

Step No. 1 - the person lies down on a hard surface, takes a comfortable position;

Step No. 2 - the doctor places his thumbs on the chewing teeth of the lower jaw, the remaining fingers seem to clasp the lower part of the face;

Step No. 3 – the specialist makes movements, moving the jaw back and down, but at the same time slightly lifting the chin;

Step No. 4 - the doctor must make sure that the articular head has moved down the back of the TMJ tubercle and returned to its original position;

Step No. 5 – the doctor needs to have time to remove his fingers from the teeth so that the person does not automatically bite them, closing the jaw.

Repositioning the jaw after a dislocation takes several minutes, but must be done very carefully.

If a person’s jaw has been dislocated for a long time and for some reason he has not consulted a doctor, the bones have shifted, he is prescribed surgery under local or general anesthesia.

In case of complex dislocations, a person is recommended to have a reconstructive operation, in which the height of the articular tubercle is artificially increased, while the articular capsule is reduced. Thus, an optimal balance of the elements of the connecting apparatus is achieved, and the jaw does not move.

As a recovery after jaw realignment or surgery to correct a dislocation, the patient is recommended to wear special orthodontic appliances.

First aid

Before visiting a doctor, the patient must be given first aid. All measures in this case will be aimed at minimizing the load on the joint and reducing the intensity of pain symptoms.

First of all, the affected joint is immobilized with a bandage or scarf. The jaw is fixed from top to bottom and from front to back using two flaps of fabric. At this time, the patient is prohibited from speaking and opening his mouth wide.

Options for fixing the jaw using a bandage

If a person has dislocated his jaw, his mouth will be slightly open. To prevent dirt and dust from getting into the cavity, cover it with a damp cloth. This will also reduce saliva production. For severe pain, a non-steroidal solution can be administered intramuscularly. An ice container is placed at the site of the suspected injury to reduce the severity of swelling. This event will also reduce the intensity of pain.

Which doctor should I go to if I have a problem? Jaw injuries require consultation with a surgeon. After examining the patient, the doctor decides whether to realign the joint or perform surgery. Jaw subluxations often occur in the dentist’s office, when the patient opens his mouth wide during manipulation. In this case, the specialist provides the person with qualified assistance on the spot.

If bone damage occurs at night, an ambulance is called for the person. The victim is taken to a 24-hour emergency room, where the necessary manipulations are performed. Before determining a treatment regimen, the doctor orders an x-ray to analyze the characteristics of the injury.

How to behave after lower jaw reduction?

If the doctor has successfully adjusted the lower jaw, the patient is recommended to wear a thick elastic bandage for 10 to 14 days, which will securely fix the bones.

During this time, you should stop eating solid food - it is better to concentrate on liquid soups, pureed cereals, fruits and berries. It is important not to overload the jaw with chewing load, so as not to provoke re-dislocation.

With successful reduction of the lower jaw after dislocation and a professionally performed operation, the prognosis for the patient is favorable. In some cases, jaw mobility may be impaired.

If you or your loved ones have a displacement of the lower jaw, contact dental specialists. Here, experienced doctors will help you with dislocations even in the most difficult cases.

Treatment method for TMJ dysfunction

1. Diagnosis of TMJ dysfunction.

• When diagnosing a joint in the clinic, a series of measurements and tests are carried out, all sensations in the joint area are recorded (discomfort, clicks, pain, deviation of the jaw when opening and closing), the difference in sensations in the right and left joint.
• The orthodontist also takes impressions of the jaws and takes photographs of the face and intraoral photographs, and also performs three-dimensional computed tomography of the face (3D CT); if necessary, the doctor can give a referral for an additional study - magnetic resonance imaging of the TMJ (MRI).
• Often, the orthodontist, in addition to manual functional analysis, conducts a visual assessment of: posture, symmetry of the shoulder girdle, shoulder blades, hip bone structures, etc., performs the necessary tests and photographs. Based on the results, it is possible to schedule a consultation with an osteopath or chiropractor to jointly manage the patient. Related specialists (orthopedist, surgeon, periodontist) can also be involved in drawing up a treatment plan.

What exercises are prescribed to patients to normalize the work and relax the masticatory muscles?

Exercise No. 1

Draw a vertical line on the mirror with a marker, stand opposite so that the line divides your face into the right and left halves, place your fingers on the area of ​​​​the articular heads, lift your tongue up and back, open and close your mouth along the line (it may not work right away), 2-3 times /day 30 repetitions. There is no need to open your mouth wide (a comfortable width), the main thing is symmetrically (so that the jaw does not “move” in any direction). If there is a click, open until it clicks.

Exercise No. 2 (cycle)

Do it whenever possible, for example, in front of the TV, at the computer, or in a traffic jam while driving. Open and close your mouth without closing your teeth for 30 seconds, then alternately reach your right and left cheeks with your tongue for 30 seconds. Open - close your mouth again, then for 30 seconds move your tongue in a circle inside the vestibule (behind the lips), first in one direction, then in the other direction (clockwise - counterclockwise), open again - close your mouth, etc.. For this a half-hour cycle, the teeth should not touch, the lips should be closed. If you want to close your mouth or swallow, place your tongue between your teeth. Repeat the cycle for 20-30 minutes 2-3 times/day

Classification

All jaw dislocations can be classified according to various indicators:

Any dislocation can and should be treated. Immediately after the incident, you should go to a hospital or emergency room to seek qualified medical care.

What are the causes of crossbite in children?

There are two groups of reasons for the development of such pathology:

1. congenital;
2. purchased.

The main congenital causes of crossbite development include:

• hereditary conditioning;
• child birth injuries;
• abnormal formation of the rudiments of future teeth;
• cleft palate;
• macroglossia - abnormal enlargement of the tongue and the like.

But more often, crossbite in children is formed due to external factors after birth. The main ones are:

• multiple caries;
• slow jaw development;
• slow process of loss of baby teeth;
• slow or disrupted teething;
• inflammation of the ENT organs;
• facial injuries and their improper treatment;
• dysfunction of chewing (if the child has lost teeth prematurely or they hurt, or for any other reason);
• bad or incorrect habits (the child props his cheeks with his fists, constantly bites his lips, etc.);
• problems with metabolism in the body (diseases such as rickets or dystrophy).

Types of crossbite

Experts identify several types of such pathology.

Crossbite in a child is classified in different ways, for example:

• dentoalveolar - when the dental arches and alveolar process change - the part of the jaw in which the teeth are fixed;
• articular - the position of the lower jaw is disrupted due to displacement in the joints;
• gnathic - changes are observed in both the dental arches and the jaw).

According to another classification, crossbite is:

1. Buccal (it can be unilateral, bilateral or combined). The changes consist in the fact that the lower dentition or the entire jaw changes (narrows or widens) from some side. Because of this, when the dentitions close, the buccal cusps of the upper teeth are overlapped by the buccal cusps of the lower teeth.
2. Lingual (the upper row of teeth expands and the lower jaw narrows on one side or both sides of the mouth). In this case, the buccal cusps of the lower teeth, when closed, overlap with the buccal cusps of the upper teeth.
3. In addition, the buccal-lingual type is often added to this classification, which combines the characteristics of both types at the same time.