Temporomandibular Joint Disorder (TMJ) is a general term for pain and dysfunction in the jaw joint and the muscles that control jaw movement. While most jaw pain is managed by a dentist or primary care doctor, an acute crisis sometimes requires immediate attention. The ER’s role is to manage the immediate emergency, stabilize the condition, and provide relief from acute pain and mechanical problems.
Identifying When ER Care is Necessary
Most TMJ flare-ups, such as general jaw soreness or clicking, do not require an emergency visit. The ER should be reserved for severe, acute crises or those involving surrounding structures. The most common reason for an ER visit is a true jaw dislocation, where the jaw is locked open and cannot be closed.
Other serious concerns include severe facial trauma leading to a suspected mandibular fracture, which requires immediate imaging and stabilization. Signs of a spreading infection, such as high fever, rapid swelling, or redness extending beyond the joint, also warrant emergency care. Any obstruction or swelling that severely compromises the ability to breathe, swallow, or speak is considered a medical emergency.
The ER Assessment Process
Upon arrival, the first step is triage, where nurses assess vital signs and pain level to determine the urgency of the condition. The ER physician conducts a physical examination, palpating the temporomandibular joint and surrounding muscles for tenderness and swelling. They also assess the jaw’s range of motion, noting any deviation or inability to open or close the mouth.
The ER team performs a differential diagnosis to rule out other causes of severe jaw pain, such as a dental abscess, parotitis, or cardiac issues. Diagnostic imaging is routinely used to visualize underlying structures. Panoramic X-rays are a common initial screening tool for fractures or obvious dislocations, while a Computed Tomography (CT) scan may be ordered for more subtle bone abnormalities or joint evaluation.
Acute TMJ Interventions
The primary goal of ER intervention is to alleviate the immediate crisis, reduce pain, and restore function. Pharmacological management begins with intravenous (IV) medication to address severe pain and muscle spasm. This includes non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation, and muscle relaxants like cyclobenzaprine or diazepam to ease muscle spasm.
If the jaw is dislocated, a manual reduction technique is performed to reposition the mandibular condyle back into the glenoid fossa. This procedure often requires local anesthesia or procedural sedation to ensure the jaw muscles are fully relaxed. The physician applies downward and backward pressure to guide the condyle back into its socket. For cases involving trauma or suspected fractures, ER staff will manage wounds and stabilize the jaw until a specialist can provide definitive care.
Post-Visit Care and Next Steps
Once the immediate crisis is resolved and the jaw is stable, the patient receives discharge instructions focused on protection and healing. A soft diet is recommended for the first week or two to minimize strain on the joint. Patients are advised to use ice packs several times a day to control residual swelling and pain.
The ER physician provides prescriptions for take-home medications, often including a short course of muscle relaxants and anti-inflammatories. A referral for follow-up care with a specialist—such as an oral and maxillofacial surgeon, a dentist, or a physical therapist—is a crucial component of the discharge plan. Patients are educated on warning signs that require a return trip, including severe, unmanageable pain, recurrent dislocation, or spreading signs of infection.