Temporomandibular joint (TMJ) dysfunction describes conditions that cause pain and limit the movement of the jaw joint and surrounding muscles. While most TMJ discomfort is chronic and managed with home care, the Emergency Room (ER) focuses specifically on stabilizing acute crises. The ER treats sudden, severe symptoms like jaw dislocation or trauma that require immediate intervention, not long-term management. The goal of emergency care is to return the jaw to a functional, stable state and manage intense pain before the patient follows up with a specialist.
When Emergency Care is Required
Emergency care is required when acute symptoms make normal function impossible or indicate a serious underlying injury. The most common emergency is a locked jaw, where the temporomandibular joint is stuck open or closed. An open lock, or anterior dislocation, is particularly distressing because the mouth cannot be closed, causing severe pain and difficulty speaking or swallowing.
An ER visit is also necessary if a severe TMJ flare-up is accompanied by trauma, such as a direct blow to the face or jaw. This includes incidents involving bleeding, suspected fracture, or an inability to manage pain with over-the-counter medication. If the jaw is locked closed, and the patient cannot consume liquids or has unmanageable pain, immediate professional attention is required.
Initial Assessment and Diagnostics
When a patient arrives at the ER with acute jaw symptoms, staff begin with a thorough patient history, focusing on symptom onset, recent trauma, and prior TMJ issues. A physical examination determines the severity and nature of the problem, checking for joint and muscle tenderness, swelling, and the jaw’s range of motion. The physician also looks for signs of malocclusion, which is an abnormal alignment of the teeth or bite.
Imaging is utilized to rule out fractures or confirm a dislocation, especially if trauma is involved. Plain film X-rays, such as a panoramic view, are commonly used to visualize the jaw structure and the relationship of the mandibular condyle to the temporal bone. In complex cases, a Computed Tomography (CT) scan may be ordered to assess for subtle bone fractures or foreign bodies within the joint. This diagnostic process ensures the correct immediate treatment and confirms the dislocation is not associated with a more serious injury, such as a mandibular fracture.
Immediate Treatment and Pain Relief
The immediate focus of ER intervention is relieving acute pain and restoring jaw function. For severe muscle spasms and pain, strong intravenous (IV) pain medications, such as opioids or non-steroidal anti-inflammatory drugs (NSAIDs), are administered for rapid relief. Muscle relaxants, like benzodiazepines, may also be given intravenously to ease the intense spasm of the masticatory muscles, which prevents the jaw from returning to its normal position.
If the jaw is dislocated, the most common procedure is manual reduction, where a trained professional gently manipulates the jaw back into the joint socket. This procedure is often performed after administering local anesthesia into the joint space or muscles. Procedural sedation is sometimes required to ensure the patient is relaxed enough for successful manipulation. Techniques involve applying downward and backward pressure to the lower jaw, such as the classic Hippocratic method or alternative extraoral approaches.
For patients with severe inflammation and trismus (inability to open the mouth fully) but without a true dislocation, treatment involves powerful prescription-strength pain relievers and muscle relaxants. The jaw may be temporarily immobilized, and the patient is advised to maintain a strict soft diet to promote rest and healing. A short course of oral corticosteroids may be considered to reduce significant inflammation.
Next Steps After Leaving the ER
Leaving the ER marks the transition from acute stabilization to long-term recovery, as emergency treatment is not a permanent solution for the underlying TMJ condition. The patient receives temporary home care instructions, including resting the jaw, maintaining a soft-food diet, and using ice or moist heat packs on the affected area. Jaw rest involves avoiding wide opening (like yawning or singing) and avoiding hard or chewy foods that strain the muscles.
Follow-up with a specialist is strongly recommended to address the root cause of the TMJ dysfunction. This specialist may be a dentist with expertise in TMJ disorders or an oral and maxillofacial surgeon. They provide comprehensive treatment, which may include custom oral appliances, physical therapy, or other long-term pain management strategies. Patients are instructed to return to the ER immediately if symptoms rapidly worsen, the dislocation recurs, or signs of infection develop.