Jaw joint

Dear Talisha,

Both knees support the body equally. However, imagine that as a child, you “twisted” the left knee. Although you don’t remember this anymore, your left knee is frequently swollen, even though you usually carry your shopping bags with your right hand. What I’m trying to demonstrate through this example is the fact that it’s still very possible for discomforts to appear in a contralateral fashion, even though one would really expect the discomforts somewhere else. The same thing happens with the jaw joint.

So you have pain in the ascending mandibular ramus? The reasons for this could be – but don’t necessarily have to be connected to – the teeth. Narrowing these down requires an exact examination! The best thing to do is to see a gnathologist/prosthodontist.

What I’m trying to demonstrate through this example is the fact that it is still very possible for discomforts to appear in a contralateral fashion, even though one would really expect the discomforts somewhere else. The same thing happens with the jaw joint.

I understand. So it could be connected to a contralateral cause as well.


So you have pain in the ascending mandibular ramus?

How did you know that?

Well, maybe pain is too strong a word. There´s pressure and pinching, and it radiates all the way into the ear interior. In the joint area (in front of the ear), there´s a slightly pressure-sensitive spot on the bone. The area from the ear downwards (the mandibular ramus) sometimes feels slightly warm. On the outside of the jaw joint, I can feel something small and round, which isn´t present on the left side. When I glide over it with my finger, it slides away. The thing itself does not hurt.

The reasons for that could be – but do not necessarily have to be connected to – the teeth.

Assuming that the (missing) teeth on the opposite side are not the cause, what could be the cause?

And could the teeth on the respective side be responsible?

Narrowing these down requires an exact examination!

Yes, that’s what I thought. I´ve already been to the dentist. The inside of the cheek was palpated and nothing was found (sometimes I have the feeling that the inside of the cheek is swollen). The salivary gland was suspected and I was sent to an ENT specialist. I wouldn’t put it beyond my teeth being the cause, but she didn’t take an X-ray.

The dentist couldn’t find anything except for otosclerosis in the right ear (hearing test, etc.). However, she didn’t do an ultrasound either – she just palpated. Of course, the salivary gland is working. I don´t experience any pain when eating.

Now I’m at a bit of a loss because it gets on my nerves.

In which sequence should the examinations take place, in your opinion?

1. Teeth/jaw by means of an X-ray
2. ENT
3. Functional diagnosis? Anything else missing?

Sometimes, I also have the feeling that something wants to erupt in the area of the extracted #48 tooth. However, I can’t feel anything and the old image doesn´t show any remains.

Thank you very much for your time. I know it’s difficult to make a determination via the web, especially without any pictures.

Kind regards,
Talisha

Dear Talisha,
Well, maybe pain is too strong a word. There´s pressure and pinching, and it radiates all the way into the ear interior. In the joint area (in front of the ear), there´s a slightly pressure-sensitive spot on the bone. The area from the ear downwards (the mandibular ramus) sometimes feels slightly warm. On the outside of the jaw joint, I can feel something small and round, which isn´t present on the left side. When I glide over it with my finger, it slides away. The thing itself does not hurt.

It could be anything or nothing. Lymph nodes? Let it be and don´t play around with it. If it worries you, it´s better to see a doctor.

Assuming that the (missing) teeth on the opposite side are not the cause, what could be the cause?

Since the descriptions of your symptoms are very vague, I can´t say much more about them.

And could the teeth in the respective side be responsible?/quot]

Anything is possible.

Now I’m at a bit at a loss because it gets on my nerves.

I would try to gain some distance. If the dentist doesn’t find anything, then it’s probably nothing. However, you can upload an X-ray if you like; I would be glad to add my two cents.

Hello Doctor,

I finally granted myself two weeks distance. Nevertheless, everything remains unsatisfactory.

Unfortunately, I don’t have a current X-ray. Nobody wants to take one, although I’m really interested in finding out how my root end resection on the #46 tooth looks right now.

My problem started like this (within a two week period):

- Sudden pinching and pressure in the mandibular ramus, pulling towards the ear; radiating pinching in the inner ear; a feeling of warmth in the mandibular ramus
- A sensation that the cheek was swollen on the inside, although I don´t bite on it. Because of this irritating feeling, my tongue permanently stays in the nos. 47/48 teeth area, as if something is in the way, but I don’t feel anything out of the ordinary
- Unilateral headache in the afternoon
- Increased hissing sound in the ear; more bleeping than usual
- Sometimes, the area in front of the ear feels “cottony;” difficult to describe

(I experienced all of this – with the exception of the headache – in April (after a cold) and then it suddenly disappeared in the beginning of July.)

Apart from the irritating feeling in the cheek, most of the symptoms have disappeared now, and every day, I hope that the feeling in my cheek will also return to normal. When I massage the cheek, I fell like it is palliative.

Am I bananas??

Is it possible for cysts to form in areas where teeth have been extracted (e.g., at the #48) or at the spot where root ends were removed (e.g., at the root end resected # 46)? Maybe there´s something there? I wouldn’t put it beyond my root end resected #46 to be the trigger of all these sensations. However, my dentist plays down this possibility.

The root canal treated #46 brought me a nice hard swelling in the vestibulum last year, which ended with a root end resection in November of 2009, after months of running to various doctors (there was nothing clearly visible in the X-ray). Isn’t it natural that this could be the “problem” again, even if I can’t feel/see any clear swelling this time around? Could it trigger the discomfort in the mandibular ramus/in the front ear area? And how does one distinguish this from other diseases? By simply making a “cut” and taking a look at it?

I think I would have to go to the dentist first, and rule out the possibility of the discomfort coming from certain teeth, but somehow, I feel as if I’m paranoid. As I said, the doctor only performed a visual check by palpating, despite knowing about the history of the #46 tooth – no picture and no examination by an ENT specialist, which was discouraging.

I think the matter would be easier to handle if I simply had a toothache, but no.

If I find the courage to somehow risk taking the next step towards visiting a dentist and an X-ray is taken, I will upload it. Somehow, I suspect a huge mass or mega-cysts or nasty tumors. Basically, I honestly don’t want to see an X-ray and also don’t want to have the #46 pulled merely on the basis of suspicion, as it may not even be the cause of my problems.

Nevertheless, thank you for your statements. I’ve got to see how this develops.

Dear Talisha,
Unfortunately, I don´t have a current X-ray. Nobody wants to take one, although I’m really interested in finding out how my #46 tooth´s root end resection looks right now.

I don’t quite understand – nobody wants to take one?

- Increased hissing sound in the ear; more bleeping than usual
- Sometimes, the area in front of the ear feels “cottony;” difficult to describe

Maybe you are suffering from multiple “problems.” What you are describing sounds like acute hearing loss.

Furthermore, I have the feeling that an ulterior motive is manifesting itself, because the solution to your problems is right in front of your eyes: Find a different dentist, have an X-ray taken, upload the image, and then, let’s go.

Dear Talisha,

I don’t quite understand – nobody wants to take one?
My neither. I discussed the problem extensively with the doctor -> the doctor just took a look and palpated. I brought up tooth #46 -> “No, that’s the parotid gland” = no image taken in order to exclude the teeth as the cause of my problems.

His colleague at the practice is looking at one-year old images as well.

Same with the ENT specialist – just a visual examination and palpating; no ultrasound or anything.
I mean, it’s not my equipment. Can I insist on an X-ray being taken? My dentist always grins with an expression that implies that she’s not taking me seriously. This is discouraging and doesn’t help me in insisting on any procedures.


Maybe you are suffering from multiple “problems,” because what you are describing sounds like an acute hearing loss.

Oh my. But wouldn’t I get to a point where I wouldn’t be able to hear anything with that ear? I’ve been dealing with this for almost three weeks now.

Furthermore, I have the feeling that an ulterior motive is manifesting itself.

I don’t understand that?! Do you mean that I “want” all this to happen and just don’t know it? Is an ulterior motive a good thing?

Because the solution to your problems is right in front of your eyes: Find a different dentist, have an X-ray taken, upload the image, and then let’s go.

Yes, that’s obvious. I’m just searching for arguments to convince my dentist to dig deeper. But you’re probably right. On November 3rd I have another appointment with her. If nothing new develops, I’ll look for another dentist to get a second opinion. And with regard to possible hearing loss, I will visit my general practitioner in order to confirm or exclude that being the cause of all my problems.

Thank you for everything. Best regards!

Talisha

Dear Talisha!
My neither. I discussed the problem extensively with the doctor -> the doctor just took a look and palpated. I brought up tooth #46 -> “No, that’s the parotid gland” = no image taken to for exclude my teeth as the cause of my problems.

Go to a different doctor. In the worst case scenario, pay for the OPTG yourself. It could be that health insurance companies in your country will only pay for another image after a certain period of time has elapsed; maybe that’s why the doctor isn’t taking an image.

Same with the ENT specialist – just a visual examination and palpating -> no ultrasound or anything.

If a clear, serous secretion is flowing out of the excretory duct, then the salivary gland is okay. You can test this yourself by massaging below the ear and looking at the inside of your cheek in the molar area in the upper jaw. It’s not easy to see, but if he did that, then an ultrasound of the salivary gland is not necessary.

I mean, it’s not my equipment. Can I insist that an X-ray is taken? My dentist always grins with an expression that implies that she’s not taking me seriously. This is discouraging and doesn’t help with my insisting on anything.
Change dentists.

Oh my. But wouldn’t I get to a point where I wouldn’t be able to hear anything with that ear? I’ve been dealing with this for almost three weeks now.

Hearing losses can vary to different degrees.

I don’t understand that. I “want” all this to happen and just don’t know it? Is an ulterior motive a good thing?

Sometimes, we try to draw attention to ourselves unconsciously. Whether that’s good or not depends on the situation. I would consider other solutions aside from just going to the same doctor and accepting the fact that there is no progress.

All the best.

Hello again,

Once again, thank you for your extensive recommendations.

If I have any ulterior motives in the sense of trying to draw attention to myself, it’s not because of any conscious intent. I absolutely don’t want to suffer from something all the time. It would have to be coming from the subconscious or I’m a mental case – just a joke...

I visited my dentist today. She really made an effort, hats off! There was even a current x-ray taken, which unfortunately, I can’t upload as she was not able to upload the digital image. I watched her as she was trying.

However, we looked at it together. The jaw joints are fine and the teeth on the respective side are fine as well. No. 47 is doing great and the root end resected #46 also looks good, according to my dentist. There were very tiny black spots on the cut places that I pointed out to her. However, she said that these were probably bone defects. The area of the extracted #48 is also inconspicuous: No cysts.

Now, I suppose I will continue on my journey: General practitioner, ENT specialist, and possibly a CT. Let’s see; my salivary gland salivates, so that’s okay as far as that goes. Teeth nos. 46 & 47 were also vigorously tapped again, during which I didn’t feel anything (but I know from experience that problems do not always have to be connected to pain).

My dentist says that the “foreign object” feeling in the area of the nos. 47/48, where my tongue keeps wandering to all the time, is because of the tissue scars that formed after last year's three surgeries. Also, there’s the possibility of weather sensitivity. The fact that my discomforts (pressing/pinching/warmth in the mandibular ramus and jaw joint/ear) were suddenly completely gone from July to October has nothing to do with the teeth, according to my dentist.

I would like you to take a look at the image. I can try to save it on a USB stick in a few days if I find the courage to ask for it.

Maybe my discomfort is originating not from the teeth but the ear? I’ve recently noticed that with every step I take, there’s a cracking sound in the ear, especially in the morning. I don’t know where the cracking originates, but I think it comes from somewhere on/in my head. Also, when I jerk my head to the right, there’s a cracking sound in the ear region.

Maybe I should visit an ENT for this. I can’t imagine it, but maybe everything is related to the otosclerosis? After all, these are inflammatory osteogenetic processes, if I’m correct.

Anyway, to make a long story short, thank you for your assessment and your time. If I should have an image to upload, I will post it!

Until then, keep up the good work you're doing!!!

Best regards,

Talisha

Dear Talisha,

If I have an ulterior motive in the sense of trying to draw attention to myself, it’s not because of any conscious intent. I absolutely don’t want to suffer from something all the time. It would have to be the subconscious at work or I’m a mental case…

Just as an aside, there is only the unconscious and the conscious. The subconscious does not exist, except in the case of the coked-up Dr. Freud. However, he was given permission because he was poor, suffered from a carcinoma in the upper jaw, and his dear family doctor treated his morphine addiction with cocaine, and succeeded with partial success. In the end, he was addicted to cocaine and morphine and this resulted in his excursions into the “subconscious.”

I visited my dentist today. She really made an effort, hats off! There was even a current photo, which unfortunately I can’t upload as she was not able to upload the digital image; I watched her as she was trying.

USB stick.

I would like you to take a look at the image, Dr. Belsky. I can try to save it on a USB stick in a few days if I find the courage to ask for it.

What do you mean, find the courage?

Maybe I should visit an ENT. I can’t imagine it, but maybe everything is related to the otosclerosis? After all, these are inflammatory osteogenetic processes, if I’m correct.

Do you suffer from an otosclerosis?

Dear Talisha

Just as an aside, there is only the unconscious and the conscious. The subconscious does not exist, except in the case of the coked-up Dr. Freud. However, he was given permission because he was poor, suffered from a carcinoma in the upper jaw, and his dear family doctor treated his morphine addiction with cocaine, and succeeded with partial success. In the end, he was addicted to cocaine and morphine and this resulted in his excursions into the “subconscious.”

Thank you for the clarification.

What do you mean, find the courage?

I don’t know. I’m embarrassed to ask them. I felt the same way today. There was an awkward pause when I asked. She then printed it out on a sheet of paper because she wasn’t able to send it by e-mail. I simply don’t want to have to answer the question, “Why do you want the X-ray image?” I can’t really say, “The Internet-doc in Austria will take a look at it.” They will then just send me to you.


Do you suffer from an otosclerosis?

Yes, on the right, the side where everything’s a mess (jaw, mandibular ramus, jaw joint, ear). I was diagnosed by an ENT specialist in July.

Kind regards,

Talisha

Dear Talisha,

I don’t know. I’m embarrassed to ask them. I felt the same way today. There was an awkward pause when I asked. She then printed it out on a sheet of paper because she wasn’t able to send it by e-mail. I simply don’t want to have to answer the question, “Why do you want the X-ray image?” I can’t really say, “The Internet-doc in Austria will take a look at it.” They will then just send me to you.

Be open and honest: You want to get a second opinion in accordance with the motto “more heads, more thoughts.” This doesn’t signify that treatment needs to be immediately terminated. Recently, I had a colleague here who gave me good advice during a particular treatment. I then integrated his advice into my treatment, educated the patient, and thus, improved the system. Cooperation is essential; if the doctor doesn’t understand that, then she doesn’t understand anything.

Do you suffer from an otosclerosis?
Yes, on the right. The side, where everything’s a mess (jaw, mandibular ramus, jaw joint, ear). I was diagnosed by an ENT specialist in July.

That could very well be responsible for your pain phenomena. It would be an exclusion diagnosis. So if everything else fits, your discomfort could be connected to the otosclerosis.