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673940 tn?1232411764

to TMJDOC exposed mental nerve +jaw realignment

hello TMJDOC..... right 2years ago i had a very brutal bottom right tooth extraction ,i recieved 7 injections that i know of {1 of wich went through my cheek} my jaw bone was ground to a pulp and my mental nerve left exposed!, now i have tmj,and tn, i will be seeing a maxo surgeon next week and my ENT says that i have to have my mental nerve damaged{at last} and my jaw needs to be realigned,does this mean that they will break it first? i am scared stiff,
4 Responses
Avatar universal
It is very possible you could have had the mental nerve damaged, but your symptoms would give me a better clue as to the problem.  Jaw realigned?  What is meant by that?  Temporary repositioning of the mandible with a mouth splint to change the relationship within the TMjoint to relieve pain and allow soft tissue healing may be what they mean.  If you have a displaced disc that is proper treatment--generally speaking.  Surgical realignment is questionable as I'm not clear what is being done.  Nerve damage has some fairly specific symptoms.  Please post your symptoms--I'm curious.  Surgical damage would not be classic Trigeminal Neuralgia because the cause is different--trauma, and therefore the treatment may be different and directed specifically to the traumatized area.  TN otherwise is generally treated with medications, e.g. Neurontin before any surgical intervention.  With trauma, cortisone injections at the trauma site may be a better option.  I have treated damaged mental nerves this way, and if it is being compressed against bone, surgical option are available,  The nerve would not be 'exposed' now.  It can easily be damaged with extractions however.  Great care needs to be taken by the dentist/oral surgeon when working in this area..But all treatment has to start with a proper diagnosis.   TMJDoc
673940 tn?1232411764
thanyou for taking time to reply  my symptons are ,touch my tongue on mental nerve area or top of front teeth sharp pain shoots along gum to and around side of right ear,tingles on top lip,pain at back left side of head,now and then sharp pains to what feels like inside of brain!, right side and under ear allways swollen and sore to slightest touch,limited mouth opening,with a grinding/crunching sound {i think only i can hear this} continual pain persisting .had mri,no compression on the 3 points for tn,ENT says jaw out of alignment either due to the force of extraction or becouse i do not eat at that side {i have bottom back dentures wich when touch my other teeth or gum cause extreme pain hence i can,t wear them i have also lived off soft foods for 2years yuk}  he did not want to commit to either ,rather leaveing that to the maxo.i have been on gabapentin tramadol ,patches etc, now on pregabalin and other meds..2years ago my neurologist said i have a damaged mental nerve or it needs to be damaged, thankyou again for your reply i feel alittle more settled knowing that my nerve will no longer be exposed at this time.how would one know iff the nerve is compressed against the bone ?the injections sound abetter option.     thankyou for your time ......
Avatar universal
Sounds as if you have two seperate issues--the mental nerve and TMJoint disorder.  The first think you should ask someone to do is a diagnostic block of the mental nerve.  If that is where the nerve is irritated or damaged the pain should stop while the anesthetic is in effect.  If it does stop, I would suggest that an oral surgeon expose that area to see if there are any sharp areas of bone around the nerve (from extractions) and possibly decompress the nerve.  
As far as your TMJ problems, they may be easily solved by the correct bite in your lower partial denture.  Correct bite is the issue however, and you would need a TMJ specialist rather than an 'uninitiated' dentist to help solve this issue.  Loss of posterior (back) teeth can cause over closure of the mandible (lower jaw) and force the disc in the TMjoint out of place and/or compress the tissues in the joint.  This can cause inflammation and swelling that can compress nearby nerves.  Those nerves can cause pain in the lower jaw and around your ear (they are the inferior alveolar and auriculo-temporal nerves).  Your symptoms are consistent with that possibility.  Get the mental nerve issue resolved first so you can wear you lower partial denture to get the TMD issue addressed.  You may need to have injections and continued drugs to get you over the hump.   Good Luck,  TMJDoc
673940 tn?1232411764
hello again ,thankyou, did anyone ever tell you that you are a godsend,,,can you not move to england please, lol,, as you say my mental nerve is my main concern and this is the first thing i will ask to be addressed, everthing you said "hit,s the nail on the head" perfectly,i am now looking forward to my appointment with great enthusiasm,,!!!!! your support and advice on this site {particualy for myself} is appreciated more than you could ever know! thankyou again xx
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