STUDY - Technical - New Dacian's Medicine
jaw
pain (Classical / Allopathic Medicine)
Jaw pain may arise
from either or both of the bones that hold the teeth in the
jaw - the maxilla (upper jaw) and the mandible (lower jaw).
Jaw pain also includes pain in the temporomandibular joint
(TMJ), where the mandible meets the temporal bone.
Life-threatening disorders, such as myocardial infarction and
tetany, also produce jaw pain, as do drugs (especially
phenothiazine) and dental or surgical procedures.
Jaw pain may
develop gradually or abruptly and may range from barely
noticeable to excruciating, depending on its cause. It usually
results from a disorder of the teeth, soft tissue, or glands
of the mouth or throat or from local trauma or infection.
Systemic causes include musculoskeletal, neurologic,
cardiovascular, endocrine, immunologic, metabolic, and
infectious disorders.
Jaw pain is seldom
a primary indicator of any one disorder; however, some of its
causes are medical emergencies.
ALERT:
If the patient complains of sudden severe jaw pain:
- take his vital signs
- find out if the pain radiates to other areas
- place him on a cardiac monitor and administer oxygen
- assess him for associated symptoms of a life-threatening disorder, such as chest pain or shortness of breath
- initiate emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If the patient complains of sudden severe jaw pain:
- take his vital signs
- find out if the pain radiates to other areas
- place him on a cardiac monitor and administer oxygen
- assess him for associated symptoms of a life-threatening disorder, such as chest pain or shortness of breath
- initiate emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient to describe the character, intensity, and frequency of the pain. When did he first notice the jaw pain? Did it arise suddenly or gradually? Has it become more severe or frequent? Also, ask about recent trauma.
Ask the patient where on the jaw he feels pain. Does the pain radiate to other areas? Ask the patient about aggravating or alleviating factors.
Ask the patient about associated signs and symptoms, such as joint or chest pain, fatigue, headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss.
Ask the patient to describe the character, intensity, and frequency of the pain. When did he first notice the jaw pain? Did it arise suddenly or gradually? Has it become more severe or frequent? Also, ask about recent trauma.
Ask the patient where on the jaw he feels pain. Does the pain radiate to other areas? Ask the patient about aggravating or alleviating factors.
Ask the patient about associated signs and symptoms, such as joint or chest pain, fatigue, headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss.
PHYSICAL
ASSESSMENT:
Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling.
Check the TMJ. Place your fingertips just anterior to the external auditory meatus. Ask the patient to open and close his mouth, and then ask him to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.)
Observe how wide the patient can open his mouth. Less than 1¼″ (3 cm) or more than 2¼″ (6 cm) between the upper and lower teeth is abnormal.
Palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling.
Check the TMJ. Place your fingertips just anterior to the external auditory meatus. Ask the patient to open and close his mouth, and then ask him to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.)
Observe how wide the patient can open his mouth. Less than 1¼″ (3 cm) or more than 2¼″ (6 cm) between the upper and lower teeth is abnormal.
Palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
SPECIAL
CONSIDERATIONS:
If the patient is in severe pain, withhold food, liquids, and medications he normally takes until the diagnosis is confirmed. Apply an ice pack if the jaw is swollen, and discourage the patient from talking or moving his jaw.
If the patient is in severe pain, withhold food, liquids, and medications he normally takes until the diagnosis is confirmed. Apply an ice pack if the jaw is swollen, and discourage the patient from talking or moving his jaw.
PEDIATRIC
POINTERS:
Be alert for nonverbal signs of jaw pain, such as rubbing the affected area or wincing while talking or swallowing.
Mumps cause unilateral or bilateral swelling from the lower mandible to the zygomatic arch.
Parotiditis due to cystic fibrosis may cause jaw pain.
When trauma causes jaw pain in children, always consider the possibility of abuse.
Be alert for nonverbal signs of jaw pain, such as rubbing the affected area or wincing while talking or swallowing.
Mumps cause unilateral or bilateral swelling from the lower mandible to the zygomatic arch.
Parotiditis due to cystic fibrosis may cause jaw pain.
When trauma causes jaw pain in children, always consider the possibility of abuse.
PATIENT
COUNSELING:
If jaw pain is the result of abuse, encourage the patient to seek counseling and protection. If the patient is a child and abuse is suspected, consult social services.
If jaw pain is the result of abuse, encourage the patient to seek counseling and protection. If the patient is a child and abuse is suspected, consult social services.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)