Jaw Pain Diagnosis and Evidence-Based Clinical Guidelines
Based on the patient’s symptoms, the primary diagnosis for this patient is temporomandibular joint (TMJ) disorders. Ear pain linked with TMJ occurs due to inflammation spread from the jaw area (Dimitroulis, 2018), so the patient had jaw pain radiating to the ear. The ear is very close to the TMJ; the inflammation will be shorter if joint swelling and tenderness occur. Ear pain associated with the TMJ mainly affects the middle ear (Dimitroulis, 2018). Ear pain related to TMJ is dull but can sometimes be sharp. This pain is worsened with jaw movements (Dimitroulis, 2018). Improvements in the TMJ will lead to the improvement of ear pain. The first differential for this patient would be a dental infection. Dental infections can be a source of secondary ear pain, and this is because of complex neuronal connections to cranial nerves (Earwood et al., 2018). The second differential for this patient is trigeminal neuralgia, a sharp and sudden pain in the jaw that can cause secondary otalgia (Majeed et al., 2018).
Non-surgical management of TMJ disorders is the most effective way of managing this condition in most patients. There are many non-surgical treatment options for managing this patient, and they will be combined to manage the patient’s needs effectively. The first step will be to reassure and explain to the patient, and will involve explaining to the patient the nature and the causes of the disease (Dimitroulis, 2018). The next step will involve formulating a self-care routine for this patient. This will include home exercise, stress avoidance, avoiding excessive chewing, and massaging of the affected muscles (Dimitroulis, 2018).
The patient will be advised on ways of limiting voluntary mandibular function. Avoiding excessive talking and chewing will promote the immobilization of articular and muscular structures (Dimitroulis, 2018). In addition, the patient will be advised to avoid foods that require excessive chewing and to eat soft diets. Lifestyle is critical in the management of TMJ disorders. The patient will also be discouraged from wide signing, yawning, gum chewing, and other activities resulting in excess mandibular function.
Furthermore, the patient will be advised to massage the affected muscles by applying moist heat, which will help soothe the tired and aching muscles by promoting muscle relaxation (Dimitroulis, 2018). The patient will also be advised to develop better coping strategies. The patient will be advised to identify any stress sources and find better ways of dealing with these stresses (Dimitroulis, 2018).
Dimitroulis, G. (2018). Management of temporomandibular joint disorders: A surgeon’s perspective. Australian Dental Journal, 63, S79-S90. https://doi.org/10.1111/adj.12593
Earwood, J. S., Rogers, T. A., & Rathjen, N. A. (2018, January 1). Ear pain: Diagnosing common and uncommon causes. AAFP American Academy of Family Physicians. https://www.aafp.org/afp/2018/0101/p20.html
Majeed, M. H., Arooj, S., Khokhar, M. A., Mirza, T., Ali, A. A., & Bajwa, Z. (2018). Trigeminal neuralgia: A clinical review for the general physician. Cureus. https://doi.org/10.7759/cureus.3750
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Select one of the following discussion questions:
A 66-year-old patient presents to your office with jaw pain. She states she has had jaw pain that radiates to her ear for the last week. She thought she had a tooth infection, but her dentist told her nothing appeared to be wrong. He recommended she see her primary care physician. She is requesting pain medication because it hurts so badly. Provide at least three possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.
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