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"There was a crooked man, who walked a crooked mile. He had a crooked cane, and he wore a crooked smile."
August 31, 2011 4:15 AM   Subscribe

Due to a recent and very vigorous visit to pukesville, I'm pretty sure that I've dislocated my jaw. Would a walk-in clinic or urgent care clinic (if those exist) be able to put my jawbones back in order, or does this mean a lengthy trip to the ER? I am in downtown Toronto.

Background:

I noticed on the day following my middle-of-the-night escapade that the part of my jaw just in front of my right ear hurt like hell. I also noticed that the teeth on the left side of my mouth were highly sensitive, almost as though they were swollen due to an infection. I assumed at this point that the cause of my trouble was merely a pulled muscle, an inner ear infection... or possibly lockjaw since I'd accidentally stabbed myself with a dirty bike tool a few days before.

Five days later, since the pain wasn't subsiding, I finally put two and two together and realized (a) that my jaw actually hangs a bit askew, (b) that I can only in fact bite down on the left side of my mouth, and (c) that if I try to bite down hard on the right side, my brain explains to me that this is the most painful and therefore stupidest thing I have ever done in my life, and that the only sensible thing to do is to stop doing it immediately. I then proceed to bite down a couple more times just to make sure my theory is correct.

Sooo...

(a) would a walk-in clinic be able to pop this bad boy back into place?
(b) if not, would an urgent care clinic be able to manhandle my mandible?
(c) or, if no such clinics exist, does this then mean I have to go to the ever-so-dreadful ER?

My sole reason for asking is that I don't want to wait a day or three at the bottom of an ER triage list to be seen for something that is really quite non-emergent (by this point, anyways) and not painful at all (except when I try to bite stuff) if I could just get it handled at a much closer, quicker, and more convenient venue. I thought about trying to reseat it myself, but then got scared and figured that with my luck, I'd unhook it completely and it'd fall right off or something. I really have no clue what the best course of action is, and I'm waiting until tomorrow morning to leave.
posted by anonymous to Health & Fitness (10 answers total)
 
Find out what clinics are available in your area, and then your best bet would be to call and ask. M guess is that you're more likely to find an "urgent care clinic" that can perform this procedure, and not to bother containing a clinic billed as a lower-level "convenient care clinic".

My son was a frequent shoulder dislocator, and one time I decided I'd rather pay half as much in copays and have a shorter wait by taking him to an urgent care clinic. Their website mentioned being equipped to set broken bones and such, so I *assumed* that they could pop a shoulder back into place!. Got there, paid a $50 co-pay, and waited 30 minutes only to be told that there was no staffperson in that afternoon who could perform the procedure, and got redirected to the ER anyhow. Unnecessary agony all around.
posted by drlith at 4:34 AM on August 31, 2011


Sounds to me very much like a bout of TMJ that I had about a decade ago. My childhood orthodontist was able to make me a little device that reset my bite and brought relief in a couple of hours. Before you go to the ER, you might try at least calling a dentist or orthodontist first.
posted by dseaton at 6:01 AM on August 31, 2011


Call telehealth! Talk to a medical professional, not the internet.
posted by monkeymonkey at 7:54 AM on August 31, 2011 [1 favorite]


monkeymonkey, Telehealth will probably just tell the OP to go the ER.

Personally, I would go to the ER. Putting it back in place can be a pretty painful process, and at the ER, they can give you sedation to make it a bit more pleasant. The urgent care centre at Women's College should be able to do this: I'd give them a call first, since the waiting time there is usually pretty reasonable.
posted by greatgefilte at 8:16 AM on August 31, 2011


Don't know how much pain you're experiencing, but I used to "pop" my jaw all too frequently.
It cleared up all but permanently after a summer taking t'ai chi classes, if that's worth anything.

Anyway, the fix for me involved a lot of neck twisting and awkward positioning of my head, all while doing various yawn-like and grimace-like movements, until it would pop back. I never had it last more than a few hours, though. But if you can do what I've just described without passing out from the pain, you're probably going to be able to help it find the sweet spot where the muscles, after all, want it to go.

So try that, then try urgent care. Check to see that they have an orthopedist on call, though.

Regarding my own experience, I always also considered that this was one of the few things (along with lower back pain) I would trust a chiropractor with. I've never given that a shot, though. On the upside, you may well be able to find one who can see you right away.
posted by dhartung at 11:31 AM on August 31, 2011


The longer a dislocation is out for, the harder it is to put back in. If your jaw has actually been dislocated for 5 days, it might be really tough to reduce it. Agreed with the vote to go to the ER. Disagree with chiropractor. See a physician. I'm not sure what time zone you're in, but if you have a choice about it, go at like 7 or 8am - it's typically one of the lowest volume times in the ER and you are more likely to be seen right away.
posted by treehorn+bunny at 12:20 PM on August 31, 2011 [1 favorite]


drlith, OP is in Canada. We don't have "co-pay" here.

Is there some distinction in Ontario between "walk in" and "urgent care"? There isn't here in Alberta. Also you don't mention if you have a family doctor. If you do, go see her/him.

ER isn't as bad as you might think incidentally. My last two visits (again, this in Calgary but I'd be shocked if Toronto is any worse) were, for me most recently, 5.5 hours for a vist that comprised a CT scan and counting triage/intake/doctor/CT/doctor again I was in some sort of "care" almost constantly; the time before that my partner had broken a bone in this leg and we were seen in less than 15 minutes and back home, x-ray cast and all, in less than 2 hours.

No co-pay. Obviously.
posted by ethnomethodologist at 3:20 PM on August 31, 2011


From the OP:
Thanks all for the responses:

(i) I called telehealth that night, and the nurse basically said that her script told her to refer me to a physician within four hours. She seemed none too worried when I told her I'd go to a clinic in the morning.

(ii) I went to the urgent care clinic at Women's College Hospital within twelve hours.

(iii) Urgent care clinics are Ontario's intermediate clinic for issues that are more serious than the average walk-in issue, but which are not emergencies.

(iv) The doctor there said it is TMJD

(v) This makes sense because, at least as Wikipedia states, "The dysfunction involved is most often in regards to the relationship between the condyle of the mandible and the disc. The sounds produced by this dysfunction are usually described as a "click" or a "pop" when a single sound is heard and as "crepitation" or "crepitus" when there are multiple, rough sounds."

These rough sounds existed before the injury: when I'd move my jaw to the left, I'd hear grinding below my right ear. I believe what I did to cause this whole thing, though which I remembered only after the visit to the doctor, was to turn my jaw too far too the left (until it popped), under the inane presumption that getting rid of this grinding sound would be as simple as cracking a knuckle. It was... but hoo boy is it painful.

(v) A chiropractor will be my next step: I've heard good things from a person who had TMJ. It seems that the whole problem is just that something (but not a joint, apparently) is out of place and I need somebody to push that something back in. The doctor recommended a visit to a dentist if it doesn't clear up, and that'll be my third step...

A final question, thouh, if anyone is still reading:

Will the fact that I caused this by having moved by jaw laterally until it popped have affected the doctor's diagnosis? I told him that I thought it was from opening wide, but then I remembered what I'd really done: the grinding was annoying me at the time, and it was the same sort of grinding you feel in a joint that's about to pop, so I figured...
posted by jessamyn at 4:44 PM on August 31, 2011


This is dentist territory, not physician or (g*d forbid) chiropractor territory, so a trip to the dentist is in order. There's a lot of anatomy in and around the tmj, and none of it likes to be inflammed. Muscles get sore, ligaments gets stretched, the capsule (where the condyle sits when you are fully closed) gets inflammed and tender. start taking otc nsaids if you can tolerate them, keep the muscles loose but don't go too far in any one direction. reducing a truly dislocated jaw is uncomfortable, but not very difficult , and a dentist can get you numb.
posted by OHenryPacey at 11:46 PM on August 31, 2011 [1 favorite]


TMJ is definitely a dentist thing, as OHenryPacey correctly says above. Go to your dentist, they can give you a device that will help prevent future TMJ pain, including teeth grinding which may be part of the whole deal.
posted by 1000monkeys at 1:09 PM on September 1, 2011


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