An interesting article titled “The relationship between third molar extractions and TMD: Or is there one?” written by Dennis Marangos appears in Cranio: the Journal of Craniomandibular and Sleep Practice (Volume 41, Issue 4, 2023). The author was prompted to write the article based on patients coming in saying they did not have jaw pain before my wisdom teeth were extracted but, now have jaw pain and clicking. As a result the author did a literature review to examine the possible relationship.
One of the most common surgeries in the 20th century is wisdom teeth surgery. Experts have suggested that our face and jaw structure has become smaller due to the introduction of processed foods over generations. This smaller jaw size means underdeveloped cranial structures and that wisdom teeth just do not fit. Temporomandibular disorder (TMD) is a term used to describe facial pain, pain in masticatory muscles, pain in the temporomandibular joints (TMJs), and any associated structures and also incldes the pain and clicking sound when chewing. TMD symptoms are estimated to affect up to 45% of the population.
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When examining if there is a relationship between TMD and wisdom teeth surgery the author reviewed an article that suggested that patients exposed to wisdom teeth surgery were at higher risk in developing TMD. Other studies showed that wisdom teeth extractions are a risk factor for the development of TMD. Additionally, articles showed that TMD can be aggravated depending on the location of a wisdom tooth, the degree of impaction and surgical difficulty, age, and gender. One study showed there was an insignificant risk of TMD 6 months surgery. The author found that the use of excessive force during extraction was a common theme. In a study the prevalence of TMJ injuries after extractions was between 50% and 63%; however, in different study, only 16% of the patients reported severe TMD post-surgery. It does seem that the time one has the jaw open during the surgery may play a role in the development of TMD. The author states:
“We can safely say that trauma may lead to TMD. Is third molar [wisdom tooth] surgery ‘enough’ trauma to cause TMD (or perpetuate an existing condition)?”
Nonetheless an association of wisdom tooth surgery with TMD does not prove causation yet feels it is important to include a full temporomandibular joint assessment prior to any wisdom tooth surgery. The author states that treatment of TMD arising from a traumatic surgery should focus on improving function and reducing pain. The authors says conservative management is key and the pharmacological management of TMD along with oral appliances and prolotherapy to assist in healing is what is commonly used in treatment today.