Brief Answer:
Please explain more in details and give some more information

Detailed Answer:
Hello,

Thank you asking to talk to me again.
Yes, I have access to your previous questions.

Can you please explain to me a bit more in details what exactly is going on?
- So, as I understand it, you got better the first time and now this is a relapse because of another wisdom tooth pulled? - please explain me the course of your problem.
- What makes is worse?- moving the jaw? moving your neck? swallowing? eating?
- How many days ago did you remove the last wisdom tooth?
- Are you using anything to relieve the pain for the moment? - Ibuprofen? Local analgesic? Ice/heat?
- Why did you took the doxycycline? Did you had an infection in the ear? Is your cheek swollen?

Looking forward to your follow up question.

Kind regards,
Dr. Papaqako

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Brief Answer:
I still think it is TM joint inflammation. Take higher doses of painkiller.

Detailed Answer:
Hello again,

Of course, I read my previous answers, but from your description of "same problem" seems like it got better and now it is returning again.
Anyway, thank you for the added information.

The fact that you have started using a mouth guard, it only eliminates the further damage of the teeth, but the teeth grinding (even if less) it is still there.

For me, it makes sense that the pain is because by the jaw inflammation which is caused by the teeth grinding.

I don't see any reason for using the Doxycycline, because clearly, you didn't seem to have an infection, and the fact that it didn't help, despite taking it, proves the same also.
I also doubt that it will be an ear problem, so expect the hearing test to be normal.

My recommendations are:
- Use Ibuprofen regularly- 400mg 3 times/day for the next 2-3 days.
- Use Ice/heat in the joint and avoid eating solid foods. It is like an open wound now and it needs to heal, which will happen slowly.

- Let me know what will the ENT say though. I will be happy to follow up with you after if you think I can help you with clarifications in case of any further questions.

Regards,
Dr. Papaqako

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Brief Answer:
More practical advises.

Detailed Answer:
Hello,

Glad that you confirmed for sure your diagnoses with an close examination.

It is very common that once one side is inflamed, the other will become too because the jaw moves the same in both sides.

Now, you will need lots of patience, because it may need up to 6 weeks to settle down.

Here are some other suggestions of what you can do, except of the above suggestions:
- self-care may aid in healing and prevention of further injury and includes
a) resting masticatory system by limiting mandibular function
b) massaging affected muscles
c) performing gentle range of motion exercises

- therapeutic exercise may include
a) lateral jaw movement
b) protrusive jaw movement
c) resisted closing
d) resisted opening
e) tongue-up exercise

After trying the analgesics, ice and heat for 1-2 weeks, and if not better, then you can seek for the help of a physical therapist who can explain to you by showing specific exercises.

Hope I have helped more.

Let me know if you have other questions.

Regards,
Dr. Papaqako

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