Dental Patient's Jaw Becomes Dislocated During Cleaning

Case Overview

This case involves an elderly, non-verbal man with Alzheimer’s who went to a dentist’s office for a cleaning. The cleaning was performed by a hygienist under the supervision of a dentist. A bite block was placed during the procedure. After the procedure, the patient could not close his mouth. This persisted and the next day, the patient went to an urgent care facility. The patient was then referred to the hospital emergency room where a stroke was ruled out. An X-ray revealed that the patient’s mandible was dislocated. The patient required a corrective procedure and a stay in the hospital.

Questions to the Dentistry expert and their responses

How often in your practice does a hygienist assist in dental cleanings?

Our dental hygienist performs nearly all of our routine dental cleanings as well as most root planning and scaling treatments. This is customary for most dental practices.

In general, what aspects of the placement of a bite block and subsequent management can help prevent a dislocated jaw?

Use of a mouth prop/bite block in a patient with some form of dementia may be essential in order to be able to make a proper diagnosis and safely provide treatment. It is also more comfortable for some patients to rely on this artificial form of support than to voluntarily hold their mouth open for the duration of treatment. Proper use of a bite block should not cause a TMJ dislocation.

What is the management, in general, of a dislocated jaw after a procedure?

Following the dental procedure, I would have certainly tried to determine if the problem seemed like a muscular problem, a TMJ dislocation or even a possible fracture of the jaw. Dislocations can be successfully managed by either a primary care dentist with some experience or an oral and maxillofacial surgeon. Management of a case like this starts with a proper diagnosis. A routine 2D panoramic radiograph or 3D Conebeam (available in many dental offices) would likely show the dislocation. If a diagnosis could not be made, then referral would be indicated.

About the expert

This highly qualified expert has over 35 years of experience in general dentistry. He obtained his BA in chemistry from Temple University, before receiving his DMD from the Temple University School of Dentistry. He then completed an internship in general practice dentistry and a residency in implant surgery at Temple University, followed by a second residency in oral pediatrics at St. Christopher's Hospital for Children. Today, this expert is a licensed dentist in New Jersey and New York, and he is certified in laser dentistry. He is an active member of several professional organizations, including the American Dental Association, the Academy of General Dentistry, and the International Academy of Dentofacial Ethics. He is also active in academia, having published over 50 scholarly studies, abstracts, and scientific articles, as well as a textbook on dental impression taking. This expert previously served as a clinical associate professor of cariology and comprehensive care and as the educational director of the CDE esthetic dentistry programs at the NYU College of Dentistry, as the director of predoctoral esthetic programs at Columbia University College of Dental Medicine, as a staff dentist at the Cooper Hospital/University Medical Center, and as an attending dentist at Medford Convalescent and Nursing Center. He is currently a dentist at a general dentistry private practice, an associate attending dentist at an Ivy League-affiliated hospital, and an associate clinical professor of operative dentistry at an Ivy League dental school in New York.

E-373564

Specialties:

Dentistry

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

Dental Patient’s Jaw Becomes Dislocated During Cleaning