Sir, I write in response to the letter from K. Parker of London regarding their unfortunate experience of a patient dislocating their jaw while performing RCT.1 There are a few points I would like to make which may be of benefit. Firstly, jaw dislocation is relatively common and can occur during any form of dental treatment, extractions or oral surgery. It can also become dislocated during other scenarios: seizure, oral sex, eating, yawning and vomiting.
The acutely dislocated mandible is often exquisitely painful and timely reduction is paramount for a variety of reasons. It can be done with ease in the dental chair and does not always require administration of local anaesthesia. The earlier a reduction is performed, the easier it is to do, and less likely that the patient will require hospital treatment for sedation or general anaesthesia. There two main techniques of reduction but misconception surrounds both of them frequently. It is a subject often never covered, or poorly covered, in dental school as K. Parker alludes to. This leaves many dentists in fear of attempting reduction at all.
K. Parker describes the classic teaching of 'push back and down' which is incorrect and will fail in a large proportion of patients to reduce the dislocation. The most successful position in which to stand is behind the patient (and most dentists are used to this position, the opposite can be said for doctors). Placing the thumbs onto the external oblique ridge and the fingers under the lower border of the mandible, slowly increasing force should be applied in a caudal direction to overcome the spasm of the temporalis, pterygoid and masseter muscles. Very little 'posterior' force is required as once the condylar head is inferior to the articular eminence the muscle pull will draw the condyle back into the fossa and reduce the dislocation.
For further reading there is a good paper in the literature outlining the anatomy, aetiology and treatment of this injury.2
Parker K . Dislocated jaw. Br Dent J 2012; 213: 377.
Luyk N H, Larsen P E . The diagnosis and treatment of the dislocated mandible. Am J Emerg Med 1989; 7: 329–325.
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Parbhoo, A. Relocating the jaw. Br Dent J 214, 274 (2013). https://doi.org/10.1038/sj.bdj.2013.280