Acute Temporomandibular Joint Dislocation Immediately Following Mandibular First Molar Extraction: A Case Report and Review of Clinical Management

Abstract

Introduction: Temporomandibular joint (TMJ) dislocation is an uncommon but potentially distressing complication that may occur during dental treatment as a result of prolonged mouth opening, excessive mandibular translation, or predisposing joint laxity. Although frequently reported following lengthy dental procedures and third-molar surgeries, acute TMJ dislocation after a routine extraction is infrequently described in the dental literature.¹˒⁷ Prompt recognition and chairside management are essential to prevent patient discomfort, muscle spasm, and the need for emergency intervention.
Case Presentation: A 26-year-old healthy female presented for extraction of the mandibular right first molar (#30) due to extensive dental caries with pulpal involvement, cracked tooth syndrome, dental pain, and associated periapical abscess. Medical history was noncontributory, and the patient denied previous surgeries, tobacco use, or a history of temporomandibular joint disorders. Local anesthesia was achieved with one carpule of 4% articaine with 1:100,000 epinephrine administered by infiltration and one carpule of 2% lidocaine with 1:100,000 epinephrine administered as an inferior alveolar nerve block. Extraction was completed uneventfully using elevators and forceps, and hemostasis was achieved. Immediately following the procedure, the patient developed an inability to close her mouth consistent with acute mandibular dislocation. Manual reduction was performed chairside using downward and posterior mandibular pressure, resulting in immediate restoration of mandibular function and symptomatic relief. Postoperative instructions focused on avoiding excessive mouth opening and minimizing the risk of recurrence.
Discussion: Acute TMJ dislocation during dental treatment is uncommon but may occur even during routine procedures requiring sustained mouth opening.¹˒⁷˒¹⁰ Risk factors include prolonged mandibular depression, ligamentous laxity, previous episodes of dislocation, and excessive opening during treatment.⁷˒¹¹ Early recognition and immediate manual reduction remain the cornerstone of management.⁷˒¹⁰ Dentists should be familiar with the clinical presentation and reduction techniques to ensure prompt intervention and prevent complications.
Conclusion: This case highlights an uncommon complication occurring after routine mandibular molar extraction and demonstrates successful chairside management through immediate manual reduction. Awareness of TMJ dislocation, its predisposing factors, and appropriate management strategies is essential for all dental practitioners.