An Algorithm for Jaw Pain among Divers

Abstract

Background: Temporomandibular disease (TMD) is commonly seen, and divers also experience pain in the temporomandibular joint (TMJ) or masticatory muscles. This article aims to provide a tool for diving physicians or medical professionals involved in diving medicine since jaw pain among divers is a pertinent subject and can be challenging to evaluate without some background in dentistry or maxillofacial surgery. Method: A basic algorithm was developed to provide a tool to differentiate jaw pains experienced by divers. Three brief case studies were developed, and five diving physicians were tasked with diagnosing the cases using the algorithm. Additionally, simple exercises and massage techniques that can benefit patients with TMD, particularly immediately after diving, are outlined. Results: All five diving physicians successfully diagnosed the cases using the algorithm. However, three of them were unable to diagnose the first case (disc luxation) without consulting the algorithm. Nevertheless, all physicians acknowledged the utility of the algorithm. Conclusions: Jaw pain in divers can stem from diverse causes, but effective treatment options exist. Our study findings provide valuable insights to assist diving physicians in making accurate diagnoses and guiding appropriate patient management, which may include referrals to specialists such as dentists, maxillofacial surgeons, or orthodontists.

Keywords: decompression sickness; diving; masticatory muscles; osteoarthritis; pain; temporomandibular joint.

Figure 1

An algorithm to differentiate the causes of jaw pain among divers.

Figure 2

Relaxation of the m. masseter. Massage of the m. masseter in the cheek area. Massage the attachment points in particular. Stroking the muscle strands or circling the pain point is recommended. The pressure of the techniques is best chosen so that the pain threshold is not exceeded, and the targeted pain points can be massaged. At the same time, the lower jaw should be slightly open without tension.

Figure 3

Relaxation or massage of the m. temporalis. Massage the temporal region with your fingers. We recommend stroking the muscle strands or circling the pain point. The pressure of the techniques is best chosen so that the pain threshold is not exceeded, and the targeted pain points can be massaged three times a day for 2–3 min each. At the same time, the lower jaw should be slightly open without tension.

Figure 4

Relaxation or massage of the medial pterygoideus muscle. The inside of the lower jaw should be pressed outwards and massaged lightly. We recommend stroking the muscle strands or circling the pain point. The pressure of the techniques is best chosen so that the pain threshold is not exceeded, and the targeted pain points can be massaged. At the same time, the lower jaw should be slightly open without tension.

Figure 5

Relaxation or massage of the lateral pterygoid muscle. The area along the upper row of teeth should be pressed gently backward or upward with your finger. Press carefully, as this muscle is often painful. At the same time, the lower jaw should be slightly open without tension.

Figure 6

(a,b) Exercises to improve the lateral movement of the lower jaw. (a) Place your right hand on your right jaw. Gently push your jaw against the hand, increasing pressure of the hand. (b) Slowly move the lower jaw to your right and left. If necessary, a wooden stick, pencil, or a cork cone can also be held loosely between the teeth. Repeat this exercise five times.

Figure 7

Forward and backward movements of the jaw. Touch the front of your chin with your fingers. Slowly tense the lower jaw forward and downward without any movement. Hold the tension for 10 s.