Acute Jaw Pain Protocol

Recognize, Treat & Prevent Common Jaw Injuries that Can Lead to Chronic Pain

How should you treat a dental patient who presents with acute sudden onset jaw pain? Here are two new protocols developed by orofacial pain experts to help dentists and dental practice team members recognize, treat, and prevent Jaw Joint and Muscle Sprain/Strain (JAMSS) injuries – a condition commonly associated with dental procedures.

What is Jaw Joint and Muscle Sprain/Strain (JAMSS)?

Jaw Joint and Muscle Sprain/Strain (JAMSS)  describes an acute trauma to the jaw joint or muscles. JAMSS is characterized by sudden onset acute jaw pain, limited range of motion, tenderness or dysfunction. It is a localized, acute musculoskeletal disorder caused by traumatic or mechanical injury or both. Sudden onset acute pain associated with JAMSS refers to a patient with no prior history of jaw pain or treatment for dysfunction. It is common for both muscle strain and joint sprain to coexist.

JAMSS is one of the most common sequalae to dental procedures

Trauma during dental care may occur after local anesthetic injections, hyperextension from opening the mouth too wide or for too long a period, or placing excessive force on the jaw during a dental procedure.  Especially relevant is that more than 50% of patients with temporomandibular disorders (TMDs) report that the initial onset of pain was a direct result of dental care.

Other causes of JAMSS include car accidents, intubation during general anesthesia, yawning, a blow to the jaw, vigorous chewing, acute bruxism, or similar types of events. JAMSS injuries can be minor or quite severe, and may be complicated by a number of other health issues.

What are symptoms of JAMSS?  (some or all may occur; no prior history)

  • Acute jaw, face, ear, and/or head pain
  • Limited, pain-free range of motion, less than 40 mm incisal to incisal edge
  • Tenderness of jaw muscles and ligaments
  • Dysfunction (difficulty chewing, opening or closing mouth)
  • Inflammation with swelling and tenderness of joint
  • Localized pain

What causes JAMSS?

  • Direct trauma to the jaw muscles or joints (including injections)
  • Sustained or forceful contraction of the masticatory muscles
  • Hyperextension of the masticatory muscles and temporomandibular joints
  • Prolonged stretching of the masticatory muscles and joints, ligaments and tendons

Two New Protocols for Treatment and Prevention of JAMSS

Two new protocols have been developed by orofacial pain experts to help dentists and dental practice teams recognize, treat, and prevent, jaw and muscle sprain/strain (JAMSS). The protocols were developed by Bradley Eli, DMD, MS, and James Fricton, DDS, MS, Diplomates of the American Board of Orofacial Pain, with input from Lee Ann Brady, DMD, Clinical Education Director at the Pankey Institute.

The JAMSS Speed-to-Treat Protocol
FOR TREATMENT of Jaw Joint and Muscle Sprain/Strain Injuries

The JAMSS Speed-to-Treat Protocol is a comprehensive care plan to manage and evaluate acute jaw joint and muscle sprain/strain over a 2 to 4-week period from injury onset. It is an orthopedic model of care that recognizes the unique characteristics of the jaw joint and facial musculature and nervation. With the JAMSS Speed-to-Treat Protocol, treatment begins the same-day your patient presents with symptoms. This is a significant advantage in that a speed-to-treat approach reduces the chance of the injury progressing to a chronic condition. Furthermore, the protocol stratifies results and provides the practitioner with a clearly defined path for next steps in care. Extensive training in TMJ disorders is not required for implementation by front-line care providers.

DOWNLOAD – JAMSS Speed-to-Treat Protocol


The S.A.F.E. Protocol
FOR PREVENTION of JAMSS Injuries During Dental Treatment

The S.A.F.E. Protocol is a pre-treatment protocol to help dental professionals prevent and minimize Jaw Joint and Muscle Sprain/Strain (JAMSS) injuries during dental treatment.

S.A.F.E. stands for:
Set-up for safety
Assess risk
Follow protective measures
Evaluate the patient post discharge


DOWNLOAD – S.A.F.E. Protocol


Every Dental Team Member Needs to Understand JAMSS

Every team member needs to understand what JAMSS is, how it happens, and the systems in place in the office for prevention and management. The JAMSS Speed-to-Treat Protocol, and the S.A.F.E. Protocol documents provide dental teams with clearly defined paths for prevention and treatment. The protocols and associated documents are available free of charge to dental professionals courtesy of Dr. Eli and Orofacial Therapeutics, LP.

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