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David, Several things come to mind. Removing teeth can alter the height of the oral cavity as well as alter occlusion. This can begin a cascade of events that can alter joint mechanics as well as length / tension relationships of the muscles of mastication. Does she need a bridge? Is the left TMJ hypomobile? Inquire about the effect of parafunctional behavior on her symptoms and modify accordingly (Keep her opening to a minimum until her symptoms begin to subside - smaller bites of food, etc). Rhythmic stabilization exercises could be effective as well as a midline exercise, during opening and closing, that facilitates normal kinetics. These are challenging patients - Good Luck!! Rege At 03:24 PM 10/15/2001 +0100, you wrote: >Dear All > >I have a patient with severe O.A of the left T.M.J who since having >three lower left teeth extracted she has developed problems >with "subluxing" of the right lower jaw when she opens her mouth. Her >problem is not one of pain but instability. This is now causing >ulceration of her right inner cheek as she finds it difficult to hold >the food in the left side of her mouth. >Any suggestions what I can do for this instability. The dental surgeons >have given up on her and have recommended physio. > > Rege Turocy, DHCE, PT Assistant Professor Department of Physical Therapy Rangos School of Health Sciences Duquesne University Pittsburgh, PA 15282 412/396-5545