Persistent Orofacial Pain Following Recreational Drug Use

Case at a Glance

A 23-year-old male presents with severe jaw pain, dental discomfort, throat pain, and oral sensitivity persisting several days after recreational cocaine use.

Patient's Story

The patient reports experiencing severe jaw and tooth pain, throat discomfort, and sensitivity in the upper palate that began following cocaine use on a Friday evening. He describes this as his first use in several months and states he has never experienced such prolonged symptoms after previous occasional use. The patient sought initial care at an urgent care facility where he was told the symptoms were related to his drug use, with throat examination reported as normal.

Initial Assessment

Patient presents with complaints of persistent orofacial pain including jaw pain, dental discomfort, throat pain, and palatal sensitivity. Vital signs stable. Initial urgent care evaluation reportedly showed normal throat examination. Patient appears distressed by the duration and severity of symptoms.

The Diagnostic Journey

Initial urgent care assessment attributed symptoms to cocaine use with normal throat findings. Patient continued to experience symptoms for multiple days post-exposure, prompting further evaluation. Differential diagnosis includes bruxism-induced temporomandibular dysfunction, drug-induced vasoconstriction effects, or potential adulterant-related tissue irritation.

Final Diagnosis

Cocaine-induced bruxism with secondary temporomandibular joint dysfunction and associated myofascial pain. The prolonged jaw clenching and teeth grinding commonly associated with stimulant use resulted in muscle strain and TMJ irritation.

Treatment Plan

Conservative management with anti-inflammatory medication (ibuprofen 400-600mg every 6-8 hours as needed). Patient counseled on jaw rest, soft diet, and avoidance of stimulant substances. Heat/cold therapy and gentle jaw exercises recommended. Follow-up advised if symptoms persist beyond one week.

Outcome and Follow-up

Patient advised to monitor symptoms and return if pain worsens or fails to improve with conservative treatment. Substance use counseling resources provided. Long-term prognosis good with cessation of stimulant use and appropriate jaw care.