Trismus or lock jaw

What Is Trismus?

"Trismus" is a term used to describe any number of conditions that cause an uncontrolled inability to open the mouth or jaw. The most common cause of trismus is inflammation of the soft tissue of the mouth due to:

-An impacted molar
-Removal of the wisdom teeth
-Removal of the tonsil

Less common causes of trismus are:

-Tetanus ("lockjaw"), an acute infection from bacteria that usually enter the body through a wound
-Radiation therapy to the face and neck
-Poor oral hygiene

Diagnosis

Your dentist or physician will discuss your medical history leading up to the trismus and do a physical examination. Head and neck imaging may be needed to detect the cause. These may include:

Panoramic X-rays
Magnetic resonance imaging (MRI) scans
Computed tomography (CT) scans

Signs and Symptoms Symptoms of trismus include:

-Increased jaw pain
-Inability to open the jaw
-A "spasm" sensation when attempting to open the mouth
Difficulty chewing
Difficulty talking
Difficulty breathing
Difficulty keeping teeth clean

If you have trismus, you may be at risk for choking. Because you can't chew as well, you might have to change your diet—and this could mean not getting adequate nutrition. Even just moving food around in your mouth may be difficult, because the tongue is commonly affected with trismus.

How Can a Dentist Help?

Treatment depends on the cause of the trismus. Tests to diagnose the cause should begin as soon as possible. Otherwise, the condition can get worse. This makes treatment more difficult.
Many devices can be used to open the mouth gradually. They vary in cost, function and how well they work. They are not prescribed in every case.
Exercises usually are prescribed. They should be done several times a day. They may be required for many months to ensure that the trismus does not get worse or return. In more severe cases, physical therapy and muscle relaxants may be prescribed.

Your dentist can help restore the natural movement of your jaw and improve your daily function. Trismus tends to develop slowly. In some people, it progresses so slowly that they might not even notice it until they can open their mouth only halfway. The sooner you see your physical therapist, the better, because treatment that begins before trismus gets worse is likely to be more effective and also easier for you.

During your first visit with your dentist, he or she will:

-Review your medical history, and discuss any previous surgery, fractures, or other injuries to your head, neck, or jaw
-Conduct a physical examination of your jaw and neck
-Evaluate your posture and how your neck moves
-Examine the temporomandibular joint (TMJ) to find out how well it can open and whether there are any abnormalities in jaw motion since you developed trismus

The dentist might place his or her hand in your mouth in order to examine your jaw movement.

Following the examination, the dentist will select the appropriate treatments to improve your jaw movement and relieve pain.

Improve Your Jaw Movement

Research shows that the most effective exercise program includes opening up the jaw to the point of discomfort and holding that position for 7 seconds for 7 repetitions, done 7 times a day.

it might also help to use skilled hand movements called manual therapy to increase movement and relieve pain in tissues and joints. The dentist might use manual therapy to "stretch" the jaw in order to:

-Restore normal joint and muscle flexibility (so that you won't feel"tight")
-Break up the scar tissues ("adhesions") that may occur after disease or injury has limited movement for a long period of time

You may be taught special "low-load" exercises. These are exercises that don't exert a lot of pressure on your TMJ but can strengthen the muscles of the jaw and restore a more natural, pain-free motion. The dentist will teach you exercises that help you increase the opening of your jaw and improve the way it works.

Relieve Your Pain

In addition to manual therapy, if your pain is severe, your dentist might call a physical therapist and may decide to use treatments such as electrical stimulation or ultrasound to reduce pain.

Milan Tomic

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