Several techniques are useful, including the use of tongue depressors of serially increasing size inserted between the incisors or the molars. Patients need to know that trismus that occurs 1 year after treatment will be permanent and that there is no good surgical or medical therapy.
Trismus usually resolves itself in less than two weeks, but it can be very painful in the meantime. Permanent trismus can occur too. Whether trismus is around for days or months, daily exercises and massaging can ease the pain.
Trismus is commonly referred to as lockjaw and is usually due to sustained tetanic spasms of the muscles of mastication. Although it was initially described in the setting of tetanus, it is now used to refer to a bilateral restriction in mouth opening from any cause.
Severe trismus makes it difficult or impossible to insert dentures. It may make physical re-examination difficult, if limited mouth opening precludes adequate visualization of the site. Oral hygiene is compromised, chewing and swallowing is more difficult, and there is an increased risk of aspiration.
Trismus has also been defined as mouth opening less than 40 mm; others have defined it as an opening to 15 to 30 mm, or even less than 20mm. Additionally, other authors have graded trismus according to visual assessment of mouth opening (light/moderate/severe or grades 1 to 3, again corresponding to mouth opening).
Common medications for trismus include muscle relaxers and nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain. Depending on the severity of the symptoms, a doctor may prescribe oral medications or drugs that require injection into the jaw. Some forms of NSAIDs are also available over the counter.
Trismus can be caused by damage to the muscles and/or nerve responsible for opening and closing the mouth and for chewing.
Suggest taking analgesics: ASA or acetamiophen 325 mg, 1-2 tablets every 4-6 hrs; or ibuprofen 200 mg, 1-2 tablets every 4 hrs. Muscle relaxants may be used in combination with analgesics or alone. Benzodiazepines may also be used, such as diazepam (2-5 mg, 3 times/day).
The 3 Finger Test
A quick and easy way to identify a possible case of Trismus is to place three of your fingers, stacked, between your upper and lower teeth, or dentures. If the mouth can open wide enough to accommodate them comfortably, then Trismus is unlikely to be a problem.
Generally, trismus is gradually alleviated or disappears within approximately 1 to 2 weeks post-operatively; however, in very rare cases, trismus persists for >1 month.
Recent studies have shown that patients with trismus have persisting problems with pain, chewing and eating, dry mouth and lack of taste, all of which results in impaired HRQL [5. Int J Oral Maxillofac Surg 2006;35:337–42.
Episodes of severe, shooting or jabbing pain that may feel like an electric shock. Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth. Attacks of pain lasting from a few seconds to several minutes. Pain that occurs with facial spasms.
While most nerve damage is always accidental, negligence by a dentist during a dental procedure can also result in dental nerve damage. With treatment, dental nerve damage can heal in six to eight weeks. If, however, the effects last more than six months, then it is considered permanent nerve damage.
If you feel like you might have Trismus or lockjaw, it is important that you visit an ENT hospital. They might refer you to a dental surgeon and an orthopedician, based on the severity of the condition.
Trismus caused by inflammation resolves by itself in due course, without need of any intervention. Whereas, when there is infection, trismus persists for a prolonged duration and it may even aggravate. This can be controlled by prescribing antibiotics.
One of the most significant challenges for individuals living with trismus is maintaining proper oral hygiene. If you cannot open your mouth wide enough to insert a toothbrush, a cotton swab may be used to clean your teeth. Antibacterial mouth rinse can help minimize the bacteria in areas that are not accessible.
Sugar free chewing gum may be helpful to keep your jaw moving. Chewing gum that contains xylitol will help to protect your teeth from dental decay. Check with your Speech and Language Therapist that it is safe for you to chew gum. Keep help prevent your jaw from becoming stiff, exercise your jaw muscles as follows.
Determining the risk of nerve damage with proper imaging is critical. A panorex and CBCT scan is done to determine the level of risk during an extraction. If a tooth is considered high risk then a coronectomy is indicated.
The timeline that the tooth needs to recover from nerve damage and sensitive nerves relies on the treatment. Different procedures have different periods. For example, in the case of tooth pulling, it can take 7 to 10 days for the wound to heal.
One of the most common procedures to relieve pain relating to nerve damage is a root canal. During this procedure, damaged tissue is removed, the interior of the tooth is cleaned, and it's filled with a sterile, sturdy material. Removing damaged nerve tissue does not impact the structure of your tooth.
Doctors use an MRI to examine the entire facial nerve. This imaging test also allows a doctor to identify swelling or a growth on or near the nerve. Your doctor may recommend a type of MRI that uses a contrast agent, or dye, called gadolinium.
A dull ache along the gum line. Pain that targets a single tooth or radiates throughout the mouth. Discomfort that worsens after eating, especially following meals that are hot, cold, or acidic.