REDUKSI JAW LOCK

Introduction
The temporomandibular joint (TMJ) is located just in front of the lower part of the ear. This joint
allows the lower jaw to move. It is a ball-and-socket joint, just like the hip or shoulder. When the mouth
opens wide, the ball (called the condyle) comes out of the socket and moves forward. It goes back into
place when the mouth closes.
The TMJ becomes dislocated when the condyle moves too far. Then, it can get stuck in front of a
section of bone called the articular eminence. The condyle can't move back into place. This happens
most often when the ligaments that normally keep the condyle in place are somewhat loose. The
surrounding muscles often go into spasm and hold the condyle in the dislocated position.

Jaw Lock in mandible

The jaw locks in an open position and you cannot close your mouth. You may have discomfort
until the joint returns to the proper position. If one’s lower jaw (known as the ‘mandible’) is stuck in
either a closed or open position, it is commonly called a ‘jaw lock ’. If the jaw closes OK, to get the teeth
together, but cannot open the mouth very far, it may be a ‘closed lock ’. Normal opening should allow
about 2 inches (50 mm) between front teeth. Limited opening of about 1 inch (less than 30 mm) may
indicate a closed lock. Open locks typically occur at over 2 inches between front teeth; but it can happen
at much less in some instances. If your mouth is open, but are unable to get the teeth back together,
then it is called an “open lock” (Raman P, 2011).

A jaw lock may occur suddenly with no prior history, after an injury to jaw or following a history
of ‘catching’ or ‘intermitent jaw locking’. This is a condition where the jaw gets stuck momentarily either
in a closed or wide open position but then gets unstuck immediately. Most times people ignore this
‘catching’ since they are able to function once the jaw gets unstuck readily and because this is usually a
pain-less condition at that point (Raman P, 2011).

There are four different positions of jaw dislocation: posterior, anterior, superior and lateral. The
most common position is anterior. Anterior dislocation shifts the lower jaw forward if the mouth
excessively opens. This type of dislocation may happen bilaterally or unilaterally after yawning. The
muscles that are affected during anterior jaw dislocation are the masseter and temporalis which pull up
on the mandible and the lateral pterygoid which relaxes the mandibular condyle. Posterior dislocation is
common for people who get injured after being punched in the chin. This dislocation will push the jaw
back affecting the alignment of the mandibular condyle and mastoid. Superior dislocations occur after
being punched as the mouth remains open. Since great force occurs in a punch, the angle of the jaw will
be forced upward moving towards the condylar head. Lateral dislocations move the jaw away from the
skull and are likely to happen with other jaw fractures.

Are all ‘limited opening’ due to “closed locks”?

There are many causes of limited mouth opening including pericoronitis (infection around a
partially erupted molar tooth such as a wisdom tooth), myositis (infammation of a jaw muscle – for
example, that was injured from repeated dental anesthetic injections), jaw muscle spasms (like a Charlie
horse), Disc Displacement without Reduction (“Closed Lock ”) and others. This can cause pain, prevent
normal chewing or speaking and adequate oral hygiene. When the mandible is unable to have normal
range of motion it can lead to headaches, neck pain etc (Raman P, 2011).

What causes “jaw popping” and “closed locks”?

Inside the jaw joint located in front of the ear hole, there is a cartilage –known as the ‘articular
disc’, between the ‘socket’ which is part of the temporal bone of the skull and the ‘ball ’ called condylar
head that is part of the mandible. Normally tough collagen fibers -collateral ligaments, tie down the discs
on top of the condylar head. It is like a cap on a person ’s head if it were tied down to both ears allowing
it to slide on top of the head within limits. The disc is also tied down in the back of the socket like a
tether and in the front to a small muscle that moves the disc as the jaw opens (Raman P, 2011).

The disc can only slip out when some of the fibers of this collateral ligament are torn. If it slips in
front or medial side of the condylar head when teeth are together but yanked back into place, on top of
the ‘ball’ by the ‘tether’ in the back of the socket, with a popping sound as the mouth is opened slightly,
then it is called ‘Disc Displacement with Reduction ”. This is the common jaw popping that many people
casually report since there is no pain. Many dentists that are uninformed of the process of tearing of the
ligament and damage to the joint over time, also dismiss this as “normal ” since it does not hurt and
relatively common in our modern population (Raman P, 2011).

If an articular disc slips in front or medial side of the condylar head when teeth are together,
bunches up to prevent opening of the mouth, then it is called a Disc Displacement without Reduction
(“Closed Lock”) (Raman P, 2011).
Prevention
TMJ dislocation can continue to happen in people with loose TMJ ligaments. To keep this from
happening too often, dentists recommend that people limit the range of motion of their jaws. For
example, someone with this problem should place a fist under the chin when yawning to keep the
mouth from opening too widely.
Conservative surgical treatments can help to prevent the problem from returning. Some people
have their jaws wired shut for a period of time. This causes the ligaments to get tighter and restricts their
movement. In certain cases, surgery may be necessary. One procedure is called an eminectomy. It
removes the articular eminence so the ball of the joint no longer gets stuck in front of it.
What are the options to fix “closed locks”?

The dentist bases the diagnosis on the position of your jaw and whether you are able to close
your mouth. X-rays confirm the clinical diagnosis. Patients often hear that the only way to fix it is through
surgery. But we have successfully treated joint locks without surgery for several years. All joint surgical
procedures have associated risks including infection and anesthesia risks. Long term success rate is
mixed since the surgical procedures do not usually address the underlying cause that led to the Disc
Displacement without Reduction.

Non surgical options include Neuromuscular dental protocol of precisely diagnosing the optimal
alignment of the mandible to the head and temporarily correcting the jaw alignment with a n orthotic to
get the disc in place (Raman P, 2011).

Treatment

The muscles around the TMJ need to relax so that the condyle can return to its normal position.
To make this happen, some people need an injection of local anesthesia in the jaw joint. This may be
followed by a muscle relaxant similar to diazepam (Valium) to stop the spasms. The muscle relaxant is
given intravenously (into a vein in the arm). If the jaw muscles are relaxed enough, a doctor or dentist
can move the condyle back into the correct position. He or she will pull the lower jaw downward and tip
the chin upward to free the condyle. Then the ball is guided back into the socket.
 Rarely, someone may need to have the dislocation fixed in the operating room under a general
anesthetic. In this case, it may be necessary to wire the jaws shut or use elastics between the top and
botom teeth to limit the movement of the jaw after the dislocation has been fixed. You should follow a
soft or liquid diet for several weeks afterward. This reduces jaw movement and stress. Avoid foods that
are hard to chew, such as tough meats, carrots, hard candies or ice cubes. Also, be careful not to open
your mouth too wide.
If your TMJ becomes dislocated, visit your doctor, dentist or hospital emergency room right away
to have the joint put back in place. You may be referred to an oral and maxillofacial surgeon for
treatment. The outlook is excellent for returning the dislocated ball of the joint to the socket. However,
in some people, the joint may continue to become dislocated. If this happens, you may need surgery.

Anterior Dislocation Posterior Dislocation

Superior Dislocation Lateral Dislocation