TRISMUS

BY DR.AMR NAGUIB
LECTURER OF
PROSTHODONTICS
 TRISMUS
Trismus is defined as : a tonic contraction
of the muscles of mastication that results
in a limited ability to open the mouth.

also, known as lock jaw or limited mouth

opening condition or hypomandibular
movement .
 TRISMUS
Normal mouth opening :

The normal range of mouth opening varies from

patient to patient, within a range of 40- 60 mm,
although some authors place the lower limit at
35 mm.
 TRISMUS
Authors have used a gradual classification for
trismus
1-mouth opening >30 mm indicates light
trismus
2-mouth opening between 15 and 30 mm
indicates moderate trismus
3-mouth opening <15 mm indicates severe
trismus
 TRISMUS
How to check normal mouth opening :

By inserting the 3 middle fingers as shown in

the image .

This is a fast test can be done by the patient to

ensure normal opening
 TRISMUS
Problems associated with trismus:

1-including reduced nutrition due to impaired

mastication

2-difficulty in speaking

3-compromised oral hygiene

4-inability to perform dental treatment

 TRISMUS
Causes of trismus:

1-Acute causes

2-Chronic cause

3- Treatment related factors

Classification of trismus
Acquired causes of trismus
Iatrogenic causes of trismus
 Treatment of trismus

Early treatment of trismus has the potential to prevent

or minimize many of the consequences of this
condition.

If the clinical examination reveals the presence of

limited mouth opening and diagnosis determines the
condition due to be trismus.

treatment should begin as soon as it is practical. As

restriction becomes more severe and likely irreversible,
the need for treatment becomes more urgent.
 Treatment of trismus

1-Conservative medical treatment

2-Physical therapy

3-Surgical treatment
 1-Conservative medical treatment

• It may be necessary to take medication to reduce pain and

relax the jaw muscles. Common medications for trismus
include muscle relaxers and nonsteroidal anti-inflammatory
drugs (NSAIDs) to relieve pain.

• Pentoxifylline which increase blood supply to head and neck

showed slight improvement on long term

• Botulinium and Hyperbaric oxygen were common in the past

but further research showed no improvement on trismus but
on trismus side effect as pain
 2-Physical therapy

1-heat therapy (placing moist hot towels on the

affected area for 15-20 minutes every 1 hr).

2-Physiotherapy and massage showed

improvement in some cases
 2-Physical therapy

3- simple finger exercise can be used with one hand or

both hands as shown in the following figure.
 2-Physical therapy

4-simple devices showed better resultsb as Tongue

depressor and tapered cork screw
 2-Physical therapy

5-Jaw-stretching devices they showed the best

results in comparison to all other physical
therapy means.
 2-Physical therapy

The most common devices are :

A-the jaw(Dynasplint System )

B-The TheraBite
 2-Physical therapy

In a 2014 study, people who used such a device

when performing specific mouth exercises had
an average increase in mouth opening of 5.5–7.2
mm.
 3-Surgical treatment

• The last option is the surgical intervention if all

other treatment are not effective enough, as
all patients prefer less extensive and
aggressive treatments.
• Surgical intervention include muscle and
ligament separation and cornoiectomy
 SPLINTS
• It is an appliance used for immobilization of
soft and hard tissue until healing.
 SPLINTS
Used in
1- treatment of fractures
2-plastic surgery of facial structure (orthognathic
surgery)
3-in grafting for jaw bone
4- in treatment or mobile teeth
 Requirements for splints
• Allow periodontal ligament reattachment and prevent the
risk of further trauma or swallowing of a loose tooth.
• Be easily applied and removed without additional trauma
or damage to the teeth and surrounding soft tissues.
• Stabilize the injured tooth/teeth in its correct position and
maintain adequate stabilization throughout the splinting
period.
• Allow physiologic tooth mobility to aid in periodontal
ligament healing.
 Requirements for splints
• Not irritate soft tissues.
• Allow pulp sensibility testing and endodontic
access.
• Allow adequate oral hygiene.
• Not interfere with occlusal movements.
• Preferably fulfil aesthetic appearance.
• Provide patient comfort.
 Splints
• Can be divided into splints for

A- Dentulous patients

B- Edentulous patients
 Splints
A- splints for Dentulous patients

1-wire loop (ivy loops): for patients with

complete set of teeth
 Splints
A- splints for Dentulous patients

2-arch bar : when patient have in sufficient

number of suitably shaped teeth
 Splints
A- splints for Dentulous patients

3-labiolingual splint (stout):

 Splints
A- splints for Dentulous patients
3-labiolingual splint (stout):
This type is used when the patient is dentulous or partially
edentulous to aid in treatment of fractures without or with
minimum displacement.
It is constructed so that an acrylic band fits around the
labiobuccal surfaces of the teeth as well as the lingual aspects,
leaving the occlusal surfaces uncovered.
A stainless steel wire connects the two acrylic portions
(labiobuccal and lingual) posteriorly around the last
remaining tooth. This wire acts as a hinge.
A button at the labial portion divided it into two halves which is
closed after the stent is put in place
 Splints
A- splints for Dentulous patients

4-Lingual splint:
 Splints
A- splints for Dentulous patients
4-Lingual splint:

Lingual splint is useful in parasymphyseal fractures of the

mandible to prevent the adverse muscular forces from causing
lingual collapse and overlap of the fractured segments.

This splint may be fabricated from cast metal made prior to the
resection to provide sufficient rigidity that stabilizes jaw
fragments. It may be fabricated with acrylic since it will be used
for 4-6 weeks only.
 Splints
A- splints for Dentulous patients

4-Lingual splint:
This splint may be secured directly to the inner aspect of the
dental arch by wiring or incorporated with the wire that legate
the buccually placed arch bar to the teeth
 Splints
A- splints for edentulous patients

1-Gunning splint
 Splints
A- splints for edentulous patients
1-Gunning splint
For edentulous patients, treatment planning poses greater difficulties during
reduction and fixation of fractured atrophic mandible. Due to edentulism,
guidelines provided by occluding teeth for reduction and fixation of fracture, are
absent. Also, open reduction of fracture site is not helpful due to compromised
medical condition of the patient at older age.
 Splints
A- splints for edentulous patients
1-Gunning splint
The denture bearing area of the edentulous mandible is not only more easily
fractured, but also has less possibility of rapid and uneventful healing .For such
condition, closed reduction and fixation of fractured segment with Gunning type
splint is preferred over open reduction technique. It holds together fractured
segments of mandibular bone and immobilizes the jaws in occlusion.
 Splints
A- splints for edentulous patients
1-kingsley splint
Historical splint and not used any more