Karen Harnett explains how to improve your patients’ quality of life.
Temporomandibular disorders (TMD) is a collective term for conditions which affect the temporomandibular joint (TMJ) or jaw joint and the surrounding muscles. TMD is common, affecting eight to 15 per cent of the adult population in the UK. It is caused by problems which affect the masticatory system. Trismus is one of these conditions – in which a patient is only able to open their mouth 35mm or less.
Trismus and its causes
Trismus has many causes, including trauma, surgery (including wisdom tooth removal), radiation treatment, TMJ problems, arthritis, infection, and minor trauma (which may include bruxism). Because trismus can happen as a result of a number of things, it is important to be vigilant in order to prevent as much pain for your patients as possible.
Trismus tends to develop slowly, and in some cases, patients don’t notice that they’re struggling until they cannot open their mouth more than 20mm. It is important to catch this problem early and begin treatment as soon as possible, as it will likely be more effective early on and cause patients less pain. This is why being proactive in looking for signs of trismus is important. The ‘three finger test’ is a simple check in which a patient inserts three fingers between their central incisors. If fewer than three fingers fit in this space, the mouth opening is not considered functional as there is too much restriction – trismus is likely.
Quality of life
An individual with trismus may struggle with a number of issues that impact them mentally, physically, and socially. Because of the restricted mouth opening, trismus affects the patient’s ability to carry out proper oral hygiene. This can lead to further oral health problems such as caries if no steps are taken to improve their condition. Additionally, patients may experience difficulty chewing and swallowing food, leading to an increased risk of aspiration, causing further health problems for them. Edentulous patients in particular, may suffer with eating solid food, as a restricted opening can make it difficult to insert dentures, which could affect nutrition.
Not only this, but patients may suffer socially too. Communication can be made very difficult for those with particularly restricted openings which may take a toll on their social and family life and potentially their ability to work. All of these effects, plus the pain experienced by many patients with this condition, may have a significant impact on their mental health. Pain is often related to depression, anxiety and insomnia. As patients deal with the pain, along with the symptoms of the condition, their daily life is significantly impaired, negatively impacting their quality of life.
Treatments
When it comes to treating trismus, your treatment plan will depend on the complexity of the case. This may entail giving your patients advice and suggesting exercises. But, in more severe cases, a referral may be necessary to an appropriate specialist to ensure they receive suitable treatment. It may also be appropriate to collaborate with a medically trained colleague for patients who need access to pain relief and relief from inflammation.
Dietary changes may also aid in reducing pain. It may be helpful to advise your patients to follow a soft food diet and avoid hard, crunchy, and chewy food short-term until the pain subsides. Physical therapy could also be a viable treatment option. This involves massaging and stretching the jaw to aid in loosening the muscles and decreasing pain. When it comes to exercises, as another form of treatment, gentle, passive motion is preferred rather than rapid motions. Rapid motions have the potential to cause a reflex which makes the muscles contract, making it impossible to stretch effectively or at all. Passive motions, applied several times a day, have been shown to be effective as a treatment for trismus. The OraStretch Press, distributed by Total TMJ, is a hand-operated device designed to aid patients with jaw exercises. The device uses passive motion to stretch the jaw, joint, and facial tissues to increase mobility and function. With continual use, a typical patient struggling with TMDs, including trismus can gain 1-2mm per week. This is a fantastic option for your patients, as gaining a range of motion will actively improve their quality of life.
Trismus can be very overpowering as the symptoms can affect so many aspects of daily life. It will be a great relief for many patients that there are treatments available that may be beneficial for them.
References available on request.