Locked Jaw (Trismus)
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Symptoms of Locked (Trismus) Jaw?
The hallmark symptom of trismus is the inability to close or open the mouth.
Pain or discomfort may be constant, however is usually worse with jaw movement. A spasming or tight sensation when opening the mouth can be experienced. Location of pain may be anywhere around the TMJ, the surrounding muscles or even result in neck pain or headaches.
Misalignment of the jaw, lips or teeth may also be experienced by those suffering from trismus. A mismatch in timing of the muscles or articular disc function on either side of the jaw can result in a crooked bite. Inflammation within the TMJ can also affect changes in bite path. If a change in jaw alignment is suspected, opening and closing the mouth while looking in the mirror may help confirm this.
Functions such as difficulty speaking and eating may be affected and drooling can also be experienced with trismus due to jaw tightness and discomfort.
Other symptoms may include:
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Jaw range of movement less than 35 mm
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jaw pain, spasm, tightness and cramping when opening mouth.
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difficulty biting, chewing, or brushing the teeth
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inability to swallow some foods
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headaches
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Earache
Treatment Options for Locked Jaw?
Trismus that remains unchecked can lead to wasting of the jaw muscles or articular joint surfaces as well as limited functional ability. Several treatment options can be provided by a physiotherapist depending on the cause and symptoms of trismus.
Treatment for open lock
For an open lock that does not reduce, the joint will need to be put back into place by a doctor in hospital. Recovery from soreness and trauma to the jaw following this procedure can be guided by a physiotherapist.
Education regarding risk management of open lock jaw involves modification of all jaw opening movements. Strategies such as putting the chin to the chest or keeping the tongue stuck to the roof of the mouth are effective in controlling maximum jaw opening to reduce the risk of open lock.
Certain considerations regarding everyday activity such as eating will be discussed, for example cutting food into smaller bite-sized pieces to avoid maximum jaw opening.
Treatment for closed lock
Initial management may involve heat therapy, soft tissue release, mobilisations and recommendation for pain relief (e.g. nurofen or aspirin - the anti-inflammatory properties can also be beneficial¹) and in order to ease muscle spasm or overactivity.
Physiotherapy exercises are advised for opening and closing the jaws, correcting jaw alignment, as well as keeping the jaw moving throughout the day - for example 5 minutes of side-to-side movements every 3-4 hours¹. Examples of exercises are in the link below:
Improvements in symptoms are usually seen within 2-3 days, however therapy can continue until function is recovered with a return to pain-free status. Ensure the jaw is kept relaxed during exercise.
Reference
¹ Dhanrajani, P. J., & Jonaidel, O. (2002). Trismus: aetiology, differential diagnosis and treatment. Dental update, 29(2), 88–94. https://doi.org/10.12968/denu.2002.29.2.88
² https://www.pat.nhs.uk/gps-and-partners/Joint%20Pain%20Leaflet.pdf
