Trismus refers to multiple conditions that impair the capacity of the mouth or jaw to open due to an extracted wisdom tooth or an impacted molar causing muscle inflammation or radiation therapy. Restricted mouth opening results in various problems like issues with chewing and swallowing, dental hygiene problems, and speech difficulties. The condition is temporary, but if you start experiencing stiffness, discomfort, or trouble chewing, you should seek targeted therapy like physical therapy.

At Suarez Physical Therapy, we have physical therapists (PT) who will tailor treatment to speed healing, reduce stiffness, and restore the usual jaw movement to enable you to undertake your routines, eat, and speak with no trouble in Las Vegas.

Trismus Causes

A normal mouth opening is typically around 35-50 mm, and anything below 35 mm is restricted. If the mouth does not open past this cut-off point or is restricted, you experience issues like chewing, speech, and proper dental hygiene. This condition where the tightened or inflamed jaw muscles hinder or impede the complete opening of the mouth is trismus. For your PT to manage and craft a targeted treatment plan, they must establish the source of the condition. The common causes of trismus are:

Dental Surgery to Extract Wisdom Teeth

Wisdom teeth are the third set of molars located at the back of the mouth. Many develop these teeth in their late teens and early adulthood between ages 17 and 21. You could experience complications when these teeth are popping, particularly when there is limited jaw space, causing them to compact below the gums. When this happens, dental surgery is necessary to extract these wisdom teeth.

During the oral surgery, you could experience complications, including trismus. The disorder can develop as a complication after surgery, and it is common in oral surgery performed to remove wisdom teeth in the lower jaw. After the surgery, some patients experience inflammation or hyperextension of the muscles in the area. Also, tissue or muscle damage could happen when the oral surgeon injects the anesthesia to numb the surgical area.

Facial Trauma

The jaw is responsible for the mouth-opening movement. It enables you to close and open the oral cavity. When you sustain trauma or injury on the face that affects the jaw, it becomes stiff and painful, impairing your capacity to open the mouth properly. Jaw damage can be attributed to factors like blunt force from a strike injury, surgery or radiation during oral cancer treatment. A jaw bone fracture due to facial trauma can also immobilize the mouth to allow healing.

When muscles fail to move through the natural range of motion for at least three days, they show atrophy signs. The same happens when the TMJs are immobilized after trauma to allow healing. The immobilization causes degenerative joint changes, like cartilage thinning, affecting joint movement.

Temporomandibular Joint (TMJ) Disorder

Your lower jaw, or mandibular, is linked to the skull by the temporomandibular joint. The joint is situated on both sides of the face in front of the ears and is responsible for the opening and closing of the jaw. TMJ enables you to perform activities that appear so natural to you, like speaking and eating. Any health conditions that affect the functionality of the joint are called TMJ disorders, abbreviated as TMJD. These conditions cause joint immobility, joint tenderness, and facial pain. The disorder is very rampant, with over 10 million Americans suffering from the condition, the majority being women.

There is no precise cause of TMJD, although experts believe facial trauma on the TMJ or the jaw can be a cause. Besides, particular health conditions contribute to the disorder, including:

  • Erosion of the joint
  • Growth disorders
  • Structural jaw problems that exist from birth due to genetics
  • Habitual teeth grinding or clenching

TMJD can cause pain that radiates to nearby muscles and may lead to joint locking or restricted movement.

The symptoms associated with the condition include:

  • Jaw locking
  • Restricted jaw mobility
  • Stiffness or tightness of the jaw muscles
  • Neck or facial pain
  • Vertigo
  • Malocclusion or shift in jaws that alters the meeting of the upper and lower jaws
  • A popping sound in the jaws when chewing

Whenever you experience these symptoms, it could be an indication of trismus, and therefore, you should undergo a medical exam to establish if the symptoms are for trismus.

Head and Neck Cancer Radiation

Tumors around the throat or in the head can impair jaw functionality, leading to trismus. The jaw complications are not always directly caused by the tumors but by the radiation therapy treatment to address the tumors.

Oncologists sometimes address most neck and head cancer cases using radiation therapy, which is a high-energy wave treatment that damages or eliminates cancer cells. Radiation destroys or alters the DNA in cancer cells, stopping their growth. Unfortunately, these waves with high-intensity energy sometimes destroy even healthy and noncancerous cells. The therapy targets the tumor or the area where it was removed through surgery to kill any cancerous cells that could have spread. The treatment is preferred by many patients and oncologists because, unlike chemotherapy, which affects all body cells, radiation only targets the cells in the affected area. 

If you have a cancerous tumor around the jaw area or throat and undergo radiation therapy, the treatment could cause scarring and damage to surrounding muscles and tissues, resulting in trismus. Many patients undergoing radiation therapy for neck cancer develop trismus when the energy waves affect the TMJ and masseter muscles that help with chewing. What is even worse is that trismus can be overlooked when you are undergoing radiation therapy, allowing the condition to advance leading to secondary alteration of the muscles and joints. If trismus is discovered at an advanced stage, you should start physical therapy for passive, gentle movements to help reverse the condition. The treatment helps speed recovery, lower stiffness, and restore regular jaw motions.

Early detection of trismus in radiation therapy patients is usually tricky, although screening protocols exist to monitor jaw function in patients more susceptible to the disease. Patients overlook the condition's symptoms because they believe jaw immobility after the procedure is standard and will resolve itself.  Surgeons, oncologists, and nurses ignore the problem and focus more on the therapy. It is even more challenging to detect trismus as patients feed on tubes. As a result, joints are immobilized and undergo degenerative changes, causing trismus. The changes could advance and become permanent depending on their feeding duration through tubes. Most of the time, trismus symptoms are discovered when the patient resumes regular food intake.

Trismus Signs and Symptoms

The official mark or sign for trismus is difficulty fully opening the mouth. Other signs of the illness are:

  • Headaches
  • Jaw pain
  • Pain while moving the jaw
  • Ear ache
  • Jaw cramping
  • Muscles tightness
  • Lost chewing and swallowing capabilities
  • Challenges engaging in routine activities that involve opening the mouth

Problems Associated With Trismus

When you are experiencing trismus signs, you are likely to develop several problems, including:

  1. Eating Issues

Restricted mouth opening leads to reduced nutrition. Difficulties opening the mouth to receive a small portion of food discourage you from eating. When you find it difficult to eat, with time, you lose weight and suffer massive nutritional deficits as you are restricted on the foods you can eat. An unbalanced diet will cause severe problems, especially when recovering from chemotherapy, radiation therapy, or surgery.

Restricted opening means inadequate food chewing and limited tongue movement. The tongue is responsible for forming bolus and manipulating food for swallowing. So, eating becomes an issue when the food is not correctly masticated  because of limited opening and the bolus is poorly formed and organized because of limited tongue movement.

  1. Dental Hygiene Problems

Restricted mouth opening also compromises oral hygiene. Proper dental hygiene is crucial, especially after oral surgery, to remove impacted wisdom teeth or radiation therapy to remove a tumor on the mandibular. Inappropriate dental hygiene increases the risk of cavities, causing infections. Oral infection could spread to the surgical area or affect the mandibular, leading to severe complications.

  1. Swallowing and Speech Problems

Another problem that will present itself when you suffer from trismus is swallowing and speech problems. When you cannot sufficiently open your mouth, you cannot make the required sounds, making speaking an issue. Your swallowing is also impaired after radiation therapy or surgery as the larynx does not elevate as expected or the timing of the elevation fails to coincide with the bolus organization. 

  1. Joint Immobilization

Even though the hallmark of trismus is challenges opening the mouth, the condition is also associated with joint immobilization. During immobilization, the joints suffer degenerative alterations that cause swelling and pain. If the trismus is not treated early, the degenerative changes advance and become permanent. Days of immobilization shorten muscle fibers and reduce the mass and strength of muscles.

Diagnosing Trismus

Many cases of trismus are temporary and resolve themselves with time. However, when you notice the signs of trismus that are not disappearing, like pain and difficulty chewing, you should visit a physical therapist immediately for a thorough medical examination. Early treatment alleviates the pain and prevents further complications. An examination is necessary because the symptoms you are experiencing could be for oral cancer, joint complications, or abnormal soft tissue. During the initial consultation, the PT will:

  • Ask you to fully open your mouth to measure how wide you can open it
  • Review your medical records and inquire about any previous surgeries, injuries, or fractures on the neck, head, or jaw.
  • Perform a thorough exam of the throat and neck
  • Review your posture and neck movements
  • Evaluate your TMJ to determine if it functions optimally. Additionally, they will be on the lookout for any abnormal motions on the joint.
  • Review the muscles surrounding the jawline to check for spams, contractions, or discomfort
  • Determine if you can regain mobility through a dental device
  • Refer you to a dental expert
  • Refer you to a speech-language pathologist to fix speech or voice problems

Treatment Options

A physical therapist can help you recover jaw mobility and enhance overall mouth functionality. Trismus develops gradually, making it difficult to detect the condition until you have experienced problems opening the mouth. The earlier you visit a PT for an examination, the earlier you can arrest the condition before the damage becomes permanent, requiring highly invasive and expensive treatments. Early physical therapy makes it possible to restore normal functionality.

So, once you are diagnosed with trismus, your PT will draft a bespoke treatment plan to restore normal jaw function and relieve you of the symptoms interfering with your daily activities.

Trismus Exercise

Your PT will recommend several exercises that will help improve jaw movements. The frequency and intensity of these exercises will vary depending on your special circumstances. The PT can increase mobility through manual therapy or guide you through exercises. The common exercises include:

Manual Opening of the Jaw

Your PT will recommend mouth opening and closing multiple times to warm up. Once warmed up, place fingers on the four anterior teeth in the lower jaw and pull down gently until you feel discomfort on the affected side. Hold the teeth in that position for at least thirty seconds and return the jaw to the initial position. Repeat the exercise three times and increase them gradually to twelve.

Jaw Joint Stretch

Another exercise your PT will recommend is stretching the jaw and neck. To perform the exercise, press your tongue’s tip on the mouth of the roof, directly behind the anterior teeth in the upper jaw. Avoid contact with the teeth during the press. The next step is to apply pressure on the tongue to push the upper jaw upwards. Gradually open the mouth until you experience pain, then close it. Repeat these motions ten times. If the exercises cause pain, avoid them.

Stretch Smile

You should smile the widest with the exercises until you experience pain or stiffness. During the smile, open your jaw an extra two inches and inhale through the mouth. Next, exhale as you slowly close your mouth. Repeat these motions ten times to alleviate neck, facial muscle, and jaw stress.

There are several exercises that the PT will recommend to improve mobility, contingent on your symptoms and the cause of the trismus.

Your PT will even recommend home remedies to help alleviate the home pain. They include:

  • Massage
  • Stretching your neck
  • Heat therapy
  • Taking magnesium supplements
  • Restricting caffeine consumption
  • Avoid teeth clenching or grinding

Alleviating Pain

When experiencing severe pain, the PT will not depend on exercises alone. They will apply deep heating and electric stimulation to reduce the pain and enhance movement effectively. Therefore, if you have been overly-dependent on opioids for pain relief, physical therapy can help reduce your reliance on these medications.

Choosing a Physical Therapist

Your physician will recommend a physical therapist if you are susceptible to developing trismus or have symptoms. The challenge is picking the right PT, considering therapists specialize in different injuries or ailments.

Therefore, when choosing, consider the therapist's experience with trismus. Find an expert who has musculoskeletal or orthopedic training. Also, someone specializing in TMJD or craniofacial can increase your chances of a successful treatment.

Also, your choice of PT must be certified by the relevant board and completed residency in orthopedic physical therapy. An expert like this will have the skills and knowledge to accurately diagnose your condition and develop an effective treatment plan.

The pointers to help you find this specialist include:

  1. Recommendations

Talk to friends, coworkers, relatives, or your primary care doctor for recommendations on the best PTs in town to help with your conditions. The best referrals are from your primary physicians, particularly when they notice you are at risk of developing trismus. These medical professionals know the most reputable PTs in the market and will likely recommend the right one for your needs.

Alternatively, if you have friends, coworkers, or family members who have suffered trismus before but were successfully treated, you should ask them for a few names. Ensure you take recommendations from people whose experience during treatment was excellent. If a former patient of the expert seems unhappy with the service they received, you could suffer the same experience if you choose them for treatment. 

Write down the names or contacts of the therapists you are interested in for further investigations. You should call these contacts and schedule an over-the-phone or physical meeting to learn more about their PT services and whether they are the right professionals for your condition.

  1. Inquire About Experience

During consultation with these experts, ask about their experience handling patients with your condition. You want an expert who regularly works with trismus patients and provides effective treatment plans. You can request a few contacts of some of the PT’s previous patients and call them to inquire about their experience in the hands of the therapist you are considering. If most of the clients seem to be happy with the services provided, then you are at the right place and should choose the practice for treatment.

However, before making a decision, you should inquire about the cost of treatment because it will influence your choice of PT. Go for a practice that provides uncompromised services at reasonable prices.

Find a Competent Physical Therapist Near Me

Trismus is painful and can lead to many other problems like jaw immobility, eating, and speech problems. However, early treatment combining medication and physical therapy can reverse the symptoms because the condition is temporary. If you are experiencing trismus symptoms or are prone to the disease in Las Vegas, talk to Suarez Physical Therapy for help. Our experienced PTs will help alleviate the pain and restore normal mouth opening. Call us at 702-368-6778 to schedule an appointment.