Abstract: Trismus, commonly known as restricted mouth opening, is a frequent condition in dental and medical practice. It is often associated with infections, trauma, inflammation, or as a complication of cancer therapies. This article reviews risk factors, causes, prevention strategies, and evidence-based treatments.
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✅ Risk Factors
° Prolonged dental procedures
° Pericoronal infections
° Radiotherapy in the head and neck region
° Facial trauma
° Invasive oral surgeries
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° Infectious: peritonsillar abscesses, pericoronitis.
° Inflammatory: temporomandibular arthritis, post-radiation fibrosis.
° Traumatic: mandibular or muscular fractures.
° Iatrogenic: intramuscular anesthesia, complex surgical extractions.
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° Minimize trauma during dental procedures.
° Proper anesthetic techniques.
° Jaw exercise programs in oncology patients receiving radiotherapy.
° Early treatment of oral infections.
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° Pharmacological: anti-inflammatory drugs, muscle relaxants.
° Physiotherapy: progressive jaw exercises, mouth-opening devices.
° Surgical: scar release and reconstructive surgery in severe cases.
° Adjunctive therapies: local heat, therapeutic ultrasound.
馃搳 Comparison Table: Trismus — Causes, Risk Factors, Prevention and Treatment
| Category | Typical Causes | Risk Factors | Prevention | Treatment / Management |
|---|---|---|---|---|
| Infectious | Peritonsillar abscess, pericoronitis, odontogenic infections affecting masticatory muscles. | Untreated dental infections, delayed care, poor oral hygiene. | Early treatment of infections; patient education on hygiene and timely dental visits. | Antibiotics when indicated, abscess drainage, analgesics, early jaw physiotherapy. |
| Inflammatory / Arthritic | TMJ arthritis, inflammation, post-radiation fibrosis. | Systemic arthritis, prior head & neck radiotherapy, chronic parafunction. | Manage systemic disease; preventive exercises for radiotherapy patients; address parafunctional habits. | NSAIDs, steroid injections if indicated, jaw exercises, occlusal therapy. |
| Traumatic | Mandibular fractures, muscle contusion, penetrating injuries. | Facial trauma, high-energy injuries, delayed fixation. | Timely trauma management and appropriate fixation; early guided mobilization when safe. | Surgical repair if needed, progressive mobilization, physiotherapy, analgesia. |
| Iatrogenic / Surgical | Complex third-molar extractions, prolonged mouth opening during surgery, intramuscular injections into masticatory muscles. | Lengthy procedures, inadequate perioperative protection/exercises, poor technique. | Minimize procedure duration when possible; use protective positioning; provide post-op jaw exercises. | Progressive opening exercises, mouth-opening devices, pharmacologic muscle spasm control. |
| Oncologic (Radiation) | Radiation-induced fibrosis of masticatory muscles and TMJ structures. | High radiation dose to masticatory apparatus, lack of preventive exercise program. | Jaw exercise protocols before, during and after radiotherapy; tailor planning to spare muscles. | Long-term physiotherapy, passive/dynamic stretch devices; surgical release for severe fibrosis. |
馃挰 Discussion
Trismus significantly impacts patients’ quality of life, compromising nutrition, speech, and access to dental care. Recent literature highlights the importance of prevention in oncology patients undergoing radiotherapy and the benefits of combined therapies, where physiotherapy plays a pivotal role. Early recognition of risk factors is essential to avoid permanent functional limitations.
✍️ Conclusion
Trismus is a multifactorial condition requiring early diagnosis and multidisciplinary management. Preventive strategies in dental care and rehabilitation programs for high-risk patients are crucial for optimizing clinical outcomes and improving quality of life.
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✔ Dhanrajani, P. J., & Jonaidel, O. (2002). Trismus: aetiology, differential diagnosis and treatment. Dental Update, 29(2), 88–92. https://doi.org/10.12968/denu.2002.29.2.88
✔ Pauli, N., Fagerberg-Mohlin, B., Andrell, P., & Finizia, C. (2013). Exercise intervention for the treatment of trismus in head and neck cancer. Acta Oncologica, 52(6), 1065–1073. https://doi.org/10.3109/0284186X.2012.760846
✔ Bhrany, A. D., Izzard, M. E., & Wood, D. E. (2007). Trismus secondary to head and neck cancer: treatment strategies. Oral Oncology, 43(3), 252–260. https://doi.org/10.1016/j.oraloncology.2006.02.015
✔ Johnson, J., van As-Brooks, C., Fagerberg-Mohlin, B., & Finizia, C. (2010). Trismus in head and neck cancer patients in Sweden: incidence and risk factors. Medical Science Monitor, 16(6), CR278–CR282. PMID: 20512138
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