Dental emergencies are a group of varied conditions that refer patients to the dental office at the earliest opportunity.

The damage that these emergencies involve can be aesthetic or functional.

More often than not, however, pain is the main reason why patients come to the doctor.

It can be violent, of increased intensity and can occur suddenly following trauma or the exacerbation of infectious processes confined to the dental pulp.

A not very frequent situation that leads the patient to the dental surgery is the limitation of the mouth opening.

This has various causes and prevents the performance of movements and functional acts.

Pathologies of the temporomandibular joint. The temporomandibular joint is the essential component responsible for movements of the jaw.

Whether it is movements during speaking, chewing or swallowing, the mandible is coordinated by the complex system formed by this joint.

Located anterior to the ear and palpable in the tegument, being close to the external surface, the temporomandibular joint can often be the site of trauma or suppuration.

These can occur accidentally but are also increasingly common following incorrect surgical treatment at this level.

The elevator muscles of the mandible are the masseter, temporalis and internal pterygoid.

These muscles have a well-defined arrangement in the facial mass, their insertions being decisive for the type of movement that occurs.

When the elevator muscles relax, the mouth opens. If the elevator muscles increase in volume due to inflammation, their relaxation can no longer take place and the lowering muscles do not have the strength to complete the opening of the oral cavity.

This results in a limitation of mouth opening, directly proportional to the degree of muscle inflammation. The limitation of the opening of the oral cavity due to muscle damage is also known as trismus.

Infections of the lower molars. Particularly in the case of impacted wisdom molars, there is a situation in which the surrounding tissues may become inflamed if microbial agents find a gateway through the gingiva or alveolar bone.

Also, when wisdom molars are erupting but there is still a piece of gingiva covering them, there may be a purulent collection between it and the tooth.

As manifestations of the suppurative processes of the lower wisdom molars we have limitation of mouth opening by swelling surrounding the posterior mandibular region, throbbing pain and the appearance of a pus droplet at the pressure of the gum hood.

Dislocation of the temporomandibular joint. This can occur when the patient holds the mouth open for too long (e.g. during dental treatments) or accidentally. In this case, not only is the mouth opening limited, but it cannot close.

Opening the mouth is a fundamental action for the normal functioning of the stomatognathic system.

However, sometimes patients may experience difficulty in opening their mouth, a condition known as ‘restricted mouth opening’ or ‘trismus’.

This condition can have various causes and can significantly affect patients’ quality of life. In this article, we explore issues related to restricted mouth opening, including causes, symptoms and treatment options.

Causes of Mouth Opening Limitation:

Temporomandibular Joint Disease (TMJ): Problems with the temporomandibular joints can lead to pain and limitation in mouth opening. Joint dislocations or inflammation can contribute to this condition.

Oral Infections: Tooth abscesses or other oral infections can cause swelling of tissues around the joints or muscles, causing difficulty opening the mouth.

Recent Dental Surgery: Patients who have undergone dental surgery, such as tooth extractions or implants, may temporarily develop limitations in opening the mouth during the recovery period.

Muscle Problems: Muscle spasms or abnormal muscle contractions may limit mouth opening. This can be caused by various conditions, including muscle disease or overuse of the masticatory muscles.

Facial Trauma: Injuries or trauma to the face or jaw can cause swelling and discomfort, leading to limited mouth opening.

Symptoms of Mouth Opening Limitation:

Mouth Opening Pain: Patients may experience pain or discomfort when trying to open their mouth.

Difficulty Opening: The mouth may not open as much or as easily as usual.

Discomfort with Chewing: Daily activities such as chewing or talking may become uncomfortable due to the limitation of mouth opening.

Swelling or Tenderness: Swelling or tenderness in the jaw or temporomandibular joint area may be present.

Treatment of Mouth Opening Limitation:

Treatment of oral cavity opening limitation is tailored to the situation that caused it.

It may start with manual stimulation of maximum mouth opening, the administration of anti-inflammatory drugs or surgical maneuvers. However, the cause of the mouth opening limitation must always be eliminated.

Management of Underlying Causes: Treatment will depend on the specific cause of the restricted mouth opening. Managing infections, treating joint or muscle problems and addressing other underlying conditions are essential steps.

Medication: Taking anti-inflammatory or analgesic medication may help reduce inflammation and pain.

Physical Therapy: Physical therapy exercises may be recommended to improve muscle and joint flexibility.

Applying Ice or Heat: Applying ice or heat to the affected area can help reduce inflammation and relieve discomfort.

Surgery: In severe or persistent cases, surgical procedures may be necessary to treat the underlying cause of the mouth opening limitation.

It is crucial to seek medical attention if you experience any of the symptoms mentioned above. Your dentist or specialist will be able to provide you with an appropriate diagnosis and a personalized treatment plan to effectively manage your restricted mouth opening and improve the quality of your oral life.

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