I. Lockjaw – a limited range of motion of the mouth.
II. Lockjaw is sometimes called trismus due to association with tetanus in the early days, but it may also be caused by a variety of other reasons.
III. Information about lockjaw
Lockjaw, which relates to limited movement of the mouth, any restriction in the opening of the mouth, or limited range of motion of the oral muscles, also falls under the name of trismus. Just the word “lockjaw” is frightening, and there not many medical conditions that are as frightening to the patient at first. It usually results in spasms of the muscles, especially the masseter muscle (the powerful jaw-closing muscle), and may be caused by a variety of things, such as infection, impacted wisdom tooth, removal of a wisdom tooth, joint problems, trauma, adhesions or scarring, tumors and many other possibilities such as radiation. With radiation trismus usually occurs after a lengthy series of radiation treatment especially if it near the temporomandibular joint. On a very rare occasion, a dental injection may cause a small hematoma or bruise which results in trismus. This is not the fault of the dentist, but occurs on rare occasions when the needle barely pricks the wall of a tiny artery or vain which may result in a hematoma.
In most cases, the symptoms are severe at the onset yet often self-limiting. It is helpful to apply moist heat, non-steroidal anti-inflammatory drugs such as over-the-counter Ibuprofen, Aleve, Advil, Motrin, Naproxen, Tylenol, or Aspirin. These work by reducing the discomfort and lessening any associated inflammation. Muscle relaxants my also be utilized and exercise and massage are quite beneficial. The first signs of lockjaw are muscular stiffness of the jaw and neck, difficulty swallowing food, muscle stiffness in other parts of the body, and sometimes with sweating and fever.
Although significantly rare now, trismus, another name for tetanus or lockjaw, was usually caused by a puncture wound which later became infected. It was normally a nail or a cut by a wire which was the cause of the puncture. This infection is a very serious bacterial disease that affects muscles and nerves. If this actually is an infection, usually caused from a contaminated puncture wound, death may actually result from severe breathing difficulties or even heart abnormalities. The term “lockjaw” was associated then with tetanus and now trismus. Tetanus, the infection, is very uncommon in modern time due to widespread immunization. Tetanus is more often associated with older people and agricultural workers due to contact with animal manure and lack of immunization. The tetanus bacteria may be found in dirt, dust, intestines of animals and in animal manure.
Tetanus is not transmitted from people to people and is not contagious. It is usually contracted by those not vaccinated and who have the misfortune of acquiring a puncture wound. That being said, tetanus has also been associated with intravenous drug use, and with clean wounds such as surgical procedures, insect bites, and dental procedures.
Lockjaw, or any other restriction in the opening of the mouth, may result in difficulties with oral hygiene, such as brushing and flossing, as well as eating. Often a smaller-sized tooth-brush is required, and a slight change in diet may become necessary, such as liquid or softer food. The proper nutritional intake should always be maintained, especially fluids. That being said, if you have a case of lockjaw, you should carefully and slowly chew your food more than normal to avoid choking from swallowing too large a bolus of food. Warm, moist heat compresses and relaxation will solve the situation in most cases. Never try to “over-power” the muscles. That will only compound the problem.
One of the easy treatments for lockjaw is the “triple 7” exercise. This means open your mouth as far as you can 7 times for 7 seconds and do this 7 times per day. You may use your fingers to help open your mouth and it also helps to move the jaw to each side as far as you can for about 3 seconds. Each time the amount of opening should slowly increase. You can start with this number and progress with more repetitions as the condition improves. Do not stretch open enough to cause significant pain! Remarkable improvement will be immediately noticed but that improvement will dissipate if the exercises are not continued. You eventually should be able to insert three fingers stacked together in your mouth. Warm, moist heat, by added fairly warm water to a hand towel and applying it is always helpful. The warm, moist compresses will aid before starting the “triple 7” exercises.
Most cases, although quite rare, are from dental injections, which also rarely have a result of sometimes getting a hematoma, and this rarely occurs. A few cases are a result of wisdom tooth extractions. Fortunately these conditions are usually self-limiting with little or no treatment. One still must be cognizant of the other possibilities.
However, it must be remembered that a full blown tetanus infection might include spasms of the larynx, spasms of the respiratory muscles, and difficulty breathing. Even with modern medical intervention, the death rates can be upwards of 15% so it behooves all to take the preventive tetanus toxoid vaccination which is contained in the DTP (diptheria, tetanus, and pertussis) injection followed by a tetanus booster every ten years. Since being fully immunized is the best tool to prevent tetanus, we should all do so.
Life Member of American Dental Association, Emeritus Fellow of Academy of General Dentistry, American Association of Implant Dentist