Temporomandibular Joint Dysfunction

Case Description: The patient is a 73 y/o female.  She presented to physical therapy with a 2 wk hx of progressive stiffness and pain following a dental procedure to remove multiple back lower molars on her right side.  The next morning, she woke up with severe pain and was barely able to open her mouth.  She notes that her pain continued to the point where she could no longer brush her teeth and she had lost several pounds as eating was both difficult and painful.  She was referred to physical therapy by her dentist with a diagnosis of trismus.  

Intervention: The patient was seen for 9 physical therapy visits over 8 weeks

	Opening	Treatment
Initial Evaluation (IE)	9 mm (10/10 pain)	Soft tissue mobilization to masseter/temporalis and home heating routine.  Diet modification to improve nutrition while lacking opening
5 visits (2 weeks after IE)	27 mm (painful)	Passive stretching as well as instruction in home self-stretching routine (10x daily with tongue depressors or finger overpressure)
7 visits (4 weeks after IE)	39 mm (0-9/10 pain)	Passive stretching. Continued instruction in self-stretching home routine
9 visits (8 weeks after IE) Discharge	38 mm (no pain)	Light maintenance routine to insure sustainability of results. Education provided on return to her normal diet with gradual introduction of once painful foods. Consultation follow-up offered as needed.

Summary: Although rare, there are cases of trismus following dental procedures with a similar history such as the one presented in this case study.¹ After early referral (within 2 weeks of onset) from his dentist, physical therapy played an important role in reducing her pain and providing a plan to improve her overall mobility and function.  Her Temporomandibular Dysfunction Disability index improved from 56% to 0% impairment with good prognosis for full recovery. 

Luke Vander Zouwen, DPT
Full Potential Physical Therapy

1. International Journal of Applied Dental Sciences 2019; 5(4): 353-355