Temporomandibular Joint Dysfunction

Case Description: The patient is a 53 y/o male.  He presented to physical therapy due to complaint of L sided jaw pain and difficulty opening that had progressively worsened for 2 weeks to a point he could hardly get a finger in his mouth.  His stiffening started gradually and progressed for 3-4 days following at dental procedure where he had a crown placed.  He had lost nearly 15 lbs in two weeks due to inability to eat and was even having difficulty with basic dental care.  He had no serious co-morbidities. 

Intervention: The patient was seen for 7 physical therapy visits over 3.5 wks

	Opening	Treatment
Initial Evaluation (IE)	20 mm (6/10 pain)	Soft tissue mobilization to masseter/temporalis and home heating routine.  Diet modification to improve nutrition while lacking opening
1 week after IE	26 mm (painful)	Passive stretching as well as instruction in home self-stretching routine (10x daily with tongue depressors)
2 weeks after IE	35 mm (mild pain)	Passive stretching and TMJ oscillatory distraction to improve mobility and reduce pain.  Self-stretching home routine
Discharge (3.5 wks after IE)	50 mm (no pain)	Light maintenance routine to insure sustainability of results.  Consultation follow-up offered as needed

Summary: Although rare, there are cases of trismus following dental procedures with similar history 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 his pain and providing a plan to improve his overall mobility and function. He was able to undergo further dental work at the 2-week mark without issue.  His Temporomandibular Dysfunction Disability index improved from 28% to 5% 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