Trismus of the masticatory muscles is a severe spasmodic condition when the temporomandibular joint is immobilized, the masticatory muscles are very tense, they become stone-like, the teeth are clenched, and the patient cannot open his mouth freely. In such cases, urgent dental care is necessary, since the person can neither eat nor drink, respiratory function is impaired, and severe pain is felt. It is very important to provide emergency dental care as quickly as possible, since trismus puts a lot of stress on the nervous system, jaw, teeth and gum tissue.
The main causes of trismus
Often the causes of trismus are diseases that are localized near the jaw:
- osteomyelitis of the jaw;
- inflammatory process of masticatory muscles;
- jaw injuries;
- periostitis;
- advanced caries, extensive carious damage to teeth;
- inflammation of the gum tissue;
- acute stage of pulpitis;
- inflammation of the periosteum of the lower jaw;
- abscesses.
Compression can also occur in the background:
- neurosis;
- brain inflammation;
- cerebrospinal meningitis;
- epileptic seizures;
- paralysis;
- cerebral hemorrhages;
- rabies;
- muscle cramps;
- tetanus;
- tumor processes;
- hysteria.
Sometimes the disease can occur due to a direct blow to the jaw area, due to an unexpected dousing with cold water. Often a spasm occurs after an animal bite (one of the consequences of rabies).
Is trismus dangerous?
Absolutely yes. Firstly, due to the inability to open the jaw normally, a person stops eating; over time, this leads to problems with the stomach and intestines and threatens physical exhaustion.
Difficulty breathing is also dangerous, as this can lead to oxygen starvation. If the jaws are tightly closed, damage to the tooth enamel is also possible.
Trismus caused by infectious (meningitis, tetanus, rabies), oncological (brain tumors) and cardiovascular (stroke) diseases is especially dangerous.
Symptoms and degrees of trismus
- sharp contraction of the jaw;
- the patient cannot open his mouth;
- teeth are tightly clenched;
- severe pain when unclenching teeth;
- swelling and hardening of the muscle;
- breathing problems;
- speech problems;
- inability to eat normally;
- The lower part of the face may hurt, with severe pain spreading to the neck and back.
There are several stages of trismus:
- the first – when a person can open his mouth 30-40 mm;
- second – if a person is able to open his mouth slightly by 10-20 mm;
- the third is the most difficult, when the mouth opens less than 10 mm.
The consequences of strong clenching of the jaws can be chipping, loss of teeth, damage to enamel and dentin.
Diagnosing trismus requires a qualified approach, since the disease’s symptoms are similar to other problems. For example, with inflammatory processes (arthrosis) of the jaw joint or a fracture of the jaw. In this case, only an experienced traumatologist will help. To examine the oral cavity, the patient is given an injection of botulinum toxin, which has a relaxing effect on the chewing muscles and provides pain relief.
Treatment of jaw lockjaw
With trismus, the jaws are tightly clenched, so specialists have to resort to various kinds of tricks to establish the true causes of its occurrence and to bring it as close as possible to the patient’s normal lifestyle. So a medicinal injection is made into the damaged area or they try to open the jaws a little using special instruments so that the person can calmly eat food and not suffer from dehydration. Without the use of appropriate medications, all this, of course, does not lead to an improvement in the patient’s condition, but it becomes the right step on the path to success. The treatment itself can be carried out using sedatives (if trismus is of a neurotic nature), sulfonamide drugs (used for inflammation) and physiotherapy. You should not ignore the help of a dentist or facial surgeon if the reasons lie in their spheres of influence.
According to statistics, the number one cause of lockjaw is problems with the teeth and the entire oral area as a whole, so do not forget to promptly contact professional dentists and dental surgeons who have proven themselves to be exemplars in dentistry, implantology and reconstructive surgery. The specialist will make a correct diagnosis in a timely manner and begin treatment. Patients often confuse jaw lockjaw with a jaw fracture or arthrosis of the temporomandibular joint, postponing treatment “until better times.” Over time, lockjaw becomes less treatable and can lead to undesirable consequences.
How to treat trismus of the masticatory muscle?
Treatment involves the following steps:
- jaw immobilization;
- elimination of the disease or condition that caused trismus;
- taking medications with a relaxing effect (neuropsychic stimulants);
- taking antibiotics;
- the patient takes sedatives;
- Physiotherapy is recommended.
If trismus is caused by an inflammatory process in the mouth, the dentist sanitizes the lesion (for example, opens an abscess), cleans the hole and, if necessary, removes the tooth along with the root.
Complications
Many infectious and traumatic causes of trismus may also have associated complications; for example, an odontogenic infection causing trismus may be further complicated by facial cellulitis or mandibular osteomyelitis. Trismus can also interfere with proper oral intake and hydration. In addition, trismus may be associated with aspiration due to impaired swallowing mechanisms. It should also be noted that oropharyngeal intubation may not be possible in patients with significant trismus, requiring other approaches such as nasopharyngeal intubation or tracheotomy. As the duration of the condition increases, trismus can lead to fibrosis of the TMJ, requiring targeted therapy.
Symptoms of paratonsillar abscess
The typical clinical manifestation of PTA is severe sore throat (usually unilateral), fever, and muffled voice. Patients may also complain of drooling and difficulty swallowing.
Trismus (spasm of the masticatory muscles), associated with irritation and reflex spasm of the internal pterygoid muscle, occurs in almost 2/3 of patients and is an important distinguishing feature of PTA in comparison with severe acute tonsillopharyngitis. Patients may also complain of neck swelling and ear pain on the affected side.
Forms
There are three degrees of trismus:
- easy – the mouth opens, the distance between the central incisors is 3-4 cm;
- medium – the mouth opens 1-2 cm;
- severe – inability to open the jaws, mouth opening less than 1 cm.
Since diagnosis requires a visual examination of the oral cavity, Botox is injected into the inflamed area. Otherwise, unclenching your teeth is problematic.
Diagnostics
In the vast majority of cases, the diagnosis of PTA is made clinically, based on the results of pharyngoscopy (examination of the pharynx). It is confirmed by obtaining purulent discharge during drainage of the abscess or by instrumental studies (most often ultrasound).
Pharyngoscopy reveals a swollen and/or fluctuating tonsil with deviation of the uvula in the direction opposite to the lesion, hyperemia (redness) and swelling of the soft palate. In some cases, there is plaque or liquid discharge in the palatine tonsil. There is an increase and tenderness of the cervical and submandibular lymph nodes.
Bilateral PTA is extremely rare and its diagnosis is more difficult due to the lack of asymmetry in the pharynx, as well as the rarely present spasm of the masticatory muscles.
Laboratory tests are not required to make a diagnosis; they are additionally prescribed to determine the severity of the disease and select a treatment method.
Laboratory tests may include:
- general blood test with leukocyte formula;
- study of electrolytes (potassium, sodium, chlorine) for signs of dehydration;
- strepta test to exclude GABHS;
- culture for aerobic and anaerobic bacteria if the abscess was drained (culture is recommended only for complicated PTA, recurrent PTA, or in patients with immunodeficiency conditions).
Instrumental examination methods - ultrasound, computed tomography, lateral neck x-ray, magnetic resonance imaging or angiography - are not necessary and are performed to exclude other diseases if the diagnosis of PTA is not obvious.
Treatment of peritonsillar abscess
In case of a complicated course, children (especially young children) are indicated for hospitalization and treatment in a hospital setting.
The main treatment method for PTA is systemic antibacterial therapy. In severe cases, severe intoxication, difficulty swallowing, nausea, antibacterial therapy is prescribed parenterally (bypassing the gastrointestinal tract) with subsequent transfer to oral forms of drugs - until the completion of the 14-day course of treatment. Courses of antibiotic therapy for less than 10 days increase the likelihood of disease relapse.
After prescribing systemic antibiotic therapy, dynamic observation for 24 hours is recommended. It is acceptable in patients with suspected paratonsillitis, without obvious signs of PTA, without signs of airway obstruction, sepsis, severe spasm of the masticatory muscles, or other signs of a complicated course of the disease. And also in children under 7 years of age with small abscesses and rare episodes of acute tonsillopharyngitis in history.
Studies have shown that systemic antibiotic therapy is effective even without draining the abscess. According to available data, 50% of children responded to systemic antibiotic therapy and did not require abscess drainage or tonsillectomy.
Systemic antibacterial therapy should include antibiotics active against GABHS, Staphylococcus aureus and respiratory anaerobes. For PTA, amoxicillin-clavulanate, ampicillin-sulbactam, and clindamycin are most often prescribed. If there is no or severe response, vancomycin or linezolid is added to treatment to ensure optimal coverage of potentially resistant Gram-positive cocci.
Treatment
Treatment of trismus is directed at the underlying etiology and is usually treated symptomatically. Symptom-focused interventions, including heat therapy, analgesics such as non-steroidal anti-inflammatory drugs, and muscle relaxants, can be considered in the acute phase and have been described as the mainstay of treatment for uncomplicated transient trismus. Patients with post-traumatic and post-operative trismus, especially if it persists for more than 1 week, may also require stretching exercises. The exercises usually consist of repeated attempts to open the mouth against applied resistance, usually divided into several sessions per day. Trismus can become chronic due to fibrosis or ongoing radiation therapy; In these cases, intensive physical therapy, sometimes using commercially available jaw movement devices or microcurrent therapy, may help, especially in cases refractory to more conservative approaches. Some authors have also described treatment with xanthine derivatives such as pentoxifylline.
What is muscle spasm, its types and causes
Muscle spasms are involuntary contractions of muscle tissue. Unlike natural contractions (for example, during the digestion of food, during exercise, swallowing water), spasms occur without any external or internal cause, in the absence of a person’s desire, and unpredictably.
As a rule, muscle spasms in the head area affect the temples, forehead, and back of the head. Involuntary contractions of the masticatory muscles can occur due to the use of stimulants (caffeine, taurine, narcotics) or for internal physiological reasons. In the second case we are talking about:
- trismus - a spasm that provokes a tight clenching of the jaws;
- bruxism - involuntary muscle contractions that occur mainly during sleep, at night, and are accompanied by grinding of the upper and lower rows of teeth.
Muscle spasms in the cervical spine can be either unilateral or bilateral. They are often associated with pinched nerves or spinal pathologies (for example, a hernia).
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Types of head muscle spasms:
- episodic involuntary muscle contractions: headache, neck muscle pain lasts no more than 14 days over a period of 1 month;
- chronic spasms: 15 days a month or more.
Typically, the causes of spasms in the muscles of the head, jaws, and neck are:
- metabolic disease;
- lack of physical activity;
- diseases of the musculoskeletal system;
- vascular pathologies;
- deficiency of vitamins, microelements;
- stress: physiological, psychological, emotional stress;
- hypothermia;
- increased body temperature;
- obesity;
- genetic predisposition;
- injuries;
- pinching of nerve fibers.
Types of bruxism.
There are two forms of bruxism: daytime and nighttime.
Daytime bruxism manifests itself while you are awake. A person clenches his teeth strongly (even to the point of dental stenosis) in moments of emotional stress.
Night bruxism manifests itself in the clenching of teeth and grinding or knocking them during sleep, when a person cannot control himself. In this case, several attacks may occur during the night. Nighttime bruxism occurs much more often than daytime bruxism.
Signs of involuntary muscle contraction are:
- with bruxism – grinding of teeth during sleep, a feeling of overexertion in the jaws after waking up;
- with spasms of the head muscles - hoop-shaped pain in the temples, in the forehead, in the back of the head;
- pressing, pulsating, squeezing nature of pain;
- feeling of heaviness in the area of spasm;
- pain when pressing trigger points (try to palpate the area of the head when it hurts: when you press certain points, the pain increases significantly);
- nausea, vomiting, dizziness;
- painful reaction to light, loud sounds (infrequently).
When to see a doctor:
- headaches appeared suddenly and do not go away;
- you are experiencing muscle pain for the first time after 50 years;
- pain is accompanied by dizziness, weakness, numbness of the limbs;
- pain lasts more than two weeks in a row;
- painkillers either do not work at all or give an insignificant short-term effect;
- the pain is localized on one side of the head/neck.
Muscle spasms that provoke pain indicate a disruption in the healthy functioning of the body. To prevent the development of the disease, it is important to consult a doctor in time. We advise you to visit a therapist, neurologist, endocrinologist, who will prescribe detailed laboratory diagnostics for you. Based on the research results, specialists of another profile may be involved in your treatment: an orthopedist, a cardiologist, a chiropractor. Complex treatment may include taking medications, a massage course, and therapeutic exercises. A good doctor will definitely give you recommendations on nutrition and daily routine.
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Prevention of bruxism in children.
- Give your jaws a rest . Unless your child chews, swallows, or talks, the top and bottom teeth should not touch. If your teeth touch, they clench, which is just one step away from grinding. Explain this to your child and ask him to try to keep his teeth slightly apart when his jaw is relaxed.
- Encourage exercise . Regular exercise can help your child relieve stress and muscle tension, which can cause nighttime teeth grinding in susceptible individuals.
- Quiet activities before going to bed . The child should not take part in wrestling, active and violent games before going to bed. Tense muscles need time to relax before your baby falls asleep. Make sure that the child is in a calm state an hour before going to bed. During this time, you can read a book or let him read on his own or look through a picture book.
- Try putting your baby to bed earlier . Your child may be overtired, which may encourage him to grind his teeth while sleeping. In this case, going to bed earlier may help.
- Avoid eating before bed . If digestive juices are working during the night shift, this can lead to unnecessary stress for the child during sleep. Don't give your child anything to eat or drink other than water an hour before bedtime.
- Talk to your child about his problems . If your child is worried about a difficult assignment or the upcoming premiere of a school play, this may be the reason that makes him grind his teeth at night. If something is bothering your child, don't let him go to bed with that worry in his head. Talking to him before going to bed so that he can leave all his worries behind, this often helps relieve tension. Make a five- or ten-minute conversation with you a daily calming procedure before your child falls asleep.
- Apply warm, moist compresses . If your child's jaw hurts in the morning, soak a washcloth in warm water, wring it out, and apply it to the sore jaw until your child feels better. This will help soothe the pain.
What can you do at home if:
Head muscle spasms
To relieve spasm and pain, you can take aspirin, a painkiller tablet like Ibuprofen, or a painkiller in powder form (for example, Nimesil). Give yourself peace of mind. You can try pressing trigger points and stretching your earlobes.
Jaw muscle spasm
If trismus manifests itself, before the doctor arrives, you can self-massage the masticatory muscles, accelerating the blood in them, alternately pressing on the muscles constrained by spasm. It is also possible to use compresses (alternate warm and cold compresses, apply them to the lower third of the face).
Cervical muscle spasms
Make gentle rotational movements with your head, lower and lift it (without throwing it back too much), turn it right and left. You can try stretching your neck muscles with your hands. Warm compresses and rubbing are effective.
*Attention! The information is for informational purposes only and does not constitute medical advice.
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