My Jaw is Locked, Help!
Whether due to trauma or perhaps just waking up to find the jaw locked in a closed position can be a frightening experience. While not a common occurrence, we typically see a handful of patients each year with this condition. The closed-locked TMJ (temporomandibular joint) position is characterized by the inability to open one’s jaw more than 20-30mm. Or, simply to open more than a finger’s width compared to a normal range of 40mm to over 50mm. A closed-locked position can either be associated with pain, but in some instances there is no associated pain. When this condition occurs, patients often become frustrated and become fearful perpetuating the pain cycle with tightness of the muscles responsible for opening and closing the jaw. They often make things worse by further clenching and tightening of the jaw muscles. Facial pain, neck pain, pain at the top of the head, and behind the head and neck, with pain behind the eyes and/or pain around the eyes and tenderness as the lower border of the corner of the lower jaw are just some of the problems patients can experience.
The closed-locked position of the mandible (lower jaw) is the result of a dislocation of the TMJ’s disc that becomes an impetiment to opening, or a disc dislocation without reduction in dental terms. Clinically, a properly trained TMJ/TMD (temporomandibular joint disorders) dentist can make the appropriate diagnosis by noting: i) the jaw opens no wider than 30mm and does not widen any further when pressure is applied, ii) the jaw deflects on opening to the side of the dislocation, and iii) the patient can move their jaw within the normal range laterally in the ipsilateral direction, but is restricted in eccentric movements to the contralateral side.
It is imperative that the patient who has a closed-locked jaw see a properly trained TMJ/TMD dentist as soon as possible because the odds of recapturing the disc are diminished over time. Research has shown that conservative treatment and rehabilitation is ideal. We recently treated a mother from Lakeway who could only open her mouth 10mm when she came into our office. After a roughly one hour session with our TMJ/TMD therapist the muscles of the jaw were sufficiently relaxed to allow her to open to 30mm. More importantly, the patient was now relaxed enough that we could reduce or recapture the disc. Once we did this, she could then open to 40mm. We then placed this patient on her first of two different orthotics. This is the key as most dentists are not trained in the different orthotics required to treat the disparate TMDs. To help ensure the best possible long term outcome, it is imperative that patient achieves orthopedic stability with a proper orthotic before moving the patient to a long term stability orthotic.
We often have patients come to our office several weeks after the onset of the closed-locked jaw after having their dentist attempt to treat them with his/her “go to orthotic’. Unfortunately, in most instances, the orthotic they constructed is not only inappropriate for the condition, but also, works contrary to what needs to be achieved in order to recapture the disc.
Back to our Lakeway mother, she has now returned to her original opening of over 45mm and has been stable for over six months now. If you or someone you know is suffering from a closed-locked jaw, the time to act is now by calling a properly trained TMJ/TMD dentist in your area. You can find one by contacting the American Academy of Craniofacial Pain, the leader in TMD and Dental Sleep practitioners. In Austin and Central Texas, you can contact Dr. Patrick Jaeckle at 512.402.1955.
Dr. Jaeckle is a member of the American Academy of Craniofacial Pain and has specialized TMD training under Jeffrey Okeson of the University of Kentucky, as well as Robert Kiersten the researcher behind Disclusion Time Reduction therapy in which Dr. Jaeckle was the first dentist in Texas and the third dentist in the nation to be trained by Dr. Kerstein.