Hi Everyone and welcome back to my YouTube channel! My name is Priya Mistry and I'm a
General Dentist whose practice is focused on taking care of patients with TMJ disorders.
Today's video is Part Two of "Jaw Locked Closed", so Part Two of talking about what I commonly call
in our practice a "closed lock", where the jaw can barely open more than one or two finger
widths and it's incredibly painful for the person going through it.
So first and foremost, we're going to discuss how we treat these patients in our office.
Then, I want to go into what you guys can do you, [what] General Dentists can do in your
office to provide some care and relief to these patients. And lastly, I want to discuss which
patients experience this most often and why. So in our office, what we do to treat these patients
is we make custom-made mouthpieces - we call them orthotics. So it's really about aligning
the jaw in three-dimensional space to allow for optimal healing. We measure where the muscles
are most relaxed - their correct resting length - and where the joints are aligned, and we build
custom-made mouth pieces to that position. We ask patients to wear them at all times unless
they're eating or drinking anything but water, and along with that we do our own specialized
physical therapy and we do our own very specialized jaw manipulation. There's a very
sensitive technique to those last two. With the physical therapy and the jaw manipulation - that
it took me a better part of a year to learn - we're able to get our patients excellent results.
If this condition occurred within the last six months, we consider that acute so it's still
new- meaning we have a better chance at resolving it. If it occurred within the last six months,
we tell our patients we can get the Disc back where it's supposed to be and stable
usually within four to six months. The way we treat these patients is we see them every week
once we deliver the orthotics to them, for our own physical therapy, for jaw manipulation, or for
checking the orthotics. Then as their symptoms get better and better, we see them every two weeks,
every three weeks, every four weeks.. until we can release them from treatment.
For more chronic cases that have been going on for longer than six months - so somebody locked
off the Disc ten months ago and they didn't know where to go, it took them that long to find us
or whatever it may be. For whatever reason that they didn't get in here sooner to see
us immediately - those patients it's really difficult to tell when the Disc will unlock.
So what happens in a chronic case is that the Retrodiscal Tissue, which is compressed
between the two bony components of the joint in a locked joint, starts to act as a pseudo-disc.
This is our body trying to compensate. It tries to pretend it's the Disc, and all this time the
Disc is still dislocated.. and the longer the Disc is dislocated and in the wrong position,
the more it starts to change shape. It goes from a biconcave shape to an oval shape, and it becomes
more of a barrier to opening. Our bodies are amazing and they can they can compensate, and so
once the pseudo-disc is formed, what happens is that the patients are
usually able to open a little bit more but not to their full maximum capacity.
So to put it in perspective with a full opening, we should all be able to open 45 to 50 millimeters
when you're measuring edge to edge from the top teeth to the bottom teeth.
In a locked situation that is acute, we find that these patients can open 25 millimeters or less.
In a locked situation where it's chronic, we find that these patients have adapted and can
maybe open 35 millimeters or so, so they've gained back some range of motion but definitely not their
full range of motion - and they're typically still in pain. So this is not a situation that
you want to let go for too long because there's a certain window of opportunity where we can really
get in there and make things right and give you a time frame for how long that will take. We have
certainly treated patients that are chronically locked, but it's taken me anywhere from maybe six
to nine months or so to get them unlocked and stable, and even then they have a lower chance
of regaining as much range of motion as those people that come in when they're acutely locked.
But essentially, they have their quality of life back - they don't have pain anymore. No pain with
yawning, chewing, they can open a lot bigger, they can eat a big sandwich.. and so at the end of the
day, it comes down to quality of life. But we're typically able to get all of our patients very,
very good results. General Dentists - what can you do in your practice? There's a list of Do's
and a list of Don'ts. Let's start with the Do's! Do: prescribe your patient Flexeril or Advil if
they're in severe pain, and you'll know when these patients are not comfortable. We're able to read
people's pain levels pretty quickly as dentists, and Flexeril and Advil can just help relieve that.
I typically put my patients on about a 10-day regimen of that, but
I ask them to make sure they return for treatment ASAP [as soon as possible], because I can't keep
prescribing those. DO: another thing to do is have these Aqualizers handy! These things are amazing
and I wish I had invented them! So what they have is two pads that are filled with sterile water
and these pads, when they rest between the top and bottom teeth in the back on both sides,
they serve as a water bed for the muscles in your head, neck, and jaw.. and it can really help with
headaches, jaw pain, and ear pain associated with this condition. It won't typically get the patient
unlocked. Unfortunately that requires more such as jaw manipulation and physical therapy, but
it can really help with their quality of life in the short term. I have seen this get one patient
unlocked - they didn't stay unlocked, but it was pretty neat that it was able to do that for that
one patient. Another thing you want to DO: is make sure you can recognize what's going on! The five
main signs and symptoms that go along with this as I listed in "Part One" of this series - know them
forwards and backwards and be able to identify them. Have this little scale handy so that you
can measure how much your patients can open and also the right and left measurements as well.
It's so important to have this handy and with you. DON'TS! So DO NOT: try to force the jaw open! that
can be incredibly painful and incredibly ineffective. It's not going to work unless
the muscles are relaxed with some very specific physical therapy to some very specific muscles.
The other DON'T is DON'T: make a nightguard that replicates their natural bite.
This was my go-to solution for everything when I practiced General Dentistry for 11 years,
and I know it ended up doing more harm than good to some of these patients, because I just didn't
know better. I'm not trying to shame, I'm not trying to make anybody feel bad, I'm just trying
to get knowledge out there! Definitely DO NOT make a nightguard that duplicates their original bite,
because a problem in their bite could be what got them locked in the first place,
so we don't want to go that route. The last thing I was going to discuss in this video was which
patients this happens most commonly in and why! This most commonly happens in women and the reason
for this is: hormones! The jaw joint has a ton of connective tissue in it and this connective tissue
is highly under the influence of hormones - particularly Beta-Estradiol and Relaxin. Both
of these are found predominantly in women and at much higher levels in women. Beta-Estradiol and
Relaxin have been linked to degenerative problems and changes in the joint - so they actually can
cause those! And Relaxin also makes it so that ligaments are looser, so the ligaments that are
holding the Disc and helping it remain where it's supposed to remain - if they get looser,
that Disc has a higher probability of dislocating or not being where it's supposed to be.
In my practice -I have been working here for about two years, and in that time - every week,
there's two to four patients that come in with their jaws locked closed!
And I don't know what the math is there, but out of all those patients that I've seen that
have come in with their jaws locked closed, only two have been men.. and both of these
men had some hyperflexibility going on as well and they were they were kind of aware of that.
So it's predominantly a condition that occurs in women, and for women that are watching that are
going through this - we have high pain tolerance and we tend not to complain! But if you're going
through this, seek help! There is help for this! General Dentists - one last tip is find a TMJ
specialist in your area, make a connection with them, have a good relationship with them. Find out
what methods they're using for this condition and you know to increase your knowledge base.
It's so important to be able to help all of our patients that walk through our doors!
Thank you so much for listening. If you liked what you heard, please click "Like" below, SUBSCRIBE to
my channel; there's so much more to come and I'm so excited to share it with you guys! Thank you!