TMD is Locked, Stuck, or Blocked, Opening 1 finger

A Restriction opening (RO) is inability to open mouth more than 1 finger, usually with moderate pain.

A Limited opening (LO) is completely displaced disc that has adapted to complete displaced disc that will not recapture. The retrodiscal tissues have stretched and the anterior displaced disc turned into small blob-thus-not blocking the opening as much.

A restricted opening tells patient and dentist there is MODERATE to SEVERE DAMAGE in TMD and it needs urgent REFERRAL to promote adequate healing.

Review science to patient:

1. Why you can’t open wide
2. What are causes not being able eat-chew-bite without pain
3. Why doe we need ability eat
4. Caution patient: No quick fixes
5. Single therapies are unsuccessfully tx all causes
6. Seeking latest medical or dental fad is frustrating & waste money & not promote healing
7. Research science personally on moderate jaw joint damage
8. Request refer to orofacial pain specialist
9. Analogy of “torn ACL of knee” is clue
10. Testing conservative therapies is safer-smarter than invasive procedures
11. Would it be urgent problem, if it was your mother or child
12. If problem was teeth, research teeth; If problem is muscle/joint research orthopedics
13. Awareness joint muscle damage is field orthopedic's
14. Orofacial pain specialist is chewing system orthopedist

Names for jaw restriction:

1. Lock jaw
2. Limited opening
3. Restricted opening (RO)
4. Stuck opening

Causes:

1. Completely Displaced disc
2. Osteoarthritis
3. Spasm muscles

Levels:

1. ½ finger --- severe
2. 1 finger --- moderate
3. 2 fingers--- adaptive
4. 3 fingers --- normal

Facts on Restricted opening

1. Indicates moderate damage TMD
2. Impairs treatment for hygienist-dentist-surgeon
3. Recapture is possible with timely referral
4. Tx for Restricted opening is orthopedic therapy
5. Dentist are not trained joint muscle pathologies
6. Dentist know very little about orthopedic therapy
7. Best practice: refer any Restricted opening SAP to orofacial pain specialist

A Restriction opening is inability to open more than 1 finger, with moderate pain:

1. Mastication inefficient
2. Nutrition impaired
3. Chewing impaired-social problem
4. Roughage fiber in food is reduced
5. Dental work impaired
6. Inability Open wide for diagnostics & treatment difficult
7. Xrays –impressions-exam-dental tx are difficult
8. Home cleaning is difficult
9. Patients adapting to untreated RO is slow-painful-costly-opening impaired

Hidden Restricted opening facts:

1. Restricted opening is usually completely disc displacement
2.  Recapture before disc loses it biconcave shape
3. Referral before disc turns into blob
4. Referral before elastic in back joint looses elasticity
5. Orofacial team is only specialty that effectively recapture displaced disc, but cannot accomplish this w/o dentist making prompt-urgent referral

Restricted opening happens: 1) Upon Awakening 2) Yawn Loud Pop 3) Opening wide loud pop 4) Prolonged open mouth procedure 5) MVA 6) Blow jaw 7) Rheumatoid affecting TMD 8)Progressive arthritis

Progression damage to joint disc complex:

1. Muscle overrecruited to pull disc ligament
2. Tearing Lateral Ligament Disc
3. Causing disc to displace at lateral pole
4. Progressive tearing lat ligament
5. Complete disc displacement

1) Micro tearing lateral ligament of disc a) Parafunction (moderate to severe) b) Tension in muscles (high stress-anxiety) c) Inadequate healing MacroTrauma’s: 1) Blows face-chin-jaw, 2)MVC-whiplash jaw & neck d) Head and neck pains (muscle guarding)

2) Other causes tearing lateral ligament of disc a) Open locking tearing muscles b) Dual bites c) Occlusal interferences/bites off d) Pains escalation

Outcome of complete displaced disc whether recapture or pseudo disc formation: 1) Patient Considers eating an important priority 2) Patient enhances all health habits, 3) Patient chooses best team 4) Patient priority in life for 4 months is jaw joint damage 5) Patient implements anti-anxiety tools w/ passion 6) Patient is willing to invest their hard earned money in health 7) Patient is willing Fight for their rights against insurance companies unwilling help with chronic pain

Recapture is Possible:

1. Does Disc still have biconcave shape at medial pole
2. Patient seeks urgent care for locked jaw
3. Dentist urgent referral soon after 1^st locking
4. Health Habits are improved
5. Healing all tissues in joint
6. Relaxation Lateral Pterygoid muscle

Pseudo disc
1) Formation is guided by orthopedic team 2) Joint is free of inflammation 3) Improved health habits 4) Decrease loading jaw joint 5) Relaxation of pull LP muscle on disc 6) Embryonic cells turns into fibroblast 7) Fibro cartilage from from fibroblast 8) Fibrocartilage is organized into pseudo disc 9) Pseudo disc protected from causes returning 10) Ongoing passionate anti-anxiety management 11) No chasing parked cars or eating hand grenades

Failure by patient to heal:

1. Lack trust
2. No research science
3. Lack respect
4. Hidden agenda
5. Uncontrol anxiety
6. Unmedicated or undiagnosed personality disorder
7. Fear

We prefer recapture disc with return to normal opening, but it is your dentist earnest referral and your passion for health that is key to success.