last Thursday i did my first conservative treatment (or better known as filling) on my patient who is also my friend here. i plan to do only one filling on one tooth because that was my first time doing. after doing the x-ray of all thet teeth, my supervisor asked me to do 2 filling on 2 different tooth instead. because the x-ray shows that the tooth next to the indicated tooth was also infected.
so i drilled of the infected area or better known as caries area. showed it to my supervisor. i need to correct the cavity preparation for a few times before i can finally restore it with amalgam ( the black thing u use for filling).
when i was about to show the well prepared cavity, suddenly my patient complained that she cannot closed her mouth completely. i panicked. i don't know what to do. my supervisor was busy listening to my friend's case presentation. i could not disturb her. for about 15 minutes, my patient was unable to close her mouth completely. can u imagine how it feels when u are unable to close your mouth. for 15 minutes????
when my supervisor came to see my patient, her jaw can already be closed completely. but when she checked the movement of her jaw, it was slightly deviated. so my supervisor asked everybody in the group what will u do if somehow our patient experienced that problem or better known as locked jaw during the treatment?? all of us were quiet. so she gives me assignment that ought to be presented to her this Sunday.
so this is what i found.
There are different causes of lock jaw and the cause determines treatment. Tetanus is an acute infection caused by a bacillus and characterized by spasmodic contractions of the jaw muscles. With a tetanus infection, incorrect diagnosis leads to death. The most common cause is spasm and shortening of the jaw muscles. Muscle spasm is treated with moist heat and TMJ exercises to loosen the muscles. With muscle spasm, the lower jaw can slide laterally but not open.
Sometimes lock jaw happens after a dental injection, when an anaesthetic is accidentally injected into the jaw muscle. If the spasm is from dental infection, it should be treated aggressively. An abscessed tooth makes pus which may extend into the jaw muscles causing muscle spasm and inflammation. If a jaw opens and won't close, it's due to a forward dislocation of the jaw joint. The joint pops forward and out of place and won't go back. It's treated by firmly gripping the lower jaw and rocking it downward and backward until it pops in place. This problem can occur after yawning or remaining open for a long dental appointment. A closed lock jaw can be from anterior dislocation of the TMJ disc.
Locking can occur after an overdose of phenothiazines or in some neurological disorders especially in the basal ganglia. Patients who experience lock jaw often have regular headaches and neck aches. There is often a history of head and neck trauma and these patients often grind their teeth. Massage therapy and TMD treatment can help.
so about my patient, my supervisor adviced her to compress her TMJ with warmed towel and practise opening her mouth at certain limit. she must control her mouth opening during laughing or yawning so that she won't experienced the problem again.
actually before i started treatment I'd checked on my patient TMJ (that's a routine to us) and both side were clicking on opening. i thought that it may be my fault as she had to open her mouth for a long period but during the treatment i noticed that she didn't open her mouth too big. and i didn't forced her to open it bigger. so maybe it was my fault or may be the problem was already there, i just make it worse. hoho.
luckily that patient is someone that i know. so she didn't sue me. haha. for me who knows the patient before the treatment, i know that she had the habit to yawn as wide as she can. memang dah tak senonoh dah dia nie. haha. no offenced girl!
