Where to refer a patient with jaw locking?

Referral for Jaw Locking: Temporomandibular Joint Disorders

Patients experiencing jaw locking should be referred to a dentist or oral surgeon with expertise in temporomandibular joint disorders for prompt evaluation and management.

Understanding Jaw Locking

Jaw locking, also known as "closed lock," is typically a manifestation of temporomandibular joint (TMJ) dysfunction that can significantly impact quality of life. It presents as:

• Inability to fully open or close the mouth
• Restricted mandibular range of motion
• Possible pain during jaw movement
• May be preceded by clicking sounds in the joint

Appropriate Referral Pathway

Primary Referral Options:

1. Dentist

   • For initial evaluation of jaw locking
   • Can perform basic assessment and determine need for specialized care 1
   • May provide conservative management options

2. Oral Surgeon

   • For more complex cases requiring surgical intervention
   • When jaw locking is severe or persistent 1

Secondary Referral Options (based on findings):

• Periodontist - if periodontal disease is contributing 1
• Temporomandibular Joint Specialist - for complex TMJ disorders

Management Approach Based on Presentation

For Acute Jaw Locking:

1. Initial Management:

   • Relaxation of jaw muscles
   • Laterotrusion movement (moving jaw to one side) which is more effective than simple relaxation for resolving acute locks 2
   • Gentle manipulation techniques to restore condylar position

2. Conservative Treatment:

   • Has shown success in many cases of closed lock 3
   • May include mandibular appliances to prevent complete closure during healing

For Chronic or Recurrent Jaw Locking:

• Arthrocentesis - lavage of the upper joint compartment has shown long-term efficacy with 95% improvement and sustained normal joint function 4
• Physical therapy - to improve range of motion
• Occlusal splints - to reduce joint loading

Important Considerations

• Jaw locking may be associated with other conditions requiring specialized care:

  • Temporomandibular joint ankylosis (fusion)
  • Masticatory muscle myositis
  • Neoplasia affecting the jaw
  • Medication side effects (such as with certain antipsychotics) 5

• Patients with severe facial swelling, trauma history, or systemic symptoms should be evaluated urgently

When to Consider Emergency Referral

• Acute trauma with jaw displacement
• Inability to maintain airway
• Signs of infection (swelling, fever)
• Severe pain unresponsive to conservative measures

Prevention for Patients at Risk

For patients with clicking TMJs that occasionally lock briefly, preventive treatment is recommended to prevent future persistent locking episodes 3.

By following this referral pathway, patients with jaw locking can receive appropriate care to address both the mechanical dysfunction and any associated pain, ultimately improving their quality of life and preventing chronic complications.