Tetanus (lockjaw)

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What is tetanus?

Tetanus, commonly called lockjaw, is a serious bacterial disease that affects muscles and nerves. It is characterized by muscle stiffness that usually involves the jaw and neck that then progresses to involve other parts of the body. Death can result from severe breathing difficulties or heart abnormalities.

Who gets tetanus?

As a result of widespread immunization, tetanus is now a rare disease in the United States. Tetanus occurs more often in older people and in agricultural workers for who contact with animal manure is more likely and immunization is inadequate. In the United States, neonatal (newborn) tetanus is rare but can occur if mothers are not immunized appropriately against tetanus.

How is tetanus spread?

In unvaccinated individuals, tetanus is contracted through a cut or deep wound which becomes contaminated with the organism. Tetanus has also been associated with clean wounds, surgical procedures, insect bites, dental infections, and intravenous drug use. It is not transmitted from person to person.

Where is the tetanus bacteria found?

The tetanus bacteria are everywhere in the environment and is commonly found in soil, dust and manure.

What are the symptoms of tetanus?

A common first sign of tetanus is muscular stiffness in the jaw (lockjaw). Other symptoms include stiffness of the neck, trouble swallowing, painful muscle stiffness all over the body, spasms, sweating, and fever.

How soon after infection do symptoms occur?

The incubation period is usually 8 days but may range from 3 days to 3 weeks. Shorter incubation periods are associated with more heavily contaminated wounds.

What are the complications associated with tetanus?

Complications include spasm of the vocal cords and/or spasms of the respiratory muscles causing interference with breathing. Other complications include fractures of the spine or long bones from stiff muscles, elevated blood pressure, abnormal heartbeats, coma, clotting in the blood vessels of the lung, and pneumonia. Even with modern intensive care, tetanus is associated with death rates of 10-20%.

What is the treatment for tetanus?

The use of tetanus toxoid-containing vaccine and tetanus immune globulin (TIG) or antitoxin in the management of wounds depends on the nature of the wound and the history of immunization. Persons with clean, minor wounds may need to catch-up their tetanus toxoid-containing vaccine. For more severe wounds, persons may need TIG in addition to vaccine.

If the disease develops, supportive care and therapy to control severe spasms are indicated.

Does past infection with tetanus make a person immune?

Recovery from tetanus may not result in immunity. Second attacks can occur and immunization is needed after recovery.

Is there a vaccine for tetanus?

An effective vaccine called tetanus toxoid has been available for many years. It is contained in the DTP (diphtheria, tetanus, pertussis), DT (diphtheria, tetanus), DTaP (diphtheria, tetanus, acellular pertussis), Tdap (tetanus, diphtheria and acellular pertussis), and Td (tetanus and diphtheria) vaccines. A tetanus booster shot is recommended every 10 years after the completion of a 3-dose series.

In New York State, children born after 1/1/2005 are required to have at least 3 doses of DTaP to attend pre-kindergarten programs and school. Children born on or after 1/1/94 are required to have one dose of Tdap. Tetanus vaccine is highly recommended for all children.

What can be done to prevent the spread of tetanus?

Being fully immunized is the best tool to prevent tetanus.

Lock Jaw: What You Need To Know

Often associated with the bacterial infection Tetanus, lock jaw is one of a number of disorders that can affect the jaw, causing a range of uncomfortable symptoms for sufferers. While most cases are temporary and able to be treated easily, lock jaw can sometimes be a sign of a more serious underlying illness, so it is important to seek prompt medical treatment.

In this guide to lock jaw, we discuss what lock jaw is, the main symptoms and lock jaw causes, and provide advice about how to unlock a locked jaw.

What is lock jaw? And what are the main lock jaw symptoms?

Lock jaw, or trismus as it is known medically, is a disorder that causes the jaw muscles to spasm, preventing the mouth from opening properly. Most cases of lock jaw are temporary, with symptoms typically peaking within a few hours, and lasting for less than two weeks.

The locking sensation that lock jaw causes typically affects the entire jaw and results in a range of painful symptoms that are felt on both sides of the face. The main symptoms of lock jaw include:

• Jaw locking – the defining symptom of lock jaw is the jaw not opening fully, typically to less than 35mm. This jaw locking may also prevent sufferers from fully closing their mouths
• Jaw pain and cramping, caused by spasming jaw muscles
• Difficulty biting, chewing and swallowing due to limited jaw mobility
• Difficulty talking, which may make it hard for other people to understand you
• Headache, due to increased tension within the jaw
• Earache

Because lock jaw prevents sufferers from opening their mouths, it can have a secondary effect of causing poor oral hygiene. Sufferers are often unable to swallow properly, and can’t practice their usual dental care routines, which may result in halitosis (bad breath), dry mouth and oral inflammation.

Main lock jaw causes

Lock jaw occurs as a result of spasms in the jaw muscles, so anything that causes intense jaw muscle spasms can cause lock jaw. Often, you’ll see the term ‘lockjaw’ used interchangeably with Tetanus. While lock jaw is one of the main symptoms of Tetanus, this bacterial infection is not the only cause of lockjaw.

The main lock jaw causes include:

Temporomandibular joint (TMJ) disorders

Temporomandibular joint (TMJ) disorders can cause inflammation of the soft tissues surrounding the jaw, sometimes resulting in jaw locking. The temporomandibular joint connects your jawbone to your skull. TMJ disorders refer to disorders that cause this joint to malfunction, and typically result in pain in the jaw joint and muscles that control the jaw, as well as headaches and jaw clicking or popping when moving your jaw. In particularly severe cases, lock jaw may occur as one of the symptoms. Risk factors for developing TMJ disorders include chronic teeth grinding and clenching, injury to the jaw, rheumatoid arthritis and osteoarthritis, and certain connective tissue disorders.

Inflammation

Medical conditions that cause oral inflammation, or inflammation in the jawbone may cause jaw locking. Examples include pericoronitis, which is inflammation in the soft tissue around a tooth, arthritis, scleroderma—an autoimmune disease that affects connective tissue—and soft tissue fibrosis.

Tetanus

Tetanus is a serious disorder of the central nervous system caused by infection with the Clostridium tetani bacterium. It is often called ‘lockjaw’ as toxins released by the bacterium result in severe muscle contractions, particularly of the jaw and neck muscles, that cause jaw locking. Infection in Australia is relatively rare due to high vaccination rates, however it can still occur if spores from the bacterium make their way into someone’s body through broken skin (e. g. getting dirt in a wound, or stepping on a nail). There is no cure for tetanus, so treatment focuses on managing symptoms until the effects of the toxins resolve. If you suspect you may have, or be at risk of developing Tetanus you should seek prompt medical attention.

Trauma to the jaw

Trauma to the jaw that results in injury or damage can cause jaw locking. Common examples of trauma to the jaw that can cause lock jaw include fractured jawbones and tissue damage as a result of dental surgery.

Dental surgery

Dental surgery, such as a wisdom tooth extraction, can lead to jaw locking if it causes inflammation in the mouth, or results in hyperextension of the jaw. Hyperextension refers to the jaw being open beyond its typical range of motion.

Medication

Certain medications can cause lock jaw as a side-effect. This typically occurs as the medications alter nerve functioning. Examples of medications that may cause jaw locking include anti-nausea medications and some antipsychotic medications.

Cancer and cancer treatments

Cancer and cancer treatments (such as surgery and radiation) can cause jaw locking if they result in injury to certain parts of the jaw that control movement. Head or neck cancers are the most common cancer types associated with lock jaw.

Other infections

Tetanus is not the only infection that can cause lock jaw. Other infections such as mumps, tonsillitis and abscesses including peritonsillar abscesses can also cause jaw locking by resulting in inflammation.

Other causes

Other causes of lock jaw can include low calcium levels (hypocalcemia) and nerve or muscle diseases that result in muscle spasms.

Because there is such a wide range of lock jaw causes, it is important to consult your healthcare professional to determine what is causing your jaw locking.

How is lock jaw diagnosed?

If you suspect you might have lock jaw, it’s important to see a healthcare professional as they will be able to make a proper diagnosis. Not only will they be able to provide relief of the lock jaw symptoms, but also identify any underlying illnesses that may be causing the lock jaw.

Lock jaw is typically diagnosed by a healthcare professional based on a physical examination and an assessment of your medical history. During the physical examination, your doctor will likely consider the following:

• How wide you can open your mouth. Most healthy people can usually open their mouths between 35 and 55mm (or 1.4 to 2.2 inches) wide. However, lock jaw sufferers can typically only open their mouths 35mm (1.4 inches) at the most.
• How easily you can open and close your mouth. Patients suffering from lock jaw are often unable to fully close their mouths and have difficulty opening them.
• Stiffness and tightness in the muscles in your jaw and neck.
• Any problems you might have with your teeth, such as clenching.

When considering your medical history, your doctor will look for factors that point to an underlying illness. If necessary, they may request additional testing such as blood tests to rule out infections, or imaging studies to identify any injuries or tumours that may be affecting the jaw.

Because lock jaw can make it difficult to speak, it may be helpful to take someone with you to the appointment so they can explain your medical history on your behalf.

How to unlock a locked jaw?

Fortunately, most cases of lock jaw can be successfully treated through a combination of medication and physical therapy. However, it’s important to seek help as soon as possible, as the earlier a person begins treatment, the better the outcome.

In terms of how to unlock a locked jaw, treating lock jaw typically involves both alleviating the condition’s primary symptoms, and addressing the underlying cause of the lock jaw. In many cases, lock jaw treatment involves a combination of muscle relaxants and physical therapy.

Muscle relaxants are used to provide relief from the painful muscle spasms that commonly cause lock jaw. Depending on the nature of the lock jaw, oral muscle relaxants or injected muscle relaxants will be used. Common examples of medications used to treat lock jaw include Flexeril (Cyclobenzaprine) and Skelaxin (Metaxalone), while injected muscle relaxants may include Botox or anti-inflammatory steroids. Because injected muscle relaxants only target the specific site of spasm, they typically do not cause the drowsiness that may be associated with oral medications.

Physical therapy is also commonly used to help relax the jaw and return it to normal functioning. Physical therapy for lock jaw typically involves performing a series of specific mouth exercises. These are similar to other TMJ exercises that may be recommended to help alleviate the pain associated with TMJ disorders. In some cases, a doctor may also recommend the use of a jaw stretching device to encourage greater mobility and flexibility in the sufferer’s jaw joint and tissues.

Home remedies for lock jaw

The most appropriate treatment for each case of lock jaw depends on the underlying cause, so it is vital to see your healthcare professional to develop a treatment plan. However, there are a number of helpful remedies you can use at home to get some relief. These include:

• Applying a warm compress to your jaw and/or neck. Doing this several times a day for around 20 minutes per session can help relieve muscle stiffness by encouraging more blood to flow to your jaw. You can use a heat pack, hot water bottle, or warm towel.
• Applying a cold compress to your jaw and/or neck. If the pain is severe, using a cold compress may be a good option to numb the pain. Freezer bricks or ice wrapped in a tea towel work well if you don’t have a medical cold pack. Just make sure to never apply the ice directly to your skin.
• Self-massage. Gently massaging your jaw muscles after you have used a warm compress can help to reduce tightness. Apply a small amount of massage oil to your fingertips and gently rub the muscles next to your ears in a circular motion.
• Switching to a soft food diet. Hard, chewy or crunchy foods that place pressure on your jaw can aggravate your lock jaw symptoms. While experiencing and recovering from lock jaw, eating soft foods (such as soups, pureed vegetables and yoghurt etc.) can take some pressure off your jaw. You also won’t need to open your mouth as wide to eat these foods.
• Staying hydrated. Keeping hydrated is vital for proper muscle function. If you are having trouble drinking due to lock jaw, try using a straw.
• Ensure you are getting an adequate amount of calcium and magnesium in your diet. Calcium and magnesium are two minerals integral to proper muscle function, as they play an important role in helping your muscles to relax. The best way to achieve the recommended daily intake of calcium and magnesium is by eating a balanced diet, as numerous foods are rich in these minerals. However, if required, both calcium and magnesium are available as supplements.

How is lock jaw different from other TMJ disorders?

Lock jaw is one of a number of disorders that can affect the jaw. One of the most common of these is called a TMJ disorder. TMJ disorders cause pain and discomfort in the temporomandibular joint, which connects the jawbone to the skull. While a locked jaw can be one symptom of a TMJ disorder, they typically have other milder symptoms.

Some key differences between lock jaw and TMJ disorders are:

• The pain associated with a TMJ disorder is typically one sided, whereas lock jaw usually affects both sides of the jaw. In some instances, TMJ disorders may affect both sides of the jaw.
• TMJ disorders may cause jaw stiffness and reduce the range of motion sufferers have in their jaw, particularly when yawning or laughing. They may also cause clicking of the jaw. However, this is typically milder than the freezing of the joint experienced with jaw lock which usually prevents the jaw from being opened more than 35mm.

Like lock jaw, the causes of TMJ disorders are varied, and include:

• Bruxism, which is where people clench, grind or gnash their teeth. Over time this can place stress on the jaw, leading to TMJ disorders.
• Damage or displacement of the cartilage disc that covers the TMJ’s surface. This can result in TMJ movement being disrupted. The cartilage disc may move out of place, or be damaged over time by arthritis.
• Injury which damages the joint.

Because of the similarities between lock jaw and generalised TMJ pain, it’s best to see a doctor for a proper diagnosis.

References

• Medical News Today, 2020, What is trismus?
• Very Well Health, 2022, What is lockjaw?
• Mayo Clinic, 2022, Tetanus
• Sydney Centre for TMJ & Sleep Therapy, 2022, How to cure lock jaw naturally
• Gold Coast Implant Specialist, 2022, Surgery for TMJ – everything you need to know

Temporomandibular Joint Syndrome – Medical Center “Lіko-Med”

What is it?

As you know, the lower jaw is connected to the upper, forming the temporomandibular joint, thanks to which we can speak, chew, yawn. Temporomandibular syndrome (TMJ) is a whole symptom complex, the main features of which are soreness of the masticatory muscles, crunching or crackling when chewing, opening the mouth, and limiting the mobility of the lower jaw.

TMJ can be caused by osteoarthritis, bruxism (teeth grinding), malocclusion, and some other factors. Both one and both temporomandibular joints can be affected.

TMJ symptoms range from mild (moderate pain when chewing) to severe, manifested by inability to open the mouth or headache. Sometimes it is not possible to determine the exact cause of TMJ.

Most temporomandibular joint inflammation is mild and resolves on its own within a few weeks with limited stress on the joint, but occasionally TMJ symptoms may recur.

What to expect

TMJ pain can be on one or both sides, worse when chewing. In severe cases, the pain spreads to the muscles of the face, neck, chronic headaches, nocturnal bruxism, difficulty opening or closing the mouth appear. TMJ may also be accompanied by blurred vision, dizziness, or muscle stiffness.

Prevalence

It is believed that TMJ occurs in every fourth person at least once during a lifetime.

Treatment

Treatment may include:

• muscle relaxation exercises,
• joint stress relief,
• warm compresses,
• pain relievers or anti-inflammatory drugs (acetaminophen, ibuprofen, sen),
• bite correction at the dentist ,
• wearing special night guards to prevent bruxism,
• intra-articular injections.

Occasionally resort to surgery.

What you can do yourself

TMJ often goes away on its own. You can apply warm compresses, ask your doctor to show you specific exercises, and then do them regularly. You should also relieve the joint as much as possible – eat soft foods in small pieces, do not chew gum, do not gnaw on foreign objects (for example, pencils), take stress management courses so as not to strain your jaws.

What makes it worse

Chewing hard foods, malocclusion, stress, lack of sleep.

When to See a Doctor

Consult your doctor if you have trouble chewing, opening your mouth, severe or chronic pain. TMJ can lead to complete immobility of the jaw with the mouth open or closed, requiring urgent medical attention.

What to ask your doctor

Ask your doctor:

1. What are my risk factors for TMJ?

2. What can be done to reduce pain?

3. Are there other more effective treatments?

4. Should I consult a dentist?

5. Is it TMJ or something more serious?

Diagnosis

TMJ diagnosis is made on the basis of complaints, examination of the patient, as well as X-ray, MRI, CT data.

Risk factors

Arthritis, bruxism, malocclusion, fibromyalgia, jaw trauma during traffic accidents, etc.

Jaw joint clicks when mouth is opened

Clicking in the jaw joint – a sign of a malfunction of the temporomandibular joint (TMJ). If left unattended, the problem will eventually lead to immobilization and misalignment of the jaw, requiring major surgery. In our Center, the treatment of TMJ pathologies is carried out by experienced specialists using effective non-surgical techniques .

Why does the joint click when the jaw moves? Each consists of an articular head, a fossa of the temporal bone in which the head is located, an intraarticular disc and a ligamentous apparatus. Normally, when all the elements are in their places, the mouth opens silently.

If one of them is displaced or damaged, the work of the joint is disturbed. The first symptom of TMJ dysfunction is the appearance of clicks during jaw movement.

Causes of the pathology

Concomitant symptoms of TMJ dysfunction

TMJ dysfunction – insidious disease

In case of untimely treatment, it progresses and passes into stages that are not amenable to non-surgical treatment. When the first warning signs appear, we recommend that you immediately consult a doctor to diagnose and correct violations.

Levin Dmitry Valerievich

Chief Physician and Founder of the Doctor Levin CSP

What to do with clicks in the jaw, where to go

A gnathologist deals with the treatment of TMJ problems. You can also contact an orthopedist or orthodontist with additional qualifications in practical gnathology.

Gnathology is a branch of dentistry that studies the relationship between the structures of the dentofacial system, their functioning within the normal and pathological limits. The task of the gnatologist is to assess the condition of the teeth, muscles, joints in a complex, restore the correct ratio and coordinated work of the elements of the TMJ.

In some cases, it may be necessary to involve other specialists in the treatment process:

• orthopedist – if the cause of joint dysfunction lies in improperly installed prostheses;
• orthodontist – when the pathology arose against the background of malocclusion;
• neurologist – in case of hypertonicity of masticatory muscles.

Diagnosis of pathology

More than 60 indicators are studied. Main diagnostic methods:

• Digital impressions and computed tomography of the dentition
• Bite examination with facebow and articulator
• TENS diagnostics for masticatory tension
• Manual-functional examination of posture, symmetry of the shoulder girdle, shoulder blades, etc.

How to treat a joint that clicks

Treatment of TMJ pathologies involves a comprehensive approach and is carried out in a strict sequence:

1. Reducing the load on the joint with a special removable lining on the teeth – an occlusal splint (splint)
2. Removal of muscle hypertonicity (if any) using TENS-therapy, botulinum therapy
3. Occlusion correction and, if necessary, prosthetics

In parallel with the main course of treatment, drug therapy is carried out to eliminate degenerative changes:

• Corticosteroid injections to relieve inflammation in the joint
• Muscle relaxants for muscle relaxation
• Analgesics for severe pain

If serious morphological changes in the joint are detected, such as displacement of the intra-articular disc, surgical treatment is indicated.

Methods of treatment

Splint therapy

Splint therapy is a technology that allows you to restore the normal functioning of the TMJ by applying a splint to the dentition – a transparent fixing occlusal splint made of silicone or a non-toxic polymer.

Effect:

• Muscle activity regulation
• Shortened ligament sprain
• Return of the heads of the joint into place
• Fixation of the physiological position of the jaws

TENS Therapy

TENS Therapy is used when the masticatory muscles are highly active. Provides impact on them by low-frequency microcurrents. The procedure is painless, in the Center it is carried out with a non-contact device of the latest generation MIST TENS (Neurotech).

Effect:

• Relaxation of masticatory muscles, removal of hypertonicity
• Restoration of normal neuromuscular trajectory
• Setting a physiologically correct bite
• Normalization of joints

Botulinum therapy

An effective technique for TMJ pathologies that have developed against the background of bruxism, masticatory muscle hypertonicity. Provides injections of muscle relaxants or neuroproteins in areas of increased activity of muscle fibers.

Effect:

• Reduced muscle tone
• Pain relief
• Correct jaw positioning through muscle relaxation

Occlusion Correction

Indicated in the detection of malocclusion that requires correction for normal functioning of the TMJ. Depending on the type and degree of complexity of the defect, braces or aligners can be used to correct the position of the jaws. Orthodontic course is carried out only after the normalization of the state of the joint. The duration of treatment in each case is determined individually.

Restoration of teeth

In case of destruction or absence of some teeth, restoration or prosthetics is mandatory to normalize the occlusal relationship of the jaws. In case of partial destruction, inlays, crowns, veneers are used. Missing teeth are restored with bridges or dental implants.

Doctor’s recommendations

To increase the effectiveness of the treatment course, we additionally recommend that you adhere to the following rules at home:

• Perform myogymnastics to relax the masticatory muscles
• Eliminate foods that are too hard
• Get rid of bad habits (biting nails, pencils)
• Do not support chin with hands
• Fruits and vegetables should not be chewed, but cut into small pieces with a knife

Frequently asked questions from patients

Why does the joint click after implant placement?

After implantation, clicks in the joint of the lower jaw can be observed if there has been a displacement of the intraarticular discs due to improperly installed implants or prosthetic structures to them. Therefore, it is important to contact experienced implantologists who, when installing implants and prostheses, will take into account the smallest features of the bite and the prospect of normal operation of the TMJ.