Assisting patients with restricted jaw opening in speech therapy

Temporomandibular disorder (TMD) is estimated to affect around 31% of adults and 11% of children in the UK. However, it is difficult to be sure about this because many people do not seek help for the problem. Only around 5% of adults look into options for treatment.[i]

One of the causes of TMD could be patients grinding their teeth, or clenching their jaws. They may be doing this out of habit, or because of stress. It is important to make patients aware of this, and advise them to avoid doing it if they can as it could be making their TMD worse. Also, encourage patients to carry out exercises to relieve tension. This will help to reduce stress in the jaw.[ii]

Restricted speech

TMD can cause patients pain and restrict jaw opening. This can make ordinary tasks like cleaning teeth, eating, and speaking very difficult. TMD pain can also affect the jaw and neck, as well as causing headaches. Because of these unpleasant symptoms, it is important to look out for signs of TMD, and begin treatment quickly. If left untreated, the condition may get worse, eventually leading to very limited range of motion.

The inability to fully open the mouth is very likely to impact the patient’s ability to speak. This can be upsetting, and patients may have trouble communicating their problems to you. If speaking is causing the patient pain and discomfort, ensure they have another way to communicate with you. This could be as simple as a pen and paper.[iii] Once you have a clear idea of the extent of the patient’s TMD, in some cases, referral to a specialist oral/maxillofacial surgeon may be necessary to assist with treatment and management of their condition.

Speech therapy exercises

Speech therapy can be very useful for patients struggling with TMD. Exercises which stretch and strengthen the muscles in the jaw can help to increase range of motion and flexibility. It is usually better to recommend these exercises when your patients are not experiencing intense pain, as they could make it worse. ⁱⁱ

Speech therapists may recommend exercises like:

• Massaging the affected area to help relieve tension and pain. It can also be useful before exercising the joint and muscles. Massaging relaxes the jaw and makes stretching and exercising easier.
• Strengthening exercises. Use resistance while the patient holds the mouth open.
• Relaxation exercises to help relieve stress causing TMD. Recommend simple breathing exercises to reduce stress. This is useful for patients who grind or clench their teeth. It also has the added benefit of encouraging patients to notice when they are clenching. Patients are more likely to take note of the cause and actively relieve that tension.
• Stretching exercises are useful when patients are experiencing pain. Suggest that patients start with smaller stretches – to avoid over stretching their muscles and causing additional pain. Over time, encourage them to open their jaw wider. This will help to improve their range of motion, and contribute to their long-term recovery. Speech will become less painful as they are able to gradually open their mouth wider. ⁱⁱ

The OraStretch Press Rehab System, available from Total TMJ, is a handheld device which uses passive motion. It helps to stretch and strengthen the patient’s jaw. It works by opening the joint and stretching the muscles and facial tissues. This improves the patient’s range of motion and flexibility. The OraStretch Press is an excellent solution for your TMD patients. When used as recommended, exercises using the device can increase range of motion by 1-2 mm per week.[iv]

By recommending exercises early, you will help to prevent a patient’s TMD worsening. When used in combination, these exercises for relaxation, strength, and stretching work to reduce the effect of TMD. They increase range of motion and help your patients regain their ability to speak, eat, and carry out good oral hygiene.

Support patients in recovery

Difficulty when opening the mouth, especially when it impacts the ability to communicate, can be very distressing. It is important to offer patients support to aid their recovery. Make sure patients understand their options for therapy, and how to properly carry out their jaw exercises and stretches.

[i] NICE. How common are temporomandibular disorders? (accessed: 25.11.22) https://cks.nice.org.uk/topics/temporomandibular-disorders-tmds/background-information/prevalence/

[ii] Medical News Today. Jaw exercises for TMJ pain. (accessed: 25.11.22) https://www.medicalnewstoday.com/articles/317871

[iii] SLT. Augmentative and alternative communication. (accessed: 25.11.22) https://www.slt.co.uk/speech-language-and-communication/one-to-one-therapy/augmentative-and-alternate-communication/

[iv] https://www.craniorehab.com/orastretch-press-jaw-motion-rehab.html