Interdisciplinary Approach in Endodontic Management with Limited Mouth Opening - A Case Report

Abstract

Advances in life expectancy, improved quality of biomaterials used in dentistry, and the rapid development of clinical procedures have led to increasingly complex patient needs and treatment options. Managing such complexities necessitates collaboration among specialists to achieve therapeutic goals and deliver successful treatment for both functional and aesthetic enhancement.

Beginning with a full medical examination, the first stage in treating a patient entails developing a proper treatment plan and gaining a thorough understanding of the patient's condition. After the medical evaluation, x-rays and an objective assessment should be performed in order to identify any variables that may jeopardize the root canal procedure.^[1,2] Subsequently operators can conduct and evaluate diagnostic tests to ascertain a patient's condition and create a comprenshive treatment plan that takes into account their requirements and preferences. Dentists can choose cases according to their expertise, technical proficiency, and comfort level with the aid of proper treatment planning, which also helps practitioners avoid procedural mistakes.^[3,4] As a result, it is crucial to examine and evaluate the elements that contribute to RCT. In the realm of endodontics, these insights are essential for improving education and assisting practitioners in treatment planning and referral decision-making.^[2,4]

The difficulty and success rate of RCT are correlated with patient-derived characteristics like as salivation, gagging, mouth opening constraints, tooth alignment, and occlusal connections.^[5,6] According to a previous study, during an RCT, more than 40% of patients had gag reflexes or mouth-opening limitations.^[4,5] Eating, oral hygiene, access to necessary dental procedures, speech, and facial appearance can all be negatively impacted by this condition . The mouth can normally expand 30 to 50 mm, or about the width of three fingers, for the majority of healthy people. For regular functioning in day-to-day activities, this range of mobility is essential. Interestingly research has indicated that mouth opening may vary by gender, with men often displaying a wider range. A maximum opening limited to 20 mm signifies a condition known as trismus or severely restricted mouth opening, which can pose significant challenges during dental procedures.^[1,5,7]

Long-term dental operations, such as root canal therapy, may result in problems with the temporomandibular joint (TMJ) and its surrounding structures because of trauma or improper posture.^[8] There seems to be a higher chance of developing posterior temporomandibular disorders (TMDs) after molar extraction. Biomechanical, neuromuscular, biopsychosocial, and biochemical factors are all part of the complicated etiology of TMDs.^[9.10] Depending on the underlying cause, TMDs are treated differently. Although TMJ pain and discomfort might worsen after dental procedures, any difficulty opening the jaw the day after should be treated seriously. It is important to schedule an evaluation when a patient complains of minor pain and dysfunction. illness, particularly in the oral cavity, which would guarantee that patients receive more optimal care. The present study aims to bridge the gaps in knowledge following the diagnosis and understanding of the etiology of a disease, especially in the oral cavity, which would ensure the provision of more optimized care for patients. It should also be noted that limited mouth opening or trismus is a condition and is not a disease itself; therefore, it may occur as a sign orsymptom of various diseases.^[7,11]