Page 326 - Demo

Chapter 12324Exercises to begin stretching the joint, with rotational and translative movement, also can be started in this phase. By no longer keeping the tongue pressed against the palate, translational movement becomes possible. Active horizontal mandibular movements can be aided by placing dental cotton rolls or a pen between the molars (for protrusion and retrusion) or between the incisors (for active lateral movement). Active vertical mandibular movement can be assisted by using tongue blades or by active assisted exercises such as the cross-fingered exercise, in which the mouth is actively opened while being aided by both thumb and index finger, and the ‘hook-pull’ in which the index finger hooks in the floor of the mouth, aiding the downward mandibular movement during opening. (Figs. 3,4) Placement of the index fingers over the condyles allows the patient to perceive the translative movement of the condyles, aiding in guidance when opening and closing. Passive exercises, such as manual finger stretching or using a passive motion apparatus such as the TheraBite system, also can be considered. The pace at which the mouth opening evolves should not be set per day, but rather be determined by the pain-free zone to prevent inflammation from overexertion and to avoid slower progression than potentially possible. The joint distraction can be continued and massaging of the muscles can be performed.(7,9,14,43,44)The use of chewing gum can also be considered toward the end of this phase when inflammation has been subdued because this promotes active movement in the horizontal and vertical planes and reinforces the masticatory muscles. However, the total amount of gum chewing should remain limited to avoid overexertion of the muscles and the joint.(9,29,34,45)Third Phase (>4 Weeks)The third phase should aim to achieve smooth and symmetrical movements of the lower jaw. Any imbalances and asymmetry still present should be resolved in this phase and the ROM should be further increased leading to restoration of normal joint kinematics. As in the previous phase, exercises can be performed in front of a mirror to aid with muscle coordination and symmetry.(Fig. 5) Nikolas de Meurechy NW.indd 324 05-06-2024 10:15