Patient complained of pain, swelling and trismus in left mandibular last molar after inflammation subsided an extraction was done. It has has been 2 weeks yet the patient complains of chewing and mild trismus. Patient had prescribed myospaz forte and warm saline rinses but to no relief. Suggest line of treatment. Thank you.

Dr. Mihika BalaOral And Maxillofacial Surgeon4yrs exp

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Hello lybrate-user. By the terms used in the question, it seems that you are someone from dental fraternity. In my opinion, firstly check for the following: - tenderness in muscles of mastication - clicking of tmj and deviation/deflection of mouth on opening and closing - any parafunctional habits - any emotional stress that the patient might be going through since it seems mostly due to muscular injury during extraction, I am suggesting the following line of treatment. Do continue with the warm saline rinses and myospas forte. Diazepam 10 mg orally once daily every night before sleep could be added for 14 days along with isometric jaw exercises (4-5 seconds in each direction per session, 4-5 sessions per day). Also tell the patient to perform ice-cream stick exercise to slowly increase the mouth opening. If any parafunctional habits are there then stoppage of the same followed by intraoral appliances like night-guard can be given. Review the patient after 14 days. If any clicking in tmj is present then get an opg done. Reassure the patient since having discomfort even after 2 weeks might get them stressed about the same. For further discussion, feel free to drop in for private conversation.  

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