When you cannot open your mouth!!

Mouth is the vital and most active part of the face adding expressions, beauty and words to the person’s identity. Mouth and oral cavity is extremely necessary for breathing, speech and eating as well.

Usually an individual can open mouth upto 35-45mm (which is approximately three fingers wide). Males have more mouth opening as compared to females. However, due to some reasons a person cannot open his mouth completely thereby, limiting his language and eating habits. Inability to open mouth (lockjaw in ancient literature) is known as trismus in medical terminology which is a frustrating and debilitating condition. Trismus, temporary or permanent, is a common problem prevalent worldwide with more than one million affected individuals every year.

If ignored for long, trismus may lead to several facial and general complications such as difficulty in breathing and malnourishment.

Common causes of trismus:

  • Post-surgical
  • Congenital/Ankylosis
  • Systemic conditions
  • Drugs
  • Fracture or trauma to the jaw
  • Psychogenic
  • Oral diseases

Post-surgical trismus is commonly seen in dental surgeries (wisdom tooth removal), TMJ surgery and radiation therapy. Common Systemic conditions associated with trismus include tetanus, sclerosis, Parkinson disease, rheumatoid arthritis, etc. and needs appropriate treatment. Severe stress may also be one cause for restricted mouth opening for brief period of time. Ankylosis or fusion of the lower and upper jaw at the temporomandibular joint (TMJ) level might occur in newly born babies due to forceps delivery or as a sequel to the unattended trauma to the joint in children and adults. Some fractures including lower jaw (mandible) fracture, facial and cheek bone fracture might be a cause for trismus.

Injury to the muscles of face specifically seen in assault injuries and road traffic accidents might cause pain and swelling and limited mouth opening temporarily, but in few cases may cause long term calcification in muscle fibres. Several lesions of the mouth (mostly suggestive of risk of cancer!!) can cause trismus. Immediate repair of the fracture is the treatment of choice in most of the facial fractures. Muscular injury can be treated with medicines (anti-inflammatory and steroids).

Ankylosis causes severe facial asymmetry and unaesthetic facial appearance (often referred as Andy Gump appearance) and dental problems. Removal of fused structure and mobilization of the joint is the ideal treatment followed by aggressive physiotherapy and further cosmetic surgeries, bone grafts, and dental treatment.

Succinyl choline, phenothiazines and tricyclic antidepressants may lead to trismus. This condition can be also seen as an extra-pyramidal side-effect of medicines such as metaclopromide, phenothiazines, etc.

Infections of facial region most commonly associated with tooth decay, Mumps or ear infections can cause trismus and antibiotic therapy with anti-inflammatory drugs are usual treatment of choice. Oral submucous fibrosis (OSMF) is a condition commonly seen in chronic tobacco chewers often complaining trismus and burning mouth sensation. World health organization (WHO) has considered such situations (OSMF, lichen planus, leukoplakia, etc.) into precancerous lesions and conditions which carries high risk of cancer of the mouth and other parts of the body as well! Biopsy and needful treatment is indicated in such patients. Cessation of the tobacco habit or smoking is of utmost importance for successful treatment. Injection therapy, laser, surgery and skin grafts, etc are treatment modalities available however, long term follows up and mouth opening exercises are needed for these patients.

Cases with oral cancer require multidisciplinary approach and aggressive treatment as in such cases rehabilitation can be done only after successful treatment of the tumor. Trismus has been commonly seen in patients after radiotherapy.

Trismus is a troublesome sign to the more serious underlying disease. The condition may often go unnoticed or ignored by the patients as it is slowly developing in many cases. Constant awareness among general population, physicians, ENT and dental surgeons is needed as they encounter the oral cavity frequently thereby motivating the patient for early diagnosis and prompt treatment.


Key for health in your tooth: Exploring dental stem cells

“Now you can ensure healthy future simply with your falling tooth!”

Perfect health and long life is everyone’s lucid dream. In the present era, where the science has found cure to almost every other disease, still many common disorders such as diabetes, cancer, congenital anomalies, organ failure, neural disorders, etc. are the major challenges to the scientists and medical practitioners.

Recently, stem cell therapy has emerged as a viable technique in this area. Stem cells are the undifferentiated cells which has potential to give rise to more specialized cells and tissue lineage (nerve, muscle, gland, etc.). The various sources for stem cells in a human body are umbilical cord, bone marrow, adipose tissue, dental structures, etc.

Dental mesenchymal stem cells (DMSCs) have been widely studied and used successfully in regeneration of damaged tissues and treatment of various disorders. Ideally, DMSCs banking should be done in early age group (5-25 years) to obtain maximum amount of viable stem cells. DMSC can be easily harvested from teeth and other structures and can be stored for long. The whole procedure of DMSC banking is simple and can be carried out in any dental clinic under local anesthesia and good asepsis. Several parents have undergone stem cell banking for their children to ensure their safe future. With ongoing research and continuous efforts, stem cells can change the perspective of regenerative therapy.

Potential applications of stem cells

Congenital anomalies (cleft lip and palate)

Blood disorders (thalassemia, sickle cell disease)

Skeletal disorders (Muscular dystrophy, bone regeneration)

Eye (corneal, limbal regeneration)

CNS & Neuromuscular disorders (Parkinsons, stroke, Alzheimer’s, epilepsy)

Cardiac defects (myocardial infarction)

Endocrine disorders (diabetes, thyroid, etc.)


Regeneration of damaged tissues (kidney, nerve, diabetic foot, teeth)



Sources of DMSCs

Dental pulp

Periodontal tissues

Deciduous teeth

Dental follicle (tooth bud)


Lifting wrinkles! How to care for aging skin?

“The desire for long lasting youthful appearance has become an important concern for many people in today’s world.”


Aging is probably one of the physiological processes which nobody likes. Skin being the most visible and the largest organ in human body shows the signs of aging invariably and other factors such as smoking, stress, pollution, sun, diet, genetics, etc. acts as the catalyst to this process.

Wrinkles, seen as furrows or ridge on the skin causes dull appearance of the face and can affect person socially and psychologically. Lifestyle at large is the major culprit for facial wrinkles but genetic component of the human also affects the aging process. Interestingly a study from UK suggests that severity of facial wrinkling correlates with the extent of lung disease (COPD) in smokers.

Aging, although is a natural process in a life cycle of a human but is always undesirable and causes loss of confidence, stress and worry to every living soul. In the present corporate and modernized era, you have to be on your toes and best of the looks always one may not find enough time for hours long cosmetic procedure and skin care in parlours and spa.

Here are some tips and medical tricks which can definitely make you look younger than your age.


Botulinum Toxin- More commonly known as BotoxTM (Allergan, USA) is the most common non surgical cosmetic technique performed worldwide for facial wrinkles. Botulinum toxin is the most lethal substance known to mankind but when used in minute quantities can yield several therapeutic effects including muscle relaxation thereby correcting dynamic wrinkles. It usually takes 3-4days after injection for clinical results, maximum effect observed approximately after second week while the effect persist for 3-4months. The injection is safe with minimal local complications and is contraindicated in pregnancy, lactating mother and neuromuscular junction disorders (myasthenia gravis)


Laser- Laser has been widely used in the field of medicine. The photothermal effect of the laser can be used in hair removal, skin tightening, skin rejuvenation, skin lightening, scar removal and other cosmetic procedures. The laser therapy should be performed under standard laser safety conditions and requires multiple sessions to achieve optimal results. Other cheaper devices like IPL (photo rejuvenation), radiofrequency and ultrasonic cavitation machines have been explored for cosmetic procedures with results comparable to lasers.


Chemical peels- Chemical peels are routinely used products in cosmetic clinics and spa. These products contains mild acid and other natural and artificial skin rejuvenating substances (ascorbic acid, stem cells) which causes peeling of the superficial layer of skin and regeneration of healthy cells giving younger and glowing appearance to the face.


Fillers- Most common is hyaluronic acid based fillers which are used to fill static wrinkles (smile lines) and facial recontouring. They are inert and biocompatible and are degraded in usually 4-6 months.


Derma rollers and collagen induction therapy- carries several microneedles which causes superficial injury to the skin thereby promoting new collagen formation and improved blood circulation to the area. The devices are cheap and can be used at home as per the instructions by professionals.

Dental Implants: What you should know?

Dental implants have been become quite popular among dentist and patients searching for the treatment of lost dentition. Dental implants if planned and placed properly and with little constant care can give you the perfect solution for missing teeth. Dr. Ravi Sharma, a maxillofacial surgeon and implantologist practicing in Jaipur gives answers to frequently asked questions related to dental implants.

What is dental implant?
Dental implant in simple terms is an artificial substitute to the root over which crown (prosthesis) can be fixed. It is made up of a biocompatible material (titanium, alloy, ceramic, etc.) and is available in different shapes, sizes and surface textures. Sometime the surface of an implant is treated with substances (e.g. hydroxyapatite) to enhance positive interaction between implant surface and the bone.

What are the pros and cons?

The biggest advantage of dental implant is long term fixed replacement of missing teeth without cutting adjacent teeth (done for fixed bridges or FPD). Dental implants can restore oral health, form and function of the dentition, improve esthetics. The drawbacks of implants are slightly higher risk of treatment failure as compared to conventional procedures (FPD) although the success of the implants has been reported to be more than 90% in scientific literature. Common post operative complications may occur such as infection, implant loosening and nerve injury. Cost factor is also a concern as the treatment is expensive.

When you should consider for implants?

Implants can be placed anytime after tooth loss depending upon other factors; however, the best time for placing a dental implant is first six months after losing the teeth. If an individual is going for extraction by the dentist then the planning should be done from first appointment to achieve atraumatic extraction and preserve the bone to make the recipient site ideal for the dental implant.



Is everyone a candidate for dental implant?

No, the patient selection is the foremost and an important step in implant planning. Smokers, tobacco chewers, poor oral hygiene, old age groups, patients with systemic conditions such as diabetes are at higher risk for implant failure. Thorough medical history, dental examination and radiographs to assess bone quality and position of anatomic structures is mandatory prior to implant placement.

One implant for one tooth!

It’s not true. The cases where multiple teeth need to be replaced in a row, then a dentist can plan prosthesis over less number of implants to reduce overall treatment cost. Recently several articles have demonstrated great success of full mouth dentures over just four implants in each jaw (All on four concept).

Implant surgery hurts!

Implant surgery is a simple multistep procedure (sometime can be done single stage) and is done as routine dental procedure. The can achieve pain control with local anesthetic and the implant process is very much equivalent to wisdom tooth removal in terms of pain, time and complications. Routine antibiotics and pain killers (analgesics) are advised after the surgery for less than or a week.

Implants are carefree!

This is a common myth associated with dental implants. Good oral hygiene, adequate control of systemic condition, cessation of debilitating habits is essential for long term implant success. The patient should undergo dental checkup and professional care at least in a year to avoid bone loss and implant failure.