Patient Past History
The patient had a limited jaw/mouth opening for years and always struggled with her opening during dental checkups. She also had an underlying Latex allergy.
April 2024 she was eating dinner with her family and experienced a sharp pain on the right side of her face while chewing sweet potato. The pain subsided and reoccurred 3 days later with chewing on the right side. Following mouth opening reduced further and she had to go for a soft food diet and a Kids toothbrush to brush her teeth due to limited mouth opening range.
She saw her General Practitioner (GP) who recommended NSAIDs (over the counter anti-inflammatories) for one week and jaw physiotherapy with the Headache Neck and Jaw Clinic.
The patient developed anxiety about the condition and she was in a constant fight or flight mode, worried that the jaw issues would get worse. It was the fear of the unknown, the horror stories from people about jaws ‘going out’ or ‘dislocating’, and the immense discomfort that took over her life.
The patient came to see a physiotherapist in the HNJ clinic. In the initial session, she was very emotional and anxious about the treatment due to her severe latex allergy. In the HNJ clinic, we use nitrile gloves in our treatment sessions to care for allergy sufferers. She developed a compensatory mechanism during treatment with involuntary facial muscle twitching and neck extension while opening her mouth. Later it would become more severe ticing. Her jaw opening range of the initial session was 23mm ( normal jaw opening range is 45-55mm).
She felt locked into the pain and discomfort from her jaw and the constant jerking of her head and contorting of her facial muscles. Physiotherapy exercises and treatment were not successful at the time.
Some weeks later, she noticed a burning sensation in my mouth. The patient reported that it felt as though she had drunk a very hot cup of coffee and scalded her tongue and the roof of her mouth. She tried removing certain foods from her diet – strawberries, tomatoes – anything acidic and could have caused the burning. Food elimination didn’t work. By then she had transitioned to only a soft food diet and cold beverages.
She reviewed with her GP, an Ear Nose and Throat specialist, and her dentist. She also consulted with a prosthodontist who referred her to an oral specialist for the Burning Mouth Syndrome, and a neurologist to help with the anxiety and tics, which were as bad as ever. All tests came back negative and she was diagnosed with Burning Mouth Syndrome (BMS).
By this stage, her life was consumed by jaw, mouth, and tongue pain and discomfort. Her pain was 9/10 VAS (if 10 is the most pain and 1 is the least). She could only talk for a short while without her face getting sore. She was constantly throwing her head back to try to realign the jaw. Her ability to go out in public was restricted. She could barely smile, so she was constantly trying to offer apologies to people that she wasn’t unhappy, just sore.
As per the prosthodontist’s advice, she started physiotherapy treatment again at the Headache, Neck, and Jaw Clinic at Greenslopes.
Additionally, she continued walking, talking to herself, and doing the jaw exercises daily. She had plenty of projects to keep herself busy so she focused her attention on creative pursuits. She started to feel mentally better, thanks to a combination of walking and rephrasing her internal dialogue to positive thoughts and not negative ones.
Physiotherapy Treatment Approach
The physiotherapy treatment approach for the patient’s Burning Mouth Syndrome included:
- Oral posture and reset of the nervous system with nasal breathing and tongue on the roof of the mouth.
- At home masseter massage from her husband/ a familiar trusted person.
- Opening / Close alignment exercises and gentle side movements of her jaw with breaks to readjust muscle tension.
- Soft tissue release work of the jaw Masseter muscles, gentle Triggerpoint release work, and jaw stretches to increase opening range of movement (ROM).
- Progression to more self-managing strategies at home like self-jaw stretches and self-massages with her husband and retraining chewing and eating pattern “to again trust the jaw”.
Patient Update: Seven months after the initial jaw incident
Mentally, the patient has improved due to the walking and positive affirmations. Her anxiety levels are much lower. She has stopped watching the evening news and she is still keeping abreast of world events.
The Burning Mouth Syndrome is currently about a 2-3/10 VAS (if 10 is the most pain and 1 is the least). It is always there, but the burning sensation has lessened. She is continuing physiotherapy fortnightly (initially weekly). The jaw opening range is 32.5mm, with less hesitation around opening, chewing, and eating.
The patient chooses food wisely, walks for half an hour each day, keeps repeating her mantras, and is grateful for the skills of the therapists. She also practises daily jaw management with oral posture, jaw releases, and jaw exercises.
She started smiling again and going out in public to socialise and talk to her friends.
Lisa Eisfeld is a trained physiotherapist from Germany. She has also studied advanced Manual therapy and finished her Osteopathy Diploma in 2018 at the School for Manual Medicine Berlin. Lisa has also attained her Watson Headache Institute Level 1 Foundation and Level 2 Consolidation courses. Read more about Lisa.