Trismus is a restriction in the ability to open the mouth. Trismus can occur following trauma, surgery, radiation therapy, infection, inflammatory diseases, temporomandibular disorders (TMD) or less commonly as a result of malignancy. Following two cases of delayed diagnosis of carcinoma presenting with features of TMD to a specialist clinic, a checklist was developed for completion in cases of trismus, to alert the clinician to suspicious features suggesting a possible non-TMD cause. The use of this checklist, together with an increased awareness, has improved early recognition of atypical features in patients presenting with trismus and has contributed to the early diagnosis of a further case of malignancy presenting to this clinic. This article discusses the presentation of malignancy with trismus, the relevance of imaging in these cases, and the implementation of a checklist to reduce the risk of future misdiagnosis.
A deep overbite is where the vertical overlap of the upper and lower incisors exceeds half of the lower incisal tooth height. Problems associated with the deep overbite can include soft tissue trauma, lack of inter-occlusal space and tooth wear, all of which can present significant challenges for the restorative dentist. While management options very much depend on the nature of the situation and patient's symptoms, options may range from provision of a simple removable appliance or splint and non-surgical periodontal therapy, to multidisciplinary care involving orthodontics, orthognathic surgery and restorative dentistry. Restorative management may involve an increase in the occlusal vertical dimension with fixed restorations or removable prostheses, and careful assessment and treatment planning is essential. This article discusses the aetiology and restorative management strategies for deep and traumatic overbites.
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