Innovative Use of Mouth Props/Bite Blocks in Postoperative Mouth Opening Exercises

Abstract

Context

Postoperative jaw physiotherapy in the form of mouth opening exercises is an integral part of surgical treatment in oral submucous fibrosis and temporomandibular joint ankylosis. The literature has outlined multiple physical therapy modalities and modifications to aid in assisted mouth-opening exercises.

Purpose

To overcome shortcomings associated with the use of conventional devices, the authors describe an innovative use and modification of a prefabricated soft silicone bite block/mouth prop as an adjunct to the devices to aid in achieving optimal mouth opening.

Postoperative jaw physiotherapy in the form of mouth opening exercises (MOEs) is an integral part of surgical treatment in oral submucous fibrosis and temporomandibular joint ankylosis. It directly affects the intended surgical outcome of increasing maximum interincisal opening (MIO). MOEs are often performed by placing devices like Heister’s, Doyen’s, TheraBite and Fergusson jaw opener between the teeth 1, 2. Often multiple carious teeth are encountered which have to be extracted rendering the patient completely or partially edentulous. Existing physical therapy devices can only be used in dentulous patients and can have unintended complications like slippage, ill-fitting mouthpiece, unequal distribution of pressure, mobility and fractures of teeth which leads to poor patient compliance. 2, 3

The literature has outlined multiple physical therapy modalities and modifications to aid in assisted MOEs 3, 4. These aim to equally distribute forces to the dental arches 4, 5. However, the material used is either acrylic or metal and is usually applied on anteriors rather than posterior teeth.

To overcome these shortcomings, innovative use and modification of a prefabricated soft silicone bite block/mouth prop is described herein. A corrugated silicone mouth prop with bilateral elevated ridges and side slots as depicted in Fig. 1 was cut along the dotted line into two halves using a sharp blade. After this cut, two halves of mouth prop are formed with flat surface on one side and corrugated on the other. Additionally, a slot is made in the broader part of the mouth prop which connects to side slots as illustrated in Fig. 2. These two slots allow the mouth prop to be used along with Heister jaw opener from the anterior as well as lateral approach. In cases where the mouth props do not have existing side slots the heister’s prongs can be heated and inserted through the broad part of the mouth prop, and after cooling, it can be divided into two parts with the prongs being sealed inside.

Fig. 1.

Dotted lines marked on the soft silicone mouth prop designed to cut and divide into two parts

Fig. 2.

Cutouts made in the mouth prop to receive the prongs of the Heisters mouth gag

Figure 3 depicts its use in the patient's mouth for MOE through anterior approach in a completely edentulous patient. Figure 4 demonstrates the use of the same through lateral approach in patients wherein one of the arches is partially edentulous. The corrugated surface readily conforms to the alveolar ridge or occlusal surface and distributes pressure evenly onto the adapted arch or occlusal surface.

Fig. 3.

Use of the mouth prop in combination with Hiesters mouth gag in the patient’s mouth placed through anterior slot in a completely edentulous patient

Fig. 4.

Use of the mouth prop in combination with Hiesters mouth gag in patient’s mouth placed  through lateral slot wherein one of the arches is partially edentulous

This innovative use of mouth prop is economical, readily available and easily sterilized. As it is available in various sizes, it can be customized to the span of the edentulousness or the teeth present. It can function as an adjunct to the most commonly used jaw openers in any type of dentition present.