Restricted mouth opening (trismus) can significantly limit access during extractions or other oral procedures, increasing the risk of soft tissue trauma and incomplete removal.

Causes include infection, trauma, TMJ disorders, fibrosis, or muscular spasm. When mouth opening is less than 25–30 mm, surgical management under sedation or general anaesthesia is often required for safe and effective treatment.

Referral is advised when:

• Limited opening prevents adequate access for extraction or instrumentation.

• The restriction is associated with infection, trauma, or suspected TMJ pathology.

• Conservative measures have failed to restore normal function.

Oral and maxillofacial surgeons can assess underlying causes with imaging, provide treatment under IV sedation or general anaesthetic, and perform necessary surgery with minimal risk and improved comfort.

When to refer to AWOMS Oral and Maxillofacial Surgery: Any patient with restricted opening (<30 mm), suspected TMJ involvement, or infection-related trismus where access is limited for routine dental management.