Patient Expectations and Dentists' Perceptions of Those Expectations in Dental Implant Therapy: A Mirror-Design Study.

Trismus is a debilitating manifestation of upper motor neuron predominant disease that may occur in individuals with amyotrophic lateral sclerosis (ALS) []. Increased tone and spasticity of the jaw‐closing musculature can result in reduced oral opening, impairing oral intake, speech, oral hygiene, and overall quality of life. Treatment options for ALS‐related trismus are limited and often include pharmacologic management, chemodenervation, and compensatory strategies [, ]. Neuromuscular electrical stimulation (NMES) has been investigated as a treatment for spasticity in other neurologic populations, including stroke and spinal cord injury [, ]. However, the use of NMES‐facilitated mandibular rehabilitation for neurogenic trismus has not previously been reported. Given the potential adverse effects associated with interventions that weaken masticatory musculature, conservative rehabilitation approaches may represent an important treatment option before consideration of chemodenervation. We describe two patients with upper motor neuron–dominant ALS and spasticity‐related trismus who underwent a combined NMES and mandibular range‐of‐motion rehabilitation program. Patient 1 was a 37‐year‐old woman with bulbar‐onset upper motor neuron–predominant ALS diagnosed three years before enrollment. She presented with progressive trismus characterized by restricted oral opening, difficulty with mastication, impaired oral hygiene, and increased effort during speech production.