Proceedings of the Third International Conference on Smart Systems and Inventive Technology (ICSSIT 2020)

IEEE Xplore Part Number: CFP20P17-ART; ISBN: 978-1-7281-5821-1

Arduino based Smart Equipment for Pain Free Jaw

Movement
Mr. Hemanth Kumar G1 Mr. Ahammad Shanil2 Mr. Sajad K3
Asst Prof , Dept of BME Student, Dept of BME Student, Dept of BME
ACS College of Engineering ACS College of Engineering ACS College of Engineering
Bengaluru, India Bengaluru, India Bengaluru, India
[email protected] m [email protected] m [email protected]

Mr. Mohammed Adil A4 Mr. Mohammed Hisham M5

Student, Dept of BME Student, Dept of BME
ACS College of Engineering, ACS College of Engineering
Bengaluru, India Bengaluru, India
[email protected] m [email protected]

Abstract— Trismus and Oral submucous fibrosis (OS MF) is a requiring access to the oral cavity can be limited, or in some
frequently observed clinical condition. Rehabilitation with cases impossible, due to the nature of the condition itself.
mouth-opening exercises is very much essential for a fast and Examination and treatments on trismus or oral cavity issues
successful recovery. To deal with these conditions, smart
may be limited, even under certain circu mstances , it is
equipment for pain-free jaw movement has been modelled and
clinically tested. In the proposed Trismus treatment equipment
impossible due to the nature of the condition itself. The
unit, the autonomous actions are attained by employing muscle damage due to Trismus has shown in the Fig.1.
Arduino UNO as the core. Initially, the microcontroller will
activate the pump to spray the mouth cleaner by prompting
the relay interfaced to it. Upon activation, the pump will spray
the mouth cleaner into the patient’s mouth. After completion
of mouth cleaner spraying, the microcontroller will activate the
syringe to spray the pain reliever. The sprayed out medicine
from the mouth is sucked out using the vacuum pump
interfaced to the controller. Only after the completion, of
mouth cleaner and pain reliever spraying and also syringe for
intralession fibrolytics gets activated after which the action of
mouth opening mechanism unit is initiated. The level of mouth
opening threshold and the number of times the task needs to be
repeated can be set by the user by triggering the control input
switches interfaced to the controller. After the input triggered
by the control switch, the controller automatically does the
mouth opening exercises. In such a way, automation in forceful
mouth opening for the treatment of OS MF is attained in the Fig. 1. T he muscle damage due to T rismus.
proposed system.
Oral submucous fi brosis (OS MF) is a chronic fibrotic
Keywords — Trismus, Oral submucous fibrosis, Intralession
potentially malignant disease characterized by an
Fibrolytics
inflammatory reaction of the epitheliu m, together with
I. INTRODUCTION submucosal tissue fibrosis. Studies done since then reflect
many variations of the factors that are present, the main
Tris mus, also called lockjaw, is reduced opening of the jaws causal factor being chewing betel nut.
(limited jaw range of motion). It could be the result of As per the estimated experimental results, when compared
spasm of the muscle of mastication or for various causes. to areca nut alone product such as pan masala, mawa and
Short-term tris mus occurs more often than chronic tris mus. gutka contain a higher concentration of areca nut products
It is known to hinder proper oral hygiene, eating and which is increasing the incidence of OSMF[2]. Hypothesis
speaking[1]. shown to be a large amount of copper present in the areca
nut interferes with the release of the extracellu lar matrix
This intervention risks the patient in swallowing food such as collagen, and induces the repair of collagen
properly and the process of drawing breath. In some cases, production or reduced collagen degradation, subsequently
Tris mus alters facial appearance also. Th is painful condition leading to increased production leading to fibrosis under
can distress the patient. Examination and treatments epithelial tissues, which has been shown on oral biopsies.

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 Proceedings of the Third International Conference on Smart Systems and Inventive Technology (ICSSIT 2020)
IEEE Xplore Part Number: CFP20P17-ART; ISBN: 978-1-7281-5821-1

The most common hypothesis is that the format ion of countries will encounter this disease shortly. Various
epithelial atrophy in OSM F is due to a lack of perfusion, treatments including physiotherapy, surgical therapy, and
caused by reduced vascularity of subjacent connective tissue drug management have been tried with various degrees of
stroma. help, but none have been able to cure the disease.

In the year 2008 Shulman DH, Ship man B, Willis FB

developed a method of Treating Trismus with Dynamic
Splinting. The study was to retrospectively assess problems
associated with the Dinasplint Trisus system for patients
who have recently been diagnosed with tris mus after
radiation, dental treat ment, oral surgery, or after neuronal
pathology such as stroke. Stephen Co x, Hans Zellner,
Fig. 2. Oral submucous fibrosis discovered in 2009 that physiotherapy treatment imp roves
oral opening in oral submucosal fibrosis [5]. Fifty-four
In the proposed smart equip ment for pain-free jaw Nepali OSF patients were managed for 4 months in three
movement, the microcontroller will activate the pu mp to
randomly assigned groups receiving either five hours of
spray the mouth cleaner by prompting the relay interfaced to physiotherapy daily by placing tongue spatulas between
it. Upon activation, the pump will spray the mouth cleaner teeth and an inserting a new spatula every 5–10 days with
into the patient’s mouth. After completion of mouth cleaner
local inject ion of hyaluronidase with steroids; or any active
spraying, the microcontroller will act ivate the syringe to treatment. More males presented with OSF than females (p
spray the pain reliever. In response to input acceptance, the < 0.05). A ll patients reported with reduced opening and
pump will spray the pain reliever. The sprayed out medicine
47% had mucosal pain.
fro m the mouth is sucked out using the vacuum pump
interfaced to the controller. On ly after the completion, of III.EXISTING METHODS
mouth cleaner and pain reliever spraying and also syringe
for intralession fibrolytics gets activated after which the A] JAW CLAMP
action of mouth opening mechanism unit is in itiated. The
level of mouth opening threshold and the number of times Jaw Clamp is a tool fo r rehabilitat ing people who suffer
the task needs to be repeated can be set by the user by fro m Trisus (smallmouth opening) or TMJ. The hand -
triggering the control input switches interfaced to the applied step provides careful stretching to the jaw holding
controller. After which the action of the mouth opening the tissue. Fig 3 shows the jaw clamp. There are various
mechanis m unit is init iated. This processes will help in the causes for this condition they are surgery, trauma and
treatment of Trismus&OSMF stroke, but most often it because of rad iation. Limit ing the
opening of the mouth can have serious health effects, so
II. RELATED WORK patients may need to exercise the jaw muscles to regain a
wide range of movements. Passive mot ion exercises that are
Oral submucous fibrosis affects about 2.5 million people applied several times a day are an effective way to treat
in the Indian subcontinent. The limitation of oral opening, trismus or lockjaw. Jaw clamp cannot be used if the subject
leading to difficulty in eating, is the main feature of the have fracture in the maxilla or mandible (upper or lo wer
presentation. Although nutritional deficiencies and jaw) or other weaknesses of the bones of the jaw, infect ions
immunological processes may play a role in pathogenesis, of the jaw, osteomyelitis (inflammation of the bone and
available ep idemio logical evidence suggests that betel bone marrow), or osteoradionecrosis (necrosis of bone due
chewing is an important risk factor for OSMF. Haque, to radiation) of the jaw, weakened teeth, gum disease,
MFMeghji, S. Nazir, R. Harris, M. in 2001, studied with weakened bones or joints in ja w, dental Plates, crowns or
gamma interferon (IFN gamma), can reverse the bridges. If excessive force is applied when using the jaw
submucosal fibrosis of the oral cavity. Oral submucosal clamp, injuries can occur[6].
fibrosis (OSF) is a chronic disease of the oral cavity and
oropharynx characterized by submucosal fibrosis, which
leads to a progressive limitation of mouth opening[3].

Interferon-gamma (IFN - γ) is a well-known anti-fibrotic

cytokine. Krishnamoorthy, Bhuvana; Khan, Mubeen in
2013 perfo rmed a Co mparative study on Management of
oral submucosal fibrosis by two d ifferent drug regimens
Submucous oral fibrosis [4]. OSF is a chronic condition that
occurs exclusively among Indians and to a lesser extent in
other Asians. With the rise in immig ration of people fro m
the Indian subcontinent, dentists in many developed Fig. 3. Jaw Clamp

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 Proceedings of the Third International Conference on Smart Systems and Inventive Technology (ICSSIT 2020)
IEEE Xplore Part Number: CFP20P17-ART; ISBN: 978-1-7281-5821-1

B] THERABITE mechanis m un it, Pu mp, a device that expands energy to

raise, transport, or co mpress fluids wh ich is a 12v DC water
Therabite is designed to restore proper jaw movement after pump to spray mouth cleaner, pain reliever, intralession
trismus and mandibular hypomobility. It is clinically fibro lit ics, 3 levels of opening, 16×2 LCD and vacuum
proven, portable and repetitively mov ing passive device pump are the key modules interfaced with the Arduino UNO
used to stretch the tissue, strengthen weakened muscles and microcontroller in the proposed system. The action trigger
mobilize joints. On an average gain in the jaw opening is for the automation in the propos ed trismus treatment unit is
around 1–1.5 mm per week. This Motion Rehabilitation provided by relay interfaced to the controller. Init ially, the
System can also help to reduce muscle pain by reducing microcontroller will act ivate the pump to spray the mouth
joint inflammat ion and prevent reduced muscle strength cleaner by pro mpt ing the relay interfaced to it. Upon
during (chemo) rad iation in the head and neck area[7]. The activation, the pump will spray the mouth cleaner in to the
TheraBite Jaw Motion Rehabilitation System is availab le in patient’s mouth. After co mplet ion of mouth cleaner
both adult and pediatric versions. Fig 4 shows th erabite spraying, the microcontroller will act ivate the syringe to
equipment. spray the pain reliever. In response to input acceptance, the
pump will spray the pain reliever. The sprayed out medicine
fro m the mouth is sucked out using the vacuum pump
interfaced to the controller. On ly after the completion, of
mouth cleaner and pain reliever spraying and also syringe
for intralession fibrolytics gets activated after which the
action of mouth opening mechanism unit is in itiated. The
level of mouth opening threshold and the number of times
the task needs to be repeated can be set by the user by
triggering the control input switches interfaced to the
Fig. 4. T herabite controller. When the control switches are pressed, the
microcontroller sets the input such as level of mouth
IV. PROPOSED WORK opening and the number of t imes the exercise needs to be
done upon user provision. After the input triggered by the
control switch, the controller automatically does the mouth
opening exercises. In such a way, automation in forceful
mouth opening for the treatment of OSM F is attained in the
proposed system

T ABLE 1. Hardware Specifications

Hardware Specifications
Components

Arduino UNO Microcontroller ATmega328

Operating voltage; 5V
Digital I/O pins; 14
Analog I/O Pins; 6
Flash memory; 32kb
SRAM; 2kb
Clock speed; 16MHZ
LCD 16×2 LCD Display
Supply voltage; 5V
8-bit Data Pins
Fig. 5. Block diagram of smart equipment Motors DC Geared Motor
In the proposed Trismus treatment equipment unit, the 12v DC
autonomous actions are attained by employing an Arduino 3000RPM Base Motor
UNO microcontroller board based on the ATmega328 as the Torque ; 1.5kg.cm
core. The Arduino UNO technology is used as the central Load Current ; 300mA
hub part of this system. The foresaid Arduino UNO has Length ; 80mm
mu ltip le features which enable all the resolution needed for Vaccum Pump Operating voltage ; 12v
autonomous action of trismus treatment equipment to do its Load current ;1500mA
task. The control switch relays to control the load with the Maximum Pressure ; 525mmHg
signals received fro m the microcontroller. mouth opening Noise ; l60db, Size ; 60*120mm

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 Proceedings of the Third International Conference on Smart Systems and Inventive Technology (ICSSIT 2020)
IEEE Xplore Part Number: CFP20P17-ART; ISBN: 978-1-7281-5821-1

Water Pump Operating voltage; 3V-12V DC binary machine code for the target processor. Code is
Flow Rate ; 80-120 l/h developed for Level 1 of mouth opening which is less and
Load Rated Current; 0.18A the number of count for opening is 4. with the opening level
Submersible of 12-15mm. Level 2 of mouth opening is on the number of
Dimension; 45*24*3mm count for opening is 6 with the opening level of 30 mm.
Relay Circuit Rated Voltage;12V DC Level 3 of mouth opening is on the nu mber of count for
Rated Current;33.3Ma opening is 8 with the opening level of 45-55 mm. The below
Coil Resistance;360 ohm flow chart details the code developed to acco mplish the
objective of the concept of Jaw opening.
V IMPLEMENTATION
Simu lation of the setup is performed using Simulat ing
Software -Proteous 8 Professionals. Proteous 8 professional
is a software using wh ich schematics, PCB layout, code and
even simulat ion of the schematic is perfo rmed. Th is user-
friendly software helped to co mp lete the simu lation part
with the "Pick devices" button, select component, draw
wires option for Vcc, Ground terminals.

Fig. 6. Schematic Circuit by using proteus

Fig. 7. Simulation Of Circuit By Using Proteus 8 Professionals Fig. 8. Flowchart to open the Jaw with various levels

Arduino Software : This is the flow chart which shows the working pattern of
A program for A rduino hardware is written in Embedded the device. The first step is init ializing the GPIO pins. GPIO
C programming language with co mpilers that produced pins are general-purpose input-output pins. It is an

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 Proceedings of the Third International Conference on Smart Systems and Inventive Technology (ICSSIT 2020)
IEEE Xplore Part Number: CFP20P17-ART; ISBN: 978-1-7281-5821-1

uncommitted digital signal pin on an integrated circuit VI RES ULT

whose behaviour is controlled by the user at run t ime. It acts
as input or output. This GPIO have no predefined purpose
and are unused by default. In the second step, the LCD is
being initialized were our modes are going to be displayed.
The third step is the process in which displaying mode
selection on the LCD. The fourth step is the decision
making step in which mode selection is done. This is
assigned as 3 modes. That is Mode 1, Mode 2, Mode 3. In
each mode the number of count for mouth opening is
different. In mode 1, it is three times. In mode 2, it is six
times. In mode 3, it is nine t imes. In the fourth step,
switching takes place using the relay inside hardware. Here
mode is selected ( it maybe 1 or 2 or 3 ). If mode 1 is
selected, mode 1 is displayed in LCD Display. The water
pump is ON as well as OFF as explained in methodology.
Fig.9. Final Prototype Smart Equipment for Pain-Free Jaw Movement
Then the vacuum pump and syringe are Turned ON and
turned OFF. The Mouth opening and closing are done using
The aim for obtaining a device for the treatment of the
the motor (by on and off) for 3 times. If mode 2 is selected,
formed tris mus within the oral cavity is developed
mode 2 is displayed in LCD Display. The water pu mp is ON successfully. The designed prototype of smart equip ment
as well as OFF as explained in methodology. Then the for pain-free jaw movement is shown in the fig. 9 and is
vacuum pump and syringe are Started and off-ed. Then experimented on the patients suffering fro m t ris mus and
mouth opening and closing are done using the motor (by on other Jaw related problems. Init ially, the process starts
and off) for 6 t imes. If mode 3 is selected, mode 3 is with cleaning the oral cavity. Then spraying/injecting the
displayed in LCD Display. The water pump is ON as well as drugs to reduce the pain with the pain reliever to mainly
reduce and relieve them fro m the fibrosis formed. The
OFF as exp lained in methodology. Then the vacuum pump process is continued with the levels of Mouth Opening
and syringe are Started and off-ed. Then mouth opening and
closing are done using the motor (by on and off) for 9 T ABLE 2. Results showing Levels of opening
times. After executing each mode. The LCDs 'DONE' Here
It is using while loop. In the wh ile loop, the program asks Level 1 Level of mouth opening is less and the number of
the user for a positive nu mber. if the nu mber is negative, the count for opening is 4. With the opening level of
program asks for a positive number again. If the mode 12-15 mm.
selection is wrong it is again given back to the switching Level 2 Level of mouth opening is on the second level and
step. In the last step, the process ends (stop). In mode 1, the the number of count for opening is 6 with the
mouth opening range is 12-15mm. In mode 2, the mouth opening level of 30 mm.
opening range is 30mm. In mode 3, the mouth opening Level 3 Level of mouth opening is on the second level and
range is 45-55mm the number of count for opening is 8 with the
opening level of 45-55 mm.

VII CONCLUS ION

There are many Trismus and OSM F cases which are

available in the market but our concept in working towards
the same problem is Novel with its automation and pain-free
feature. The results obtained fro m our work showed the
exactness and high in solving the limited mouth opening
problems by using the Arduino UNO, relay circuit, pump
and dc motor. The mechanical device has been made to
reduce the fibrosis, pain and to perform the process of eating
and chewing which is difficult in patients with fibrosis.
When compared to the existing painful methods for Trismus

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 Proceedings of the Third International Conference on Smart Systems and Inventive Technology (ICSSIT 2020)
IEEE Xplore Part Number: CFP20P17-ART; ISBN: 978-1-7281-5821-1

and OSMS our p rototype also works with the non

transformation of fibrosis to cancerous cells.
ACKNOWLEDGMENT
The authors wholeheartedly thank the support provided by
the management and Principal of the A CS Co llege of
Engineering in carrying out our project work for the
successful completion.

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