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can be drawn on the efficacy of using mechanical aids per se. A systematic review of the literature on risk factors for and treatment of trismus found that exercise therapy with the use of a TheraBite or tongue depressors brings about significant improvement in mouth opening (ES 1,5 and 2,6 respectively), although the studies included did not record follow-up time. Microcurrent electrical therapy and treatment with pentoxifylline likewise showed a significant (though small) effect (ESO.3) (Dijkstra, Kalk et al. 2004).\u000DWhen, in addition to (or instead of) hypertonia in the mouth closing muscles and the presence of scarring, trismus is accompanied by arthrogenic dysfunction, abnormal oral behaviour, or pain spreading out from the temporomandibular joint or the muscles of mastication, TheraBite practice alone is probably not the best intervention. In such cases, physical therapy may be called upon for additional support. Arthrogenic dysfunction may present itself in function-dependent pain in the temporomandibular joint, grating/popping, or asymmetric mouth opening (misalignment of the lower jaw when opening the mouth),\u000DDepending on the underlying causes or mediators, physical therapy may consist of creating awareness and reducing underlying behavioural aspects (such as clenching, tongue pressing, grinding your teeth), coordination exercises, active relaxation, applying or learning to apply (self-) massage and other pain- reducing and relaxing techniques, manual mobilisation of the temporomandibular joint using traction and translation techniques, and instructions in using a TheraBite. Speech therapists may furthermore instruct patients in performing exercises and using the TheraBite. One should always keep in mind, however, that head and neck cancer-related trismus is less treatable than trismus due to other causes (Dijkstra, Sterken et al. 2007).\u000DA randomised controlled study (n=55) performed at the Netherlands Cancer Institute compared two intervention groups (standard versus TheraBite exercises) (van der Molen, van Rossum et al. 2011). Both groups received stretching exercises before chemoradiation in order to prevent or minimalize adverse effects on swallowing and chewing muscles. This study showed that, with preventive exercise therapy (regardless of which group patients were in), patients had significantly less tube dependency (started oral intake more quickly) compared to a historical control group at ten weeks after the last radiotherapy session (only 37% of patients still needed a nasogastric feeding tube compared to 70% after 12 weeks in an earlier study at the Netherlands Cancer Institute (Ackerstaff, Hilgers et al. 1994)). Within the Netherlands Cancer Institute a cost-effectiveness analysis of the use of the TheraBite was performed. One group of 14 patients received standard logopaedic care, a second group of 15 patients received a preventive rehabilitation programme with the aid of the TheraBite. With a probability of 70% it can be said that the TheraBite programme is cost-effective (Ret\u00E8l, van der Molen et al. 2015).\u000DBased on the available clinical evidence it is safe to say that exercises for jaw mobility give better results than no exercises at all within the group of patients who receive radiotherapy treatment for head and neck cancer (Scherpenhuizen, van Waes et al. 2015). The Netherlands Cancer Institute has therefore opted for active detection, screening and treatment. Treatment for trismus is part of the multidisciplinary programme and is included in the electronic patient file. A speech therapist sees each patient undergoing a combination of chemotherapy and radiotherapy for preventive exercises and provides guidance during treatment. A dental hygienist monitors all patients undergoing radiotherapy and screens for possible problems. In case of severe trismus the patient will be treated by a physical\u000D124\u000D