J Oral Maxillofac Surg
47:102&1029.1989
The Normal Range of Mouth Opening
MICHAEL MEZITIS, DDS,* GEORGE RALLIS, DDS,* AND
NICHOLAS ZACHARIADES, DDS, MDt
The maximal mouth opening of 1,160 healthy Greek adults, 18 to 70 years
old, was measured. The results were similiar to those reported by investi-
gators in other countries.
Introduction
All clinicians dealing with the oral cavity are
faced with varying degrees of difficulty when mouth
opening is limited. In an oral and maxillofacial sur-
gery clinic, one often deals with situations that may
lead to compromised opening such as congenital
and traumatic cases (including soft tissue bruises,
lacerations, and scars; temporomandibular joint in-
juries and ankylosis; mandibular and midface frac-
tures such as coronoid impingement by the frac-
tured zygomatic arch, etc; arthropathies, myopa-
thies (including those resulting from
maxillomandibular immobilization), and various
types of infections or tumors.
Although inability to open the mouth may occa-
sionally create legal problems,’ very few investiga-
tors have dealt with the subject. Carlsson and
Svardstrom’ examined 299 men and women and
found 44.8 +_ 9.4 mm maximal vertical mandibular
opening for the men and 39.2 + 10.8 mm for the
women. However, their material was biased as it
consisted of patients of the department of Sto-
matognathic Physiology at the University of Goth-
enburg. Agerberg3 in 1974 found the mean maximal
vertical opening of the mandible in 20-year-old
healthy men to be 58.6 mm, with a range of 44 to 77
mm, whereas for women of the same age it was 53.3
mm, with a range of 42 to 75 mm. Agerberg,4 in
another report in 1974, and Landtwing’ in 1978
came up with similar results. Agerberg,3 working
with persons 70 years old who had residual teeth,
found that the corresponding values were 52.7 mm
(44 to 65 mm) for men and 49.3 mm (38 to 59 mm)
Received from the Oral and Maxillofacial Department of Gen-
eral Peripheral Hospital of Attica KAT (formerly Apostle Paul’s
Accidents Hospital) Kifissia, Athens, Greece.
* Registrar.
7 Head of the Department.
Address correspondence and reprint requests to Dr Mezitis:
21-23 Konstantinoupoleos St, 151-24 Maroussi, Athens, Greece.
0 1989 American Association of Oral and Maxillofacial
geons
0278-2391/89/471 O-0005$3.00/0
for women. The mean value in edentulous patients
(wearing their dentures) of the same age was 50
mm, with a range of 37 to 66 mm in men and 26 to
63 mm in women. Lyssel16 in 1984, examining 67-
year-olds, found the maximal vertical opening to be
47.7 mm for men and 45.5 mm for women. He ex-
amined 129 persons and found only 15 of them with
maximal opening of <40 mm.
Maximal opening of the mouth has been de-
scribed either as the interincisal distance at maxi-
mal mouth opening or as the interincisal distance
plus the overbite.’ The Maxillofacial Surgery Clinic
in Zurich accepts 36 to 38 mm incisal edge distance
as the minimum limit for adults.5
Materials and Methods
We studied the maximal mouth opening in 18- to
70-year old adults both sexes from various parts of
Greece with no history of temporomandibular joint
(TMJ) involvement, trauma, tumor, infection, or
congenital anomaly in the maxillofacial area. All pa-
tients had their own teeth. The study consisted of
1,160 persons, 500 men and 660 women. The dis-
tance between the incisal edges of the upper and
lower right central incisors was measured with the
mouth completely open using a pachymeter. The
overbite was not included. Two measurements
were made in each case, and the mean value of the
two values was recorded. Usually, the second mea-
surement was greater.
Results
Figure 1 shows the number of cases measured in
relation to age and sex. Table 1 shows the range of
mouth opening and the mean value of maximal
mouth opening in relation to age and sex. The mean
value and the range of maximal mouth opening was
52.85 + 7.41 mm (38.74 to 67.27 mm) for men and
48.34 + 5.64 mm (36.67 to 60.45 mm) for women.
Sur-
The greatest mean maximal opening was recorded
in younger ages (18 to 30 years) both in men (56.60
mm) and women (51.04 mm), whereas the lowest
1028
MEZITIS, RALLIS, AND ZACHARIADES 1029

FIGURE 1. Number of cases measured in relation to age and sex.

was recorded in men aged 5 1 to 60 years (47.58 mm) occasionally related to factors such as body height,4
and women 61 to 70 years old (44.45 mm). These although no direct proportions have been found. In
differences are statistically significant. our study we took into consideration the age factor
and found that the mean maximal opening dimin-
Discussion ishes with age. Because many factors can influence
The maximal mouth opening was measured as the mouth opening, there is need for further research on
distance between the incisal edges of the upper and various groups such as children, old people, pa-
lower right central incisors with the mouth com- tients with maxillofacial injuries, patients who have
pletely open. We did not add the overbite because been operated in the maxillofacial region, and oth-
we believe that what is important is the functional ers, so that in the treatment of these persons an
opening of the mouth and not the vertical distance effort can be made to restore mouth opening to
that the mandible travels. Our findings were similar what is considered normal.
to those reported by investigators in other coun-
tries. References
As reported in the literature, maximal opening is 1. Weinstein IR: Normal range of mouth opening. Letters to
the editor. J Oral Maxillofac Surg 42:347, 1984
2. Carlsson GE, Svardstrom G: A survey of the symptomatol-
Table 1. The Range of Mouth Opening and ogy of a series of 299 patients with stomatognathic dys-
the Mean Value of Maximal Mouth Opening in function. Swed Dent J 64:889, 1971
Relation to Age and gex 3. Agerberg G: On mandibular dysfunction and mobility. Umea
University Odontological Dissertations, Umea Sweden,
Mouth Opening Mouth Opening 1974 (abstr 3)
Men (mm) Women (mm) 4. Agerberg G: Maximal mandibular movements in young men
Age and women. Svensk Tandlak Tidskr 67:81, 1974
(yr) Range M~~ll Range MWIl 5. Landtwing K: Evaluation of the normal range of vertical
mandibular opening in children and adolescents with spe-
18-20 52.52-60.99 56.60 40.12-57.25 49.81 cial reference to age and stature. J Maxillofac Surg 6: 157,
21-30 48.70-67.27 56.08 39.40-60.45 51.04 1978
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41-50 50.97-60.47 55.02 36.67-53.30 46.87 Maxillofac Surg 42:763, 1984
51-60 39.62-58.47 47.58 41.17-54.10 48.31 7. Wood GD, Branco JA: A comparison of three methods of
61-70 38.74-57.52 49.10 39.51-53.85 44.45 measuring maximal opening of the mouth. J Oral Surg
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