Tempromandibular Dysfunction Cases - ORTHODONTICS
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Case 1
1-
A 19-year-old female college student
reported to the dental office complaining of a generalized muscle soreness on
the left side of her face. The pain was accentuated with chewing. It had been
present for approximately 1 week. In discussing the problem, she revealed that
this type of pain had been present on several other occasions, 2, 6, and 8
months ago. She did not report any noticeable change in her occlusion but felt
that the pain did limit her mandibular opening. Further questioning revealed
that each of the three episodes of pain, as well as this episode, accompanied
her college examinations.
The clinical examination revealed tenderness of the right and left
masseters (score, 1) and the left temporalis (score, 1) muscles. Functional
manipulation of the left inferior lateral pterygoid provoked significant
discomfort (score, 3). Her comfortable interincisal opening was measured at 22
mm. She could open maximally to 33 mm, but this was painful. Passive opening by
the clinician reached 45 mm (soft end feel). The TMJ examination was negative
for pain or sounds. No other significant findings occurred during the clinical
examination.
Case 2
2- A 27-year-old insurance salesman came to the dental office
complaining of a single click in the right TMJ on opening. He reported that the
joint sound had begun 2 days after his third molars were removed (under general
anesthesia) 3 weeks earlier. Some relatively slight pain (3/10) was associated
with the clicking, but the patient was able to function normally. The pain was
not aggravated with jaw function.
The
single click occurred in the right TMJ at an interincisal distance of 4 mm of
opening immediately. The muscle and joint examinations did not reveal any pain
or tenderness except when the mouth was opened to the point of the click. At
this moment slight pain was felt. Biting on a single tongue depressor between
the posterior teeth eliminated the click. The occlusal examination revealed a
healthy dentition with no missing or carious teeth.
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