Help required for this case

[Anonymous]

Dear all ,

I require help for this case.

Female patient, a fresh medical graduate.
Medical history is non-contributory.
Patient wore braces for almost 7years
Patient first noticed a click in right TMJ in Jan 2009 on mouth opening.
The click on mouth opening was audible.
Occlusal equilibration was done in Jan 2009

Patient left it incomplete since it did not give her any relief.
Click in right TMJ become less after 6 months.

There was never a severe pain in right TMJ is less. It is more of tenderness

Now the right TMJ pains during yawning. Afterwards the pain lasts for about an hour.

The right TMJ feels tired on eating hard food or eating for long time
Another dentist suspected bruxism and made Bite guards made in end of 2009.

Patient wore it for about 5 months. It did not give her any relief. The patient is not a bruxer.

What could be the cause ? What is the diagnosis and what is the prognosis ?

Any help would be greatly appreciated.

OPG and TMJ views are attached.

Regards,

        

[Anonymous]

I would like to indicate a MRI, for this case, just OPG cant show soft tissue findings

        

[Anonymous]

Though not an important reason but i notice that the patient has silver fillings in al her molars, probably the high points were not taken care of at the right time this may have led to change in the dynamics of the TMJ system

        

[sushantpatel_doc]

I dont think minor high points would cause so much of a problem but this cause cant be completely over-ruled either…You may ask the patient to apply hot water fomentation and prescribe muscle relaxants and analgesics for symptomatic relief..

        

[Anonymous]

Hi,

Although the problems looks chronic, needs a a proper diagnosis before any therapy is carried out.The diagnosis of the disease also requires a through knowlegde about both hard and soft tissue anatomy. The radiographs displayed here are having excellenet contrast, but are not contributory for the diagnosis. The soft tissue details are the part of TMJ and required to study in detail.I prefer you to go for specialized technique like MRI to study these details ad come to dignosis. After the diagnosis come to managemnet part. The management of TMJ problem more or less is symptomatic.

        

[Anonymous]

i had referred the pt. to an oral surgeon. The oral surgeon opined a conservative line of treatment. Oral surgeon prescribed hot water fomentations and restricted mouth opening for a few days. There was a slight deviation of the mandible on the left side op mouth opening. I taught the patient to open the mouth without deviation. The patient feels slightly better now. Altho she is unable to open her mouth fully.

More comments are welcome.

veeren

        

[tirath]

dislocation of the condyles may b one of the cause..

        

[Anonymous]

Regarding management provided by oral surgeon i dont have any complaints, everyone has their own way of treatring these cases. Regarding mouth opening as you have told she can open her mouth to ceratain extent that is really good response, may be due to young age also where healing is faster. when you come to opening the mouth widely she will be able to open the mouth after some time without discomfort if she follows all those opening and closing excercises, followed by lateral movements.hot and cold application and drug route.But i canot garantee that this problem will be solved here, she might have recurrent stages in the future.

        

[Anonymous]

Regarding management provided by oral surgeon i dont have any complaints, everyone has their own way of treatring these cases. Regarding mouth opening as you have told she can open her mouth to ceratain extent that is really good response, may be due to young age also where healing is faster. when you come to opening the mouth widely she will be able to open the mouth after some time without discomfort if she follows all those opening and closing excercises, followed by lateral movements.hot and cold application and drug route.But i canot garantee that this problem will be solved here, she might have recurrent stages in the future.

 

        

[ahluwaliatony]

Well, go for a MRI in this case as it most probably looks like a case involving the articular disc of the right TMJ….maybe disc dislocation with reduction. If u want to go into details consult okeson’s textbook on TMJ abnormalities. Mostly these cases require hot sponging alongwith some kind of intraoral splint that positions the mandible slightly forward. Consult the text book for more details.

        

[Anonymous]

ahluwaliatony wrote:

Well, go for a MRI in this case as it most probably looks like a case involving the articular disc of the right TMJ….maybe disc dislocation with reduction. If u want to go into details consult okeson's textbook on TMJ abnormalities. Mostly these cases require hot sponging alongwith some kind of intraoral splint that positions the mandible slightly forward. Consult the text book for more details.

 

        

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