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Discopaty and osteoarthritis of temporomandibular joint in a patient with Paget's disease and osteoporosis – a case report

This case report describes a two-year treatment and follow-up of the temporomandibular joint (TMJ) disorder in a 58-year old retired female patient with previously diagnosed Paget’ s disease of bone (PGB). The patient was examined in 2006 due to clicking and pain in the right TMJ. The pain in the right TMJ was especially strong during speech and mastication of solid food, or on wider opening of the mouth. Pain intensity was rated on a visual-analogue scale (VAS=7). The mentioned symptoms appeared in 2004, when she visited an oral surgeon and was advised to perform oral exercises. Since PGB was diagnosed accidentally in 1992 on the basis of observed radiographic abnormalities during an examination of the urotract (radiographic irregularities in pelvic bones on right side), a multidisciplinary managing of the patient was indicated. The pagetic bones were compensated and she was treated with D vitamin only. Anterior disc displacement and shape loss as well as severe sclerosation with osteophyte formation of condyle in the right TMJ was shown by magnetic resonance imaging, and computed tomography confirmed degenerative disease of right TMJ and excluded any maxillary or mandibular bone abnormalities. Further treatment was performed in cooperation with a physiatrist-rheumatologist during 2007. The patient underwent physical therapy based on Schulte and continued the exercises at home, however, she was also advised to start treatment for osteoporosis. At the beginning of 2008 she obtained the occlusal splint again, however she was hospitalised in the meantime due to acute pains in the lower right lumbar region (lumbosacral syndrome). Recent densitometry showed spinal osteoporosis (Tscores: L1 -2.5, L2 -2.9, L3 -2.4). There is some limitation in the oral function therapy in patients with musculoskeletal and endocrinological diseases. Finally, the decision to begin with oral bisphosphonate therapy remains in the domain of her endocrinologist.

temporomandibular disorders; Paget's disease; osteoporosis

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