engleski

Osteoarthritis of temporomandibular joint – a reported case with three years follow-up

The reported case is of a 36-year-old female patient who was selected from a group of consecutively collected patients with temporomandibular disorders in the period between 2001 and 2011. Diagnostics included a clinical examination and the use of manual functional analysis. A positive finding was compared with magnetic resonance as the gold standard. In patients with pronounced clinical symptoms of osteoarthritis, computerized tomography was also used. The treatment implied fabrication of a Michigan splint. Electronic axiography was used to visualize mandibular movements - Arcus Digma II (KaVo Dental). The patient’s ailments started 15 years ago when she had the first limitations in mouth opening in the left temporomandibular joint (TMJ) and strong pain, which would subside after 10-15 minutes. She has suffered from bipolar disorder for years, which started as an unrecognized postpartum depression. She had healthy teeth with pronounced facets due to bruxism, which she confirmed during the interview. On the visual analogue scale (VAS=0-10), she rated the pain in the left TMJ 5.5 and pain on palpation 7.5. Pain with limited opening in the left and crepitation with pain (VAS=4) in the right joint were determined by dynamic compression. Radiologic diagnostics showed anterior disc displacement (DD) without reduction in the left and with reduction in the right TMJ. The left TMJ had an osteophyte with degenerative subchondral changes. The STAI test by Spielberger determined a high level of anxiety about the current condition and personality issues. There was no remission of pain during the follow-up of three years. The ‘motion analysis’ module confirmed clicking in the right TMJ at 15.5 mm of condylar movement on the articular eminence. Although the crepitation disappeared with time, asymptomatic DD in the right TMJ caused an atypical and clinically pronounced clicking. Mental health, although unnoticed in dental practice, can affect bruxism prevention.

temporomandibular joint disorder; magnetic resonance imaging; axiography

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