Saša Stanković, Nebojša Krunić,
Zorica Ajduković, Ljiljana Aleksov

Medical Faculty, Clinical of Stomatology,
Dep. of Prosthodontics, Niš, Serbia

Introduction

The signs and symptoms of temporoman-dibular disorders are extremely common. Some epidemiologic studies suggest that 50-60 of the general population has a sign of some func-tional disorders of the masticatory system. Some of these appear as significant symptoms that motivate the patient to seek treatment. Each sign represents a portion information needed to establish a proper diagnosis. So, in practice, we can meet patients which are expose on surgical inteivention in temporoman-dibularjoint. Another, but, benefit the sedatives and consultate of psychiatrist. Some problems about myofascial pain dysfunction syndrome can originate on consequence by error occlusal therapy from practicioner which dont know substance of mechanisms in this syndrom. The purpose ofthis article is that on the ba-sis ofhistory question mark and clinical investigation help doctor-practitioner to make a clear diagnosis and, after that, choice adequate ther-apy. This procedures should therefore be directed toward the identification of masticatory pain and dysfunction.
 

History

The screening history consists of several questions that will help orient the clinician to any temporomandibular disorders. The following can be used to identify functional disturbances^1-2:

1) Do you have difficulty and /or pain opening your mouth when yawning?
2) Does your jaw get "stuck", "locked", or go out?
3) Do you have difficulty and/or pain when talking?
4) Are you aware ofnoises in thejawjoints?
5) Do you have pain in or about the ears, temples or cheeks?
6) Does your bite feel uncomfortable or unusual?
7) Do you have frequent headaches?
8) Have you previously been treated for a jaw joint problem?

The history to gather data on the next way:

A. Reasons of patients comming - the patient is allowed to describe in his or her own words, the chief complaint.
B. History of pain³:
B.l. Location (specific area, localise or expanding)
B.2. Frequency (constant, intermitent or recidivans)
B.3. Qality (sharp, dul or burning)
B.4. Duration (minuts, hours, days)
B.5. Degree (individuality).
C. History of dysfunction⁴:
- limited jaw movement
- crepitation.
D. History of previous treatment⁵
E. History of other associated symptoms⁶:
- headache (number per week, localisation)
- ear pain (right, left)
- craniocervical disorders (pain in neck, numbness, history, trauma)
- other data (family history, habits, social state).
F. History of emotional stress⁷:
- connection between stress and symptoms
- presence of other psychophysiologic disorders (ulcer).

Clinical investigation

The tree cardinal components in temporomandibular disorders examination are:
- range of mandibular movement
- palpation tendemess
- joint sounds.
Primary examination procedures include next⁸:
A. Inspection (hands, posture, face, habits)
B. Mandibular movement
- opening ranges (pain-free)
- horizontal ranges (protrusive, left and right lateral).
C. Palpation
- m. temporalis (posterior and anterior fibers)
- m. masseter (origin, body, insertion)
- posterior mandibular region (stylohioid, posterior digastrici)
- submandibular region (medial pterygoid, suprahyoid, anterior digastrici)
- m. pterygoideus lateralis
- temporalis tendon
- temporomandibular joint.
D. Joint sounds (detection) tipe-click, cre-pitus; location of occurence during open/close cycle
- alteration ofnoise during open/close cycle
E. Occlusion
- stability and distribution of contacts on MICP
- length of asymmetric slide between RCP and MICP
- wear and inabilty of teeth
- gross skeletal morphology.
F. Cervical
- palpation (anterior, lateral, posterior)
- movement
- noises
- neurosensoric changes (neck, shoulder, upper extremities)
G. Neurological
- somatosensory (V, VII, IX)
- motor (III, IV, V,VI, VII, IX, X, XI, XII)
- odors (I); vision (II); hearing (VIII); taste
(VII, IX); corneal reflex (V).
H. Intraoral examination (dental, soft tis-sue, cracked pulp).

Summary

Functional disturbances in masticatory system are very complicate and oft unclear to doctor. Rather than greater precision in measuring clinical parameters, the should be focussed on:
- imroved understanding of the patients who have the problems,
- using multivariate models with high predictive yield for diagnosis,
- better understanding of the basic science of disorders such as splinting and contracture,
- broader overall models of chronic pain classification systems, to include factors such as personality, suffering, medical-neurological and physical-behavioral.

Literature
 

1. Okeson JP: Management of TMD and occlusion. 3rd ed. St.Louis, Mosby, 1995, 229-248.
2. Zarb GA, Carlsson GE: Temporomandibular joint and masticatory muscle disorders. 2nd ed. St. Luis, Mosby, 1995, 407-432.
3. Chun DS, Koskinen - Moffet GF: Distress, jaw habits and connective tissue laxity in adolescents. J Cranio Mandibular Disorders 1990,4: 165.
4. Dworkin SF, Le Resche L: Research diagnostic criteria for temporomandibular disorders:review, criteria, examination and specifications, critique. J Cranio Mand Disord 1992, 6: 301-55.
5. Rugh JD: Validity of psychological testing in TMD. In: Mc Neill C, ed. Controversis in CMD. Chicago : Quintessence Publishing company 1992, 138-142.
6. Stanković S: Doprinos tretmanu algodisfunkcionalnog sindroma. Magistarska teza 1998, 31-36.
7. Stanković S: Komparativna analiza rezultata različitih terapijskih metoda algodisfunkcionalnog sindroma. Doktorska disertacija 2001, 18-21.
8. Wilmer CG, Lund JP, Feine JS: Evaluation of diagnostic tests for temporomandibular disorders. Can Dent Assoc J 1990, 18:53-60.

• Copyright © 2003 by The Editorial Council of The Acta Stomatologica Naissi