RU2306105C2 - Method for diagnosing temporomandibular joint diseases and finishing their treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves palpating temporomandibular joint projection region to find pain zone. Additional palpation is carried out in posterior mandibular region, in oral cavity in coronoid mandible branch process projection region. When detecting painful zones in these regions and sharp pain in oral cavity when slowly opening mouth, temporomandibular joint disease is to be diagnosed. No painful zones being found, shows that the disease treatment is to be terminated.

EFFECT: improved planning of treatment course.

Description

The invention relates to medicine, namely to surgical dentistry.

Diagnosis methods are known that are based on general clinical data: patient complaints, medical history, objective examinations - external examination, palpation in the projection of the temporomandibular joint (TMJ), assessment of the dentition in general. X-ray studies are carried out: tomography, X-ray telecinemastography, computed tomography. X-ray examine two joints with closed and open mouth. / "Surgical Dentistry" edited by T. G. Robustova. - M.: Medicine, 2003, 376 /.

These methods have disadvantages: not every medical institution can afford to buy expensive equipment, and in market conditions, not every patient can pay 4 x-rays: 2 with a closed and 2 with an open mouth. Yes, and in most cases with chronic arthritis, palpation in the projection of the TMJ is painless, as well as with an X-ray examination in the joint, no changes are detected.

The technical result of the invention is to increase the accuracy of diagnosis and the end of treatment without large material costs, availability, both from the medical institution and from the patient.

The technical result is achieved by the fact that after interviewing the patient: complaints, medical history, they begin an external examination - palpation is performed in the projection of the TMJ, in the posterior maxillary region and in the oral cavity - in the projection of the coronoid process of the mandible branch.

In acute and exacerbated chronic TMJ arthritis, palpation results in pain in three areas: in the projection of the temporomandibular joint, in the posterior maxillary region, and in the oral cavity - in the projection of the coronoid process of the mandible branch, however, palpation in the projection of the coronoid process of the mandible branch will be sharper, sharper, intensifying with slow opening of the mouth than with palpation in the projections of the temporomandibular joint and the posterior maxillary region. In chronic arthritis of the TMJ, palpation in the projection of the temporomandibular joint shows pain or may not be present, palpation in the posterior jaw region under the earlobe determines moderate or weak pain, but palpation in the projection of the coronoid process of the lower jaw pain is sharper, sharper, increasing with slow opening of the mouth than in the above areas.

For comparison, palpation is always performed on the opposite side.

EXAMPLE No. 1

Patient Z. 29 years old, medical history No. 6566, was admitted to the dental clinic VGMA them. N.N. Burdenko 09.09.04, with complaints of acute pain and swelling in the region of the lateral surfaces of the face, radiating to the temporal region, throughout the lower jaw, aggravated by opening the mouth.

Anamnesis of the disease: the patient notes that for the first time the pain appeared about 2 years ago, went to the dental clinic at the place of residence about a year ago, medication was prescribed, laser therapy. During the year, aching pains bothered. About a week ago, acute pains again appeared in the middle zone of the face on both sides, aggravated by opening the mouth, talking, eating, radiating to the temporal region, throughout the lower jaw. I turned again to the dental clinic at the place of residence and was sent to the dental clinic of VGMA them. NN Burdenko for consultation and treatment.

Local status: an external examination shows slight swelling of the skin in the projection of the articular heads of the TMJ on both sides, palpation in these areas and in the posterior jaw regions under the earlobe is painful. Opening the mouth is limited due to pain.

On the part of the oral cavity during palpation in the projection of the coronoid processes of the branches of the lower jaw, acute, sharp soreness is determined, intensifying with slow opening of the mouth.

Diagnosis: Exacerbation of bilateral chronic arthritis of TMJ.

It is aimed at X-ray analysis of the TMJ on both sides with closed and open mouth.

09.09.04, General condition and locally unchanged (X-ray examination was not done due to malfunction of the X-ray machine).

Recommended by:

1. Ortofen - 1 tab. 3 times a day.

2. Suprastin -1 tab. for the night.

3. Calcium gluconate - 2 tab. 3 times a day.

4. A sparing diet.

5. Limited mouth opening.

6. At night, a vaseline dressing.

Laser therapy was performed, perifocal blockade of 2% r-rum lidocaine - 12.0 to 6.0 on both sides. Pressure bandage.

09/10/04. The complaints are the same.

Objectively: Swelling in the projection of the TMJ is held, palpation is painful, especially in the projection of the coronoid processes of the branches of the lower jaw. Laser therapy, perifocal blockade with a 2% solution of lidocaine of the TMJ projection from both sides at 6.0. Pressure bandage.

09/11/04. General condition and locally unchanged.

Laser therapy, perifocal blockade, pressure bandage.

09/13/04. Complaints of mild pain in the TMJ on both sides.

Objectively: Without visible changes, palpation in the projection of the TMJ and the posterior maxilla under the earlobe is painless, in the projection of the coronoid processes - slightly painful. Laser therapy, perifocal blockade, pressure bandage.

September 14, 2004. General condition and locally unchanged. Laser therapy, perifocal blockade, pressure bandage.

09/15/04. Complaints of mild pain when opening the mouth.

Objectively: Without visible changes, palpation in the projections of the TMJ and the posterior maxillary regions under the earlobe is painless, in the projection of the coronoid processes - slightly painful. Laser therapy, perifocal blockade, pressure dressing

September 16, 04. General condition and locally unchanged. Laser therapy, perifocal blockade, pressure bandage.

09/17/04 No complaints.

Objectively: Without visible changes, palpation in the projection of the articular heads of the TMJ on both sides, as well as in the posterior maxillary regions under the earlobe and coronoid processes of the branches of the lower jaw, is painless.

Laser therapy, perifocal blockade, pressure bandage. The treatment is over.

EXAMPLE No. 2.

Patient P., 35 years old, medical history No. 7664, was admitted to the dental clinic VGMA them. N.N. Burdenko 10/19/04, with complaints of acute pain in the left half of the face.

Anamnesis of the disease: The patient notes that a traumatic removal of the wisdom tooth was performed in the dental clinic at the place of residence - only the crown was removed, and in the private dental clinic the root was removed, which was also traumatic. Two days later, acute pain appeared throughout the left half of the lower jaw, intensified when eating, opening the mouth. Turned to the dental clinic VGMA them. N.N. Burdenko for consultation and treatment.

Local status: during external examination without visible changes. On palpation of the skin in the projection of the articular head of the TMJ, in the post-maxillary region on the left, slight pain is noted. From the side of the oral cavity there is a sharp pain on palpation in the projection of the coronoid process of the branch of the lower jaw on the left, aggravating with slow opening of the mouth.

Diagnosis: Acute traumatic arthritis of the TMJ on the left. It is aimed at X-ray analysis of TMJ on the left and for control on the right - with closed and open mouth 3.8.

10.20.04, General condition and locally unchanged (radiography was not done because of the difficulties of the material condition). Laser therapy, perifocal blockade in the TMJ 2% solution of lidocaine - 6.0, pressure bandage.

Recommended by:

1. Indomethacin - 1 tab. 3 times a day.

2. Suprastin -1 tab. for the night.

3. Calcium gluconate - 2 tab. 3 times a day.

4. A sparing diet.

5. Limit the opening of the mouth.

6. At night, a vaseline dressing.

10.21.04. General condition and locally unchanged. Laser therapy, perifocal blockade, pressure bandage.

10/22/04. Complaints of pain in the left half of the face.

Objectively: No visible changes. On palpation in the post-maxillary region on the left - weak soreness, in the area of the coronoid process - sharp soreness.

Laser therapy, perifocal blockade, pressure bandage.

10.23.04, General condition and locally unchanged. Laser therapy, perifocal blockade, pressure bandage.

10/25/04, Complaints of mild pain in the left half of the face.

Objectively: No visible changes. Palpation in the region of the articular head is painless, in the posterior maxillary region on the left - slightly painful, and in the region of the coronoid process - moderately painful. Laser therapy, perifocal blockade, pressure bandage.

10.26.04 General condition and locally unchanged. Laser therapy, perifocal blockade, pressure bandage.

10.27.04 g. No complaints.

Objectively: No visible changes. Palpation in the projection of the joint head of the TMJ and the posterior maxillary region is painless, and in the area of the coronoid process of the branch of the lower jaw there is a slight pain. Laser therapy, perifocal blockade, pressure bandage.

10.28.04, General condition and locally unchanged. Laser therapy, perifocal blockade, pressure bandage.

10/29/04. No complaints.

Objectively: During an external examination without visible changes. Palpation in the projection of the TMJ and the posterior maxillary region on the left is painless. On palpation in the region of the coronoid process, the branches of the lower jaw on the left with a closed mouth and opening the mouth are also painless. The treatment is over.

The proposed method for diagnosing TMJ diseases is simple and affordable; expensive material costs for medical institutions and patients are not required. By this method, it is possible not only to make a diagnosis, but also to determine the end of treatment of the patient. Every doctor in any conditions can use this method.

Claims (1)

A method for the diagnosis of diseases of the temporomandibular joint and the end of treatment, which consists in palpation in the projection of the temporomandibular joint and the detection of soreness, characterized in that they additionally carry out palpation in the posterior maxillary region, in the oral cavity in the projection of the coronoid process of the branch of the lower jaw, and in detecting soreness in these areas, as well as sharp pain during slow opening of the mouth in the oral cavity in the projection of the coronoid process of the branches of the lower jaw, the disease is diagnosed as temporomandibular of the mandibular joint, the absence of soreness indicates the need to end the treatment of the disease of the temporomandibular joint.