CASE SUMMARY: Treatment of Temporomandibular Disorder
by Norberto Delgado, DDS, Prosthodontist, and Specialist in TMJ of Georgia Prosthodontics
Patient “Susan” was a 42-year-old woman who came to our office for treatment of TMJ disorder. She complained of bilateral TMJ noises, pain when she locks, and headaches every day.
She had a history of mandibular closed-lock, 5 to 6 times a week for the past 6 months. These closed lock episodes last between minutes to hours with one episode lasting 3 days. Susan had all mandibular movements within normal limits with sporadic bilateral opening clicks… no history of macro trauma and health history had no significant findings… but she is a clencher/grinder and told me she was under high emotional stress.
As a Prosthodontist, I have experience with complex dental problems, and with my one year post-Doctoral Training in TMJ and Orofacial pain, I am able to diagnose and treat difficult temporomandibular disorders. After a comprehensive TMJ evaluation, which included Transcranial Radiograph (MRI pending), Susan was diagnosed with bilateral sporadic articulating discs with reduction and mild osteoarthritis on the anterior aspect of the left condyle.
The TMJ Disorder treatment sequence included:
• Starting with a maxillary full coverage anterior reposition appliance for 1 week.
• Same appliance used and change to full coverage full occlusal contact for 2 weeks.
• She was re-evaluated and step back to centric relation position.
• At a two-week re-evaluation, Susan was pain-free, no closed-lock episodes and
stable occlusion with anterior guidance while wearing the centric relation appliance.
She has now been on treatment for two months. Other treatments notes were: Placing her on 600 mg Calcium with vitamin D and 250 mg magnesium supplements… 800mg of Ibuprofen 1t / tid as needed for pain control… behavior management, stress control techniques, and relaxation exercises provided. She has made some personal life changes to control stress, which greatly helped, and we are continuing to monitor her to ensure the changes last.
Common signs of TMJ Disorders may include
Earaches, headaches, migraines, pain of maxillary molars, pain behind or around the eyes, pain in the area of the maxillary and frontal sinuses, jaw or jaw pain, pain in the neck, shoulders or back, noises at jaw opening, difficulty or limitation to open or close the mouth and change in the bite, among others.
As you know, TMJ Disorders consist of the instability of the anatomical components that make up the temporomandibular joint. There may also be growth deformations or instability caused by bad habits, bad posture, malocclusion, accidents, or illness.
In recent years, it has been demonstrated that removable and conservative (non-surgical) treatments have been able to alleviate symptoms and pain in the vast majority of these patients.
TMJ treatment is complex where the involvement of more than one dental specialist as well as other healthcare providers may be necessary. The dental specialist best prepared to serve a patient with TMJ by conservative non-surgical methods is a prosthodontist. It is advantageous for the patient to be treated by a prosthodontist who has advanced studies in this condition and who devotes much of his practice to this treatment.
TMJ Disorders: Stages of Treatment
Stage 1: Jaw manipulations
Through prosthetic intra occlusal devices in order to place the joint in a stable neuromuscular position.
Stage 2: Restorative phase
Which consists of the dental procedures necessary to maintain a permanent neutral neuromuscular temporomandibular position achieved in the first stage of treatment. These procedures maybe, but not limited to, adjustments of bite, repair or replacement of existing restorations, bridges or crowns, orthodontics, jaw or joint surgeries, the permanent use of intra occlusal prostheses, or any combination of the treatments above described.
Do you have a patient in Susan’s situation? Or another complex case?
If you have a question about a case and want another opinion, give our office a call. Or, if there is a case that you want to work together on, please fill out and send in the enclosed referral form.
We will take great care of your patient and keep you informed. Dental professionals refer to us as The Reconstructive Dentistry Team because we perform complex cases every day.
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Do you want another opinion on a complex case? Or to meet and share ideas?
There are many ways we can help each other by working together on complex cases and by sharing knowledge and experience.
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If you’d like to meet to discuss a difficult procedure or talk on the phone about how we can help each other, please call or email our office with specific days and times when you are available to talk or meet.
The Reconstructive Dentistry Team
Georgia Prosthodontics is a specialty practice focused on Implant, Cosmetic and Reconstructive Dentistry. Drs. Castro & Delgado have the training and private practice experience that makes treatments of complex cases more successful, including the following examples:
• Patients with severely worn/damaged teeth, missing all teeth, or with ill-fitting dentures can receive a full arch of natural-looking teeth to restore function & esthetics.
• Patients with congenital defects, a chronic condition, or traumatic injury can receive oral prostheses, which may be a combination of dental implants, crowns, bridges, or veneers.
• Patients with difficult anterior cases in the esthetic zone can receive single or multiple dental implants to replace missing teeth, or veneers or crowns to improve the appearance of their smile.
In addition, they have a private dental laboratory called Prostho Dental Lab. An in-house, experienced, and certified dental technician creates each custom restoration for referred patients from the best materials using the latest technology. To send an implant case to our dental lab, please visit: www.prostholab.com
Online Referral Form
We appreciate your confidence in us. To refer one of your patients to a Prosthodontist you can either download our referral form or fill it out online and send it directly to us.
We look forward to hearing from you!