Український стоматологічний альманах (Mar 2016)
DIFFERENTIAL DIAGNOSIS OF TEMPOROMANDIBULAR DISORDERS WITH THE USE OF DEVELOPED COMPUTER PROGRAM TO DEFINE THE INDIVIDUAL RISK OF THEIR DEVELOPMENT
Abstract
Urgency of an issue. Problem of diagnosis and treatment of patients with diseases of temporomandibular joint (TMJ) over the years remains relevant, due to lack of consensus on the origin, pathogenesis, differential diagnosis methods, different clinical disorders similarity. Many patients with temporomandibular disorders (TMD) do not seek for treatment. There were found some violations accidentally when visiting the dental clinic. Patients who have turned to surgeons, physicians or prosthetic dentists complaining of discomfort, pain in the jaw joint, jaw movements violations previously repeatedly appealed to the otorhinolaryngologists, neurologists and often to a neuropsychiatrist. The aim. To identify the possibilities for differential diagnosis of temporomandibular disorders using a computer program to determine the individual risk of TMD. Materials and methods. Study involved 135 patients who applied to Prosthetic Dentistry Department Danylo Halytsky Lviv National Medical University complaining specific to temporo-mandibular disorders. For diagnosis TMD classification by the B.W.Neville, D.D.Damm, C.M.Allen, J.E.Bouquot (1995) was used. In accordance to which TMD are divided into arthrogenic and myogenic. Due to the high frequency of detection to possible diagnoses included TMJ hypermobility and simulated TMD. Results. To determine the connection between the disorder and the positive or negative performance in the clinical medical recorder identified correlation was recorded. That described correlation coefficients for the pair by Spearman method. According to a survey of 135 patients with various forms of TMD or their combination the correlation coefficients for each pair of diagnosis are calculated. These indicators differ according to the power of communication but only some of them were reliable (p <0,05). The number of significant factors of clinical signs revealed that patients with arthrogenic TMD reaches 19 positions, of myogenic TMD is 30 positions, of TMJ hypermobility reaches 18 positions and with simulated TMD reaches 26 positions. Using logistic regression we have singled out 14 factors for arthrogenic TMD, 14 factors for myogenic TMD, 7 factors to TMJ hypermobility and 8 factors for simulated TMD which when combined makes effects on the development of disorders. Based on investigations we worked out a program that is a file that opens in the "Microsoft Excel". The essence of development is an automated method of calculating individual risk manifestations of disorders for every patient by introducing in information table contained in the medical recorder. Conclusions. Based on the calculations and program development we conclude that the differential diagnosis and diagnosis of temporomandibular disorder must follow the protocols examination of patients with suspected TMD. The proposed program accelerates and simplifies diagnosis and also is illustrative and easy to use. Using this algorithm of actions dentist has the opportunity to establish the correct diagnosis not dropping any important factors that may have causal relationship on the TMD development. The number of patients suffering from TMD increases. That’s why important is the amount of information received from patient's first visit and its correct assessment and quick correct selection of treatment tactics.
