Український стоматологічний альманах (Mar 2016)
REASONING FOR THE USE OF TEMPORO-MANDIBULAR DISORDER DIAGNOSTIC ALGORITHMS
Abstract
Topicality. Diagnosis and treatment of temporo-mandibular disorders is the actual conerstone through the years. According to various scientists, frequency of temporomandibular disorders ranges from 27 to 76% in the population applying for dental care. Numerous diagnostic tools, protocols, procedures and tests of temporomandibular disorders have been suggested in scientific literature, but none of them is found the ultimate or most comprehensive research method. Much attention is paid to neuromuscular disorders, which may lie from psychogenic pathology (eg, exposure to chronic emotional stress), endocrine, somatic or other pathology. For additional diagnostic of temporo-mandibular disorders one can use different imaging techniques: several radiographic techniques, arthrography, panoramic radiography, zonography, tomography, computed tomography, magnetic resonance tomography and ultrasonography. Creation of available for practicing dentist temporo-mandibular disorder diagnostic algorithms will help in clinical examination of patients with right choice of additional investigation methods and lead to qualitative diagnoses. Aim of study is to create diagnostic algorithms of temporo-mandibular disorders by improving and adapting existing methods of investigation to various clinical situations. Materials and methods. To achieve the purpose 135 patients (men - 37, women - 98) aged 4 to 88 years old were chosen from a database of prosthetic dentistry department of Danylo Halytsky Lviv National Medical University. All these patients complained of pain or other symptoms that may indicate temporo-mandibular disorder and had been examined using additional imaging techniques. Carrying out the study, 81 panoramic radiograms, 21 zonograms, 20 computed tomograms, 9 magnetic resonance tomograms and 64 ultrasound conclusions were analyzed. Results. During the clinical examination of the patient attention should be paid to the following symptoms: pain on the joint palpation of, pain on masticator muscles palpation, joint sounds, and alterations in the mouth opening pathway, limited mouth opening, eccentric occlusion and dental premature contacts. First one should use generalized clinical diagnostic algorithm of temporo-mandibular disorder which includes "Express conclusion". And afterwards use the next algorithms that are based on organ and nosology principles. The degree of necessity and sequence of application of methods of radial investigation of temporo-mandibular disorders is taken into account using these algorithms. The algorithm based on organ principle unites information of different radial investigation methods in detecting structural disorders in soft tissue and bone tissue elements of the joint. The algorithms based on nosology principle unite information from the patient’s complaints, results of clinical examination and additional methods of investigation. Conclusions. For the qualified temporo-mandibular disorder diagnosis and exclusion of other pathology that can masquerade any temporo-mandibular disorder, special questionnaires and diagnostic algorithms may comfortably be used. In each clinical situation it is important to prescribe methods of further additional examination, which possess adequate diagnostic value with minimal contraindications, including accessibility for the patient.
