Temporomadibular Disorders in a Patient With Anxiety

Autor: Tomislav Badel, Josip Pandurić, Sonja Kraljević, Miljenko Marotti, Lovko S. Kocijan, Jozo Šutalo
Jazyk: angličtina
Rok vydání: 2003
Zdroj: Acta stomatologica Croatica : International journal of oral sciences and dental medicine
Volume 37
Issue 3
ISSN: 1846-0410
0001-7019
Popis: Pacijentica (28 god.) je tijekom posljednje godine primijetila je abrazivne fasete na zubima, a pojavili su se i simptomi temporomandibularne disfunkcije - bol, limitacija čeljusti, a prije i škljocanje u desnome čeljusnom zglobu. Na analogno-vizualnoj skali od 0 do 10 ocijenila je bol sa 7. Anamnestički se doznaje da je imala psihičku traumu prije 4 godine od koje joj je porasla anksioznost i javljaju se panični napadi. Manualnom funkcijskom raščlambom utvrđena je miofascijalna bol i anteriorni pomak zglobne pločice bez redukcije u desnome čeljusnom zglobu, što je potvrđenom elektroničkom aksiografijom i magnetnom rezonancijom. Zbog prekomjernoga trošenja zuba utvrđeni su interferentni dodiri tijekom laterotruzijskih kretnji čeljusti. Anksioznost je potvrđena psihološkim mjernim instrumentom State-Trait Anxiety Inventory. Za inicijalno liječenje indicirana je i izrađena Michiganska udlaga. Nakon 2 mjeseca postignuto je poboljšanje kliničkoga stanja. Jača bol bi se javila samo pri jačem otvaranju usta. U desnome čeljusnom zglobu utvrđena je krepitacija. U zadnjih nekoliko mjeseci neredovito je uzimala propisane anksiolitike. I dalje se osjeća anksiozno, nemirno i nesigurno. Kontrolnim snimanjem magnetnom rezonancijom nakon 9 mjeseci utvrđen je anteriorni pomak zglobne pločice bez redukcije sa znacima subhondralne degeneracije i aplanacije kondila desnoga čeljusnog zgloba. Definitivnom okluzijskom terapijom (nadoklađivanje abradiranih zubnih tkiva kompozitnim ispunima) nastojalo se uspostaviti ortopedsku stabilnosti čeljusnih zglobova. Zbog popratno izraženog osteoartritisa i bolje stabilizacije čeljusnih zglobova te zaštite zuba od bruksizma izrađena je stabilizacijska udlaga. Bruksizam je psihofiziološki poremećaj nejasne etiologije. Najuočljiviji znak bruksizma jest prekomjerno trošenje zubnih tkiva, što može stvariti patološke okluzijske odnose. Temporomandibularna disfunkcija je nedovoljno razjašnjenog etiopatogenteskog mehanizma, a okluzija se smatra sekundarnim etiološkim čimbenikom. Anksioznost može biti patofiziološki čimbenik bruksizma i sudjelovati u podržavanja kronične temporomandibularne boli.
A patient (28 yrs. old) during the last year has noticed wear facets on the teeth and also symptoms of temporomandibular disorders (TMD) - pain, limitation of mandibular movements, and also clicking in the right temporomandibular joint (TMJ). The pain was evaluated with analog-visual scale (0 - 10) = 7. Case history revealed the presence of mental trauma four years ago, which had caused the increase of anxiety and occurrence of panic attacks. By means of manual functional analysis myofacial pain and anterior disc displacement without reduction in the right TMJ was determined and confirmed with electronic axiography and magnetic resonance imaging (MRI). As a consequence of excessive teeth wear the interfering contacts in laterotrusive movements of mandibule were established. Anxiety was confirmed with psychological measuring instrument State-Trait Anxiety Inventory. For the initial treatment the fabrication of Michigan splint was indicated. After 2 months improvement in clinical condition was achieved. Stronger pain was only during larger mouth opening. In the right TMJ crepitation was found. In the last few months she took irregularly prescribed anxiolytic drugs. She still feels anxious, tense and insecure. After 9 months the anterior disc dislocation without reduction and with present signs of subchondral degeneration and condylar aplation in the right TMJ was established with controlling MRI. Orthopedic stability of TMJs was established with definitive occlusal treatment (restoration of wear teeth tissues with composite fillings). Because of accompanying osteoarthritis and better stabilisation of TMJs as well as teeth protection from bruxism a stabilisation splint was fabricated. Bruxism is a pathophysiological disorder of unclear aetiology. The most noticeable sign of bruxism is excessive teeth wear which can cause pathological occlusal relationships. The mechanism of aetiopathogenesis of TMD is insufficiently explained and occlusion is considered to be a secondary aetiological factor. Anxiety can be a pathophysiological factor of bruxism and can lead to persistence of chronic temporomandibular pain.
Databáze: OpenAIRE
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