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      JOINT DISORDER: NONREDUCING DISC DISPLACEMENT WITH MOUTH OPENING LIMITATION – REPORT OF A CASE

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          Abstract

          The internal derangement of the temporomandibular joint (TMJ) represents 8% of all cases of temporomandibular disorders (TMD) posing difficulties to establish an accurate diagnosis and treatment because of its low prevalence. This article presents the case of an 18-year-old Caucasian female patient who came to our Orofacial Pain and TMD Outpatient Service with complaints of intense pain on the right TMJ and limitation of mouth opening (maximum interincisal opening of 29 mm) with deviation to right, which she had been experiencing for the past 3 years. After a detailed clinical interview, a diagnosis hypothesis of nonreducing disc displacement with mouth opening limitation was established. The proposed treatment consisted of intra-joint infiltration with anesthetic in the right TMJ followed by jaw manipulation to recapture the articular disc, which was impeding the complete translation movement of the affected TMJ. After jaw manipulation, a new evaluation was done and showed the re-establishment of jaw dynamics with mouth opening and closing without deviation to the right side, clicking, opening limitation or pain. The patient was followed up at 6 months intervals. Two years after treatment, the patient was reevaluated and her mandibular range of motion without aid increased to 54 mm with no clicking, deviation to right, trismus or pain on the TMJ, indicating success of the treatment approach without recurrence of the pathology.

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          Most cited references25

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          Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening.

          Seventeen patients complaining of suddenly occurring, severe, and persistent limited mouth opening were treated by irrigation of the upper compartment of the affected temporomandibular joint with lactated Ringer's solution. This simple treatment was found to be highly effective in reestablishing normal opening and relieving pain for a follow-up period of 4 to 14 months.
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            Management of Temporomandibular Disorders and Occlusion

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              A controlled study of the effects of an early intervention on acute musculoskeletal pain problems.

              Current conceptions of chronic pain clearly suggest that proper care at the acute stage should prevent the development of chronic problems. Patients (198) seeking help for acute musculoskeletal pain (MSP), e.g., back and neck pain participated in two studies of the effects of an Early Active intervention which underscored 'well' behavior and function compared to a Treatment as usual control group. The quantity of the Early Active treatment was a median of 1 doctor's appointment and 3 meetings with a physical therapist. Study I concerned patients with a prior history of sick-listing for MSP, while study II involved patients with no prior history of MSP. Treatment satisfaction, pain experience, activities and sickness absenteeism were assessed before, after and at a 12-month follow-up. In study I (patients with a history of MSP), the results showed significant improvements for both groups, but virtually no differences between the groups. Similarly, in study II (no history of MSP) both groups demonstrated significant improvements, e.g., for pain intensity and activity levels. However, the Early Active treatment resulted in significantly less sick-listing relative to the control group. Moreover, the risk of developing chronic (> 200 sick days) pain was 8 times lower for the Early Activation group. This investigation shows that relatively simple changes in treatment result in reduced sickness absenteeism for 'first-time' sufferers only. Consequently, the content and timing of treatment for pain appear to be crucial. Properly administered early intervention may therefore decrease sick leave and prevent chronic problems, thus saving considerable resources.
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                Author and article information

                Journal
                J Appl Oral Sci
                J Appl Oral Sci
                Journal of Applied Oral Science
                Faculdade de Odontologia de Bauru da Universidade de São Paulo (Bauru )
                1678-7757
                1678-7765
                August 2009
                August 2009
                : 17
                : 4
                : 350-353
                Affiliations
                [1 ]Graduate Student, Discipline of Prosthodontics, Department of Restorative Dentistry and Prosthodontics, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
                [2 ]DDS, MSc, PhD, Full Professor, Discipline of Prosthodontics, Department of Restorative Dentistry and Prosthodontics, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
                [3 ]DDS, MSc, Full Professor, Discipline of Prosthodontics, Department of Restorative Dentistry and Prosthodontics, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
                [4 ]DDS, MSc, Full Professor, Discipline of Occlusion, Department of Prosthodontics, Dental School, University for the Development of the State and Pantanal Region, Campo Grande, MS, Brazil
                [5 ]DDS, Assistant Professor, Discipline of Occlusion, Department of Restorative Dentistry and Prosthodontics, Dental School, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
                Author notes
                Corresponding address: Gustavo Helder Vinholi - Departamento de Odontologia Restauradora e Prótese - Faculdade de Odontologia "Albino Coimbra Filho", UFMS - Av. Senador Filinto Müller, s/n° - Bairro Vila Ipiranga - Caixa Postal 549 - 79080-190 - Campo Grande, MS, Brasil - Phone/Fax: +55-67-3345-7681 - e-mail: gvinholi@ 123456yahoo.com.br
                Article
                S1678-77572009000400014
                10.1590/S1678-77572009000400014
                4327653
                19668996
                26fab58a-f8e8-4328-a218-38cbb1922bbe

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 June 2008
                : 30 August 2008
                : 07 October 2008
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 15, Pages: 4
                Categories
                Case Report

                temporomandibular,disc displacement,mouth opening imitation

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