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Neuromuscular TMJ Dentistry Case History
Patient DescriptionFemale, age 32, personal trainer / fencer
Principal ComplaintsVery athletic young woman, sought a second opinion for her preliminary diagnosis of multiple sclerosis. Her chief complaints were facial numbness and pain on the right side of six months duration. Numbness in her right arm, especially during exercise, for the last month. Tremors, muscle spasms in her right arm and muscle twitching in her whole body for the last two months.
Her neurologist had recently prescribed an MRI.
Medical HistoryThe patient reported suffering from frequent headaches lasting 24 hours since her teen years, pressure around the eyes since adolescence, hypersensitivity to light since childhood, pain in neck and shoulder on right side for the last 10 years, jaw tenderness in the TMJ area on the right side for years, poor circulation and slow healing in her right arm for the last six months, short term memory loss for the last 5 years, digestive problems for the last month, hyperactivity since childhood, inability to relax or sit still, poor sleep, always fatigued in the morning, itchy and bloodshot eyes since her teens, and chronically tired all the time.
Oral ConditionVery healthy mouth with all teeth present. Jaw relationship was very retrognathic with a very deep bite. Her radiographs showed normal joint anatomy on the left, arthritic breakdown of bone of right joint and flattening of right socket. Both condyles were posteriorly displaced when the mouth was in closed position.
SymptomatologyCrepitation was present in both TM joints, the disc was locked out in closed position. The patient reported pain when turning her head or moving her neck. Her teeth were painful on the U/L right. She clenched and ground her teeth at night. Other symptoms were frequent dizziness and fainting, stuffiness in her right ear.
Treatment RecordAt her second diagnostic visit (three days after the first one), she was fitted with temporary occlusal guards to open the vertical dimension.
She reported immediate relief of her pain, felt like the blood vessels were opening on the right side of her head. She went home and slept four hours, so soundly that when she awoke she didn't know where she was. She said she hadn't experienced a sleep like that in ages.
When she returned 3 weeks later for placement of the Gelb MORA (mandibular oral repositioning appliance) she reported that all of her symptoms had either greatly improved or disappeared and she had decided not to have the MRI.
She responded extremely well to treatment and very shortly all of her symptoms were history. She reported she could now sit down and relax and enjoy a whole movie.
She came in for appointments every four weeks to have the orthotic adjusted. Occasionally it would wear down, and the patient could always tell right away that her bite was off, because her symptoms would gradually return and she would notice she was not fencing as well.
Six months later her maximum opening had increased from 42 mm to 50 mm. She was extremely pleased with the results of her TMD therapy and the overall improvement in her health and decided to bring in her two sons to be evaluated and treated for TMD because of their health problems.
Risto E. Hurme, D.D.S.
Craniofacial Pain and TMJ Disorders
1017 Shook Avenue
San Antonio, TX 78212