Case history
Case history
A 28-year-old woman presents to the clinic complaining of intermittent jaw pain and a clicking noise in the jaw joint when she chews or talks. She says the pain is worse in the morning when she awakens, but decreases as the day progresses. She complains of being unable to open her mouth as wide as she used to. She also complains of periodic headaches in the temporal regions. On examination, she has tenderness to palpation in the region anterior to the tragus of the ear. A clicking of the mandibular joint is palpated as the patient opens and closes her mouth. When asked about stress or depression, the patient says she has been stressed while working to meet a tight business deadline.
Other presentations
The major presenting symptoms of TMDs include pain; limited range of movements; and clicking, popping, or crepitus of the temporomandibular joint upon movement with/without locking. Pain can radiate to distant structures and may be aggravated by chewing, yawning, or talking. Other symptoms may include headache in the temporal region and otalgia, tinnitus, or both in the absence of significant ear disorders.[2]
The most common presentations of disc displacement are disc displacement with reduction and disc displacement without reduction, and patients may suffer from clicking and locking of the mandibular joint.[10] These patients usually have continuous pain.[11] They also have limited mandibular function or the mandible deviates on opening towards the side of the pathology.
Crepitus of the mandibular joint is pathognomonic for osteoarthrosis and is most often seen in older people; crepitus combined with pain suggests osteoarthritis.[12] Patients presenting with osteoarthrosis rather than osteoarthritis usually have no pain as this is due to normal remodelling of a joint with an altered load. These patients do not usually have limited mandibular function.[11]
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