The article deals with the physical examination of patients with temporomandibular joint disease. Temporomandibular joint is a single articulation of the skull, a complex, combined, incongruous joint of the condyle articulation type. The patient with temporomandibular joint dysfunction is examined in order to detect the disease cause, defines the disease development, a character of the morphological and functional impairment, caused by this disease as well as to establish the diagnosis, chooses the treatment method and manages the preventive treatment. Poor examination of the patient and incorrect data analysis instead of recovery will cause progress of the temporomandibular joint pathology, despite satisfactory or good treatment outcome. Physical diagnostics is a complex of medical measures, performed by physician for diagnosing the patient. All the procedures, which refer to this examination, are conducted by the physician (inspection, palpation, auscultation, percussion, etc.). The purpose of the study is actualization of the physical examination of the patients with temporal-mandibular pathologies. Material and methods. 133 patients (84 women and 39 men) aged 19-47 years with temporomandibular pathologies were examined by the Prosthetic dentistry department of O. Bogomolets National Medical University. The authors have analyzed and improved the sequence of physical examination of the patients with temporomandibular pathology, paying attention to some aspects of physical examination of these patients. Results and discussion. The result of the study of patients with temporomandibular pathologies proved that it is necessary to pay attention to the position the patient assumes, the position of his head, cervical and thoracic vertebral department and position of upper extremities. The physician must define how pain intensity differs according to the body position change. It is necessary to estimate the symmetry of functioning of the mimic and chewing muscles, position of lower jaw and shift of the chin related to the nose at rest and when the patient is opening the mouth. The dentist must check whether the patient supports his jaw at rest, feels discomfort during speaking, with partial or complete mouth opening, when signing or brushing his teeth; whether he closes his teeth or if there is a gap between the teeth. It is also necessary to pay attention to probable hypoplasia of the mandible, crossbite or overbite, hypertrophic masticatory muscles, position and movement of the tongue. The dentist must estimate whether the patient bites his tongue, its position at rest and during swallowing. The dentist should additionally perform debridement of the teeth and evaluate the gums and oral mucosa condition. When questioning the patient, the dentist pays attention to the character, intensity, localization and duration of pain, its possible radiation into the head, face or upper extremities. The pain may appear both at night and in the daytime, so the dentist must clarify whether pain sensations around the temporomandibular joint affect his sleep as well as the sleep position (if the patient puts his hand or a pillow, the ordinary or orthopedic one, under the head). It is necessary to drop out etiological traumatic factor of temporomandibular disorders, particularly falling or being hit onto the jaw, biting at something hard or keeping the mouth open for a long time. When the patient visits a manual therapist, traction technique (Glisson test) could be used, with mandible being pressed onto. It is necessary to define the patient’s complaints: clicking, crepitation during mandibular movements, which may appear due to dislocation of the intra-articular disc, etc. It is necessary to find out if the patient uses apparatus systems or mouth tray for correcting his occlusion, and dental prostheses (type and construction), and how long the patient has been using them. The dentist must define the patient’s lifestyle: static or dynamic head and body position, his activity style, some uncharacteristic activities, related to his psycho-emotional condition and psychological adaptation mechanisms. These aspects must be kept in mind during examination and planning the rehabilitation of the patient. The authors have established and applied practically their own sequence of physical examination of patients with temporomandibular joint disorders, which is an actualized clinical examination, possible to be conducted even with painful manifestations of the dysfunction. This sequence was successfully implemented in the stomatological center. So, nowadays there is no single apprehension of mechanisms and methods of treatment of patients with temporomandibular dysfunction and masticatory muscles dysfunction. The modern restorative medicine requires for effective treatment-diagnostic complexes for management of the patients with temporomandibular joint dysfunction and masticatory muscles dysfunction. The problems of differentiated approach to establishing the diagnosis and the adequate individual treatment strategy choice with temporomandibular and masticatory dysfunction as well as with restoration of healthy function of the dental system are insufficiently studied, being of huge scientific interest. Conclusions. To detect changes of the volume or smooth movement of the mandible, caused by the occlusal, muscular or articular dysfunction, to predict and plan the complex treatment strategy a dentist must regularly practice physical examination of the temporomandibular joint. To find the patients with temporomandibular dysfunctions and masticatory muscles dysfunctions, detect the predominating symptoms, etiological factors, pathogenetic interrelation in the disease development, estimate the pathology severity, plan the complex of diagnostic measures and treatment strategy, during the early diagnostic stage it is necessary to conduct physical examination according to the offered sequence.
Keywords: temporomandibular joint, joint pain, dysfunction, trigger points, treatment, rehabilitation, headache
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