Integrated Evaluation of Anamnestic Data in the Differential Diagnosis of Temporomandibular Disorders and Diseases That Affect Them

Abstract

In modern dentistry, temporomandibular disorders (TMD) are the third most common dental disease after caries, its complications and periodontal pathology. Despite the fact that a significant amount of research has been devoted to this problem, the etiology and pathogenesis have still not fully derermined.
 The aim is to carry out an integrated assessment of anamnestic data in the differential diagnosis of temporomandibular disorders and diseases that affect them and to determine their clinical significance in the diagnosis.
 Material and methods. 178 patients with suspected temporomandibular disorders were examined who were referred by other medical institutions in Lviv, Lviv region and other regions of Ukraine to the Department of Orthopedic Dentistry of Danylo Halytsky Lviv National Medical University aged 9 to 76 years. 142 female patients and 36 male ones were involved in this examination. During clinical examination and processing of the obtained material, it was identified a number of factors that could affect the occurrence of myogenic, arthrogenic, combined and affected disorders.
 Results. During clinical examination and processing of the obtained material, a number of factors that could affect the appearance of arthrogenic disorders have been identified. During the method of logistic regression, 13 factors were singled out from among them, which, when combined, have a probable influence on the development of this disorder. Only two of them have a preventive effect (their presence reduces the patient’s risk of arthrogenic TMD): hypermobility of all joints and pain on palpation of the muscles. All other 11 factors have a provocative effect - if they are present, the patient has an increased risk of arthrogenic TMD. Similarly, 11 factors have been identified that, when combined, have a probable effect on the development of myogenic disorder. The values of their regression coefficients are given in table 3. From 11 ones, only three have a preventive effect (their presence reduces the patient’s risk of myogenic TMD): exercise, intubation anesthesia over the past year and a history of rheumatism. All other eight factors have a provocative effect - if they are present, the patient increases the risk of myogenic TMD. Similarly, 17 factors have been identified that, when combined, have a likely impact on the development of a combined disorder. From these 17 factors, only two have a preventive effect (their presence reduces the patient’s risk of combined TMD): exercise and a past history of rheumatism. Other 15 factors have a provocative effect - if they are present, the patient increases the risk of combined TMD. Similarly, 13 factors were identified that, when combined, have a likely impact on the development of this affected disorder. The values of their regression coefficients are given in table 5. From these 13 factors have been analyzed, five ones have a preventive effect (their presence reduces the patient’s risk of affected TMD): limited mouth opening; crunch, click or crepitation on auscultation of the joints; and pain on palpation of the muscles. All other eight factors have a provocative effect - during their presence, the patient increases the risk of affected TMD. Using the method of logistic regression, it has been identified a number of factors that, when they were combined, affect the development of these disorders. It will increase the efficiency of diagnosis of temporomandibular disorders by substantiating clinical and diagnostic criteria and the development of diagnostic complexes in the diagnosis of TMD.