Preview Study Club Module – Complex Dental Case


Today we’re going to talk about Claire.
Claire’s about 50 years old, she came into my practice a few years ago with a chief complaint
of “my jaw locks and hurts and I can’t open my mouth all the way.” You can see
from the photograph that she’s got limited opening. Claire also has some aesthetic issues
although they’re not at the forefront of her concerns right now. Her main concern is
the pain that she is experiencing. She had some dentistry done many, many years ago in
the U.K. after an automobile accident that loosened some teeth and eventually resulted
in some tooth loss. She’s noticed recently that her jaw pain has, while it’s been present
ever since the automobile accident, joint noises, occasional pain, it’s gotten worse
over the past several years until now she has the chronic locking that occurs. Sometimes
she can loosen her jaw up but most recently it hasn’t been loosening. It’s staying
locked and she’s experiencing pain of different intensity on again and off again. On the right
side of the screen you can see maximum opening. It’s about 22 millimeters. This photograph
may not quite demonstrate the 22 mm. She also has some deviation and a positive load test
on the right. There are buckle shots and maximum intercuspation and you can see a lateral shot
of her models. Occlusal shots, you can see the wear that has occurred in the constricted
arch form. She’s got a constricted upper arch that manifests mostly on her left and
she has a very extreme curve Wilson in the lower arch. Although the anterior teeth are
a little dark in this photograph there are wear facets on the palatal surface. On the
left posterior you can also see there has been a lot of wear and a lot of adjustment.
Claire mentions that her bite has been changing a lot over the past few years and it always
seems to be heavy on the left side. Panoramic films shows the retained third molars in the
upper arch as well as the extensive dentistry Claire has had done over the years. At the
moment, the significant findings are pain on loading, loading of the jaw joints, she’s
got muscle pain, she has restricted movement and based on the clinical examination, she’s
got damaged and displaced discs on both sides.

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