In the dissertation the scientific data on the presence of syndromic pathologies in temporomandibular disorders are specified and supplemented and the frequency and nature of false symptoms are determined. For the first time, diagnostic complexes for differential diagnosis between different types of temporomandibular disorders and diseases that mimic them have been scientifically substantiated. Scientific data on diagnostic signs for various forms of temporomandibular disorders by the method of logistic regression have been supplemented. The level of leading methods of examination of patients with temporomandibular disorders and diseases that mimic them is outlined and evaluated.
Despite the rapid development of technology in the dental field, there are still a number of controversial issues in the diagnosis and treatment of pathological conditions associated with the masticatory apparatus, which require in-depth study. The frequency of patients with characteristic complaints of temporomandibular disorders is increasing. However, these complaints are gaining a wider range, becoming more diverse. At the same time, many similar or identical complaints may have pathologies not related to dentistry (rheumatism, cervical osteochondrosis, tension headache, etc.). The clinician faces many tasks for a clear differential diagnosis and detection of a certain temporomandibular disorder or disease that mimics it. The causes of these disorders can be many factors, as well as a number of different specific conditions. Understanding the causes of this pathology will allow, at a certain level, an experienced specialist to distinguish the pain of dysfunction from similar diseases, to establish the cause, prescribe adequate treatment or refer to a doctor of another specialty. The similarity of symptoms for different disorders causes difficulties in clinical diagnosis. The high prevalence of TMD requires the search for new, more accessible diagnostic methods. In addition to the clinical examination, various methods of visualization of the temporomandibular joints are available, such as magnetic resonance imaging, computed tomography, scintigraphy, ultrasound, etc. The improvement of these methods is actively described in the domestic and foreign literature, but there is still no agreed protocol for examination and treatment of patients with TMD. The aim of this study was to 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. In the course of performance of work the following research methods are applied: clinical - for definition of complaints, the anamnesis and a condition of dental and maxillofacial system in the presence of symptoms of TMD; additional (radiation and non-radiation methods) - for visualization of TMJ structures; analytical - to study all indicators on the maps of examined patients to form a database of complaints and symptoms in TMD; statistical - to determine diagnostic algorithms for differential diagnosis of temporomandibular disorders and diseases that mimic them. In the course of the dissertation 178 patients with suspected temporomandibular disorders who applied to or were referred by other medical institutions of Lviv, Lviv region and other regions of Ukraine to the Department of Orthopedic Dentistry of Lviv National Medical University named after Danylo Halytsky were examined. Before the clinical examination of the patient, a careful collection of complaints, life history and medical history with which the patient consulted a doctor with an emphasis on identifying possible factors that could contribute to the development of TMD, followed by comparison between the main group of patients and the comparison group. The previous clinical examination was based on the Express Conclusion of the Hamburg Protocol: 1- pain on palpation in the joints; 2- pain on palpation of the masticatory muscles; 3- the presence of noise in the joints; 4- violation of the trajectory of the mouth; 5- mouth opening is limited; 6- eccentric occlusion, premature contact. If as a result of the preliminary examination revealed only one positive sign, the patient was recognized as functionally healthy and the diagnosis of TMD was rejected.
