This dissertation focuses on a comprehensive study of clinical symptoms, electromyographic indicators, and magnetic resonance imaging (MRI) findings in patients with myogenic-articular dysfunction of the temporomandibular joint (TMD of the TMJ). Particular attention is paid to the use of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), given that the patient history and clinical symptoms remain key to diagnosis, especially where the use of additional diagnostic methods is limited by organizational or financial constraints. The research aims to facilitate the work of primary care dentists who face TMD cases by providing clear diagnostic and treatment algorithms even without sophisticated diagnostic equipment. Emphasis is placed on exploring dysfunction and pain as the primary manifestations of this condition, as well as developing modern diagnostic approaches for their identification. The suggested tools, such as the Clinical Pathway for Patients with
Orofacial Pain, the “Differential Diagnosis and Clinical Signs of Orofacial Pain” guide, and the “Diagnostic Algorithm for Primary Orofacial Pain Screening”, standardize the diagnostic process and support rapid and accurate pain assessment at the primary dental care level.
For maximum verification of TMJ myogenic-articular dysfunction (TMD), a questionnaire survey was administered to 325 patients; among them, a group of 94 patients exhibiting clinical signs characteristic of TMD was selected. The survey of these 94 patients revealed from 2 to 13 clinical signs in each individual, with more than 3 signs documented in 72.3% of the cases. Using the Diagnostic Algorithm for Primary
Orofacial Pain Screening, a subgroup of 85 patients was identified and diagnosed with TMD according to the DC/TMD. The patients ranged in age from 18 to 55 years, of whom 63 (74%) were female. Within this cohort, 8 patients (10%) presented with disk displacement with reduction, 30 (35%) had myalgia, and 47 (55%) exhibited a combined pathology (disk displacement + myalgia). The number of patients in the nonoverlapping groups was statistically lower than in the combined pathology group.
Pain syndrome was evaluated in all patients (n=85) using the Visual Analog Scale (VAS) both before and after treatment. The highest pretreatment pain level on the VAS was observed in patients with myalgia, reaching 4.7 points, which then decreased to 1.3 points after treatment. The functional status of the masticatory muscles and pain assessment were conducted before treatment and one month following orthopedic treatment using a modified occlusal splint. To identify asymmetric masticatory muscle function during static tests, interference EMG signals were analyzed, followed by calculation of the following indices: Torque Index (To%), Asymmetry Index (As%), and Activity Index (ATTIV, %). The highest pretreatment Torque Index was observed in patients with disk disorders and measured 10.02±5.21%, dropping to 7.69±3.52% after treatment, indicating improved muscle activity balance and reduced lateral deviation of the mandible.
