Abstract
ABSTRACT BACKGROUND AND OBJECTIVES: The clinical association between painful temporomandibular disorder and orofacial myofunctional disorders is frequent and requires attention. The objective of this study was to describe a clinical case of painful temporomandibular disorder in association with orofacial myofunctional disorders that evidence the importance of dental and speech therapy approaches involving myofunctional orofacial limits, as well as to discuss whether the presence of orofacial myofunctional disorders can be a comorbidity that hinders the temporomandibular disorder management. CASE REPORT: Female patient, 35 years old, complaining of pain in the orofacial region and joint noises during high amplitude mandibular movements for 17 years. She was diagnosed with myofascial pain and arthralgia (RDC/TMD) and orofacial myofunctional disorders (phonoarticulation with deviations and lingual interposition, atypical swallowing, oromandibular incoordination and mandibular hyperexcursion with eminence noise). Complementary tests (electromyography and electrovibratography) were performed in the pre- and post-treatment moments (1 year after). The treatment consisted of self-management and mindfulness orientations, stabilizing occlusal splint and speech therapy. After the treatment, there was an improvement in pain and mandibular range of motion, with consequent reduction of noise, better electromyographic balance and reduction of orofacial myofunctional disorders scores. CONCLUSION: The case report has suggested that the presence of orofacial myofunctional disorders in association with painful temporomandibular disorder could interfere in the management of pain and the balance of the stomatognathic system because it seems to act as a worsening factor to the temporomandibular disorder signs and symptoms. In this sense, the importance of dental and speech therapy interventions in patients with orofacial myofunctional disorders as possible comorbidity to painful temporomandibular disorder is highlighted.
Highlights
Temporomandibular dysfunctions (TMD) are defined as a set of signs and symptoms that indicate a painful musculoskeletal syndrome associated to multisystemic changes, as well as changes in behavior, in the emotional state and social interactions, recognized as manifestations of deregulation of the central nervous system[1,2,3]
The objective of this study was, by reporting a clinical case, to present a possible clinical association between painful temporomandibular dysfunctions (TMD) and the presence of orofacial myofunctional disorders (OMD), and to discuss if they can act as complicating factors in TMD management
The OMD presented important aspects related to TMD such as marked mandibular deviations during speech with exaggerated ceceo, swallowing with many cervical and tongue compensations, mandibular rest without free functional space, that is, in a state of teeth clenching with the tongue compressed most of the time; in some moments with the tongue interposed between the arches, causing strong marks on its sides
Summary
Temporomandibular dysfunctions (TMD) are defined as a set of signs and symptoms that indicate a painful musculoskeletal syndrome associated to multisystemic changes, as well as changes in behavior, in the emotional state and social interactions, recognized as manifestations of deregulation of the central nervous system[1,2,3]. Some TMD situations present a pain that is triggered or worsened by jaw movements In this sense, the performance of orofacial functions that respect the functional balance is of utmost importance for a favorable prognostic of its signs and symptoms[8,9]. The TMD diagnosis was carried by an experienced dental surgeon based on the revised protocol Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)[10] and the phonological by an expert in orofacial kinetics, based on the Orofacial Myofunctional Evaluation Protocol with Scores (AMIOFE)[11], that allowed to quantify the perceptive evaluation (clinical examination) and compare with the evolution obtained after the therapeutic process. As previously described[12], included strategies to eliminate the deleterious oral habits, to self-manage pain (step 1), to coordinate and strengthen the orofacial and masticatory muscles to allow flexible and symmetrical jaw movements, avoiding accidental bites in the cheeks and tongue (step 2-myotherapy)[12]. There was a reduction of pain on palpation in the masseter, anterior temporal and the TMJ region, which initially was reported with a strong intensity (variation between 8 and 10)
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