There are many indications that a pathogenic occlusion may be present. Diagnosis is often complicated because patients almost always have a combination
have extensive bone loss, rapid tooth migration may occur with even minor occlusal discrepancies. Tooth movement may make it difficult for these patients to institute proper oral hygiene measures, and the result may be a recurrence of periodontal disease. Precise adjustment of the occlusion is probably more critical in patients with a compromised crown/root ratio than in those with better periodontal support (see Chapter 32).
Musculature. Acute or chronic muscular pain on palpation can indicate habits associated with tension such as bruxing or clenching. Chronic muscle fatigue can lead to muscle spasm and pain. In one study, subjects were instructed to grind their teeth for approximately 30 minutes. They experienced muscle pain that typically peaked 2 hours after parafunctioning and lasted as long as 7 days. Asymmetric muscle activity can be diagnosed by observing a patient's opening and closing movements in the frontal plane. A deviation of a few millimeters is quite common, but anything beyond this calls for further examination (Fig. 4-24) and may be a sign of dysfunction.47 Restricted opening, or trismus, may be due to the fact that the mandibular elevator muscles are not relaxing.
Temporomandibular Joints. Pain, clicking, or popping in the TMJs can indicate TM disorders. Clicking and popping may be present without the patient's awareness. A stethoscope is a useful diagnostic aid; a recent study found joint sounds are generally reliable indicators of temporomandibular disorders,4s The patient may complain of TMJ pain that is actually of muscular origin and is referred to the joints.
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