So I thought I would post a case I ran into last week and gather some thoughts:

Chief Complaint: Chief Complaints:

6 Months ago patient noticed on photos his smile is crooked. Has no pain but notices his jaw cracked or pops on opening and closing. 2 years ago after seeing me and I mentioned his click he notices it now all the time. Never noticed before. Patient does bite his nail and feels like he clenches during the day. He currently wears an Anterior bite plane. Tries to avoid sleeping on his left side. No pain but is worried something could develope.

Exam:

Class III tendency with posterior crossbite

Zero overjet and overbite

Protrusive movement- 5mm and deviates to patient right

Lateral excursions- 5mm to left and 10mm to right

Load test negative

No pain on any excursions and no pain normally

Opening and closing click noted (stethoscope audible and felt)

Opening 35mm with max opening 55mm. No pain on opening

Opening and Protrusive deviates to right

Muscle Exam:

Positive Left Anterior Temporalis (2)

Neg Left Posterior and Right Ant and Post. Temp

Positive left masseter (3-4) Superior/Posterior belly

Negative Anterior belly and Right both

Positive Left Posterior Diagastric (3-4)

Positive Left submandibular

Positive Left Sterno

Positive Lateral Pterygoid (2)

Right Medial Pterygoid (2)

Occipitals and Traps WNL

Click:

Late opening and early close sounds. Both sides and audible with stethoscope

Will post photos in a bit.

Thoughts? Treat? Concerns?

Got to get you all thinking on a Monday

Andy

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