Abordagem das desordens temporomandibulares em paciente acometido por artrite idiopática juvenil: relato de caso e revisão de literatura

Abstract

This study was developed with the objective of reporting the clinical case of a patient diagnosed with temporomandibular disorder of articular character associated with the presence of juvenile idiopathic arthritis and emphasizing the indispensability of approaching the temporomandibular joint in patients with this diagnostic profile even in the absence of signs and symptoms. Pediatric male patient, 10 years old, previously diagnosed with juvenile idiopathic arthritis, sought the Diagnostic and Orientation Service for Patients with Temporomandibular Disorders, Faculty of Dentistry, Federal University of Juiz de Fora (SERVIÇO ATM - FO/UFJF), accompanied by his mother, complaining of pain in the temporomandibular joint region and limited mouth opening. During the clinical examination, the patient did not report pain on palpation of the accessory, masticatory and cervical muscles. On the other hand, he reported the presence of pain bilaterally in the region of the temporomandibular joint. In addition, the forced maximum opening, with pain, marked 18 mm. Thus, as a complementary exam, we opted for a cone beam computed tomography, in which images outside normal standards were observed in both heads of the mandible, with the left being more affected. After observing the exams, it was possible to achieve a diagnosis suggestive of type 3 internal derangement and the proposed therapy consisted in the use of a occlusal splint and physiotherapeutic follow-up. Two weeks later, during the return visit, an increase of 4 mm in the mouth opening was noted, without effort and without pain. After three months of proservation, a bigger mouth opening was observed, marking 32 mm with a stable patient in view of the complaints initially reported. In view of this, this clinical case emphasizes the importance of approaching the temporomandibular joint even in the absence of clinical symptoms, since this association causes long-term morphological changes, increases the levels of disability and reduces the quality of life.