Event 7: Christine's Third Follow Up

Pain Since Beginning Modified Treatment

Current Prescription Medication

Psychiatric Diagnosis

Christine says her psychiatrist just diagnosed her with bipolar disorder.

Christine's Third Follow Up Exam

Maximal Inter-incisal Opening

Christine's maximal inter-incisal opening
Maximal Inter-incisal Opening

Christine's maximal inter-incisal opening is 36 mm with mild pain in right masseter muscle, no deviation on mandibular opening or limited excursions bilaterally.

Christine's TMJ Exam

Christine's TMJ exam
Christine's TMJ exam

Christine's TMJ exam shows her to be non-tender bilaterally with no click, pop, crepitus bilaterally.

Christine's Muscles of Mastication

Christine's muscles of mastication
Christine's muscles of mastication

Christine's muscles of mastication show:

  • Anterior Temporalis Muscle
    • Non-tender bilaterally without referred pain.
  • Masseter Muscle
    • Mild on right
  • Masseter Muscle Origin
    • Mild on right

Third Assessment

  • Myalgia of right masseter muscle: improved.
  • Myofascial pain associated with anterior temporalis muscle: resolved.
  • Tension-type headache: significantly improved.
  • Parafunctional habit: partially managed.
  • Psychiatric disorder contributing to orofacial pain condition: managed by psychiatrist.

Third Updated Treatment Plan

  • Recommend custom-made occlusal appliance 
    • Dental impression completed for maxillary appliance
  • Continue gentle passive jaw stretches
  • Continue with current medications
  • Return to office in 3 weeks
  • Consultation with psychiatrist and primary care physician 

Custom-Made Occlusal Appliance

Christine had a custom-made occlusal appliance created to help with her parafunctional habit of grinding/clenching.

Custom-made occlusal appliance
Custom-made occlusal appliance

Consultation with Christine’s Dentist, Primary Care Physician, and Psychiatrist

Christine's dentist, primary care physician and psychiatrist consulted together to discuss Christine's case.

University of Pennsylvania logo
University of Pennsylvania