1 Patient N.

, 45 years old, a teacher by profession, complained of increasing

involuntary movements of the lower jaw, tongue, "twitching of the chewing
muscles", spasms of the pharyngeal muscles that arose 7 years ago; 6 years ago
metal-ceramic crowns and long bridges were made. The patient complained of
"poorly fitted crowns", "constant sliding and displacement of the lower jaw",
"periodic occurrence of involuntary head turn to the right."
Complete neurological examination was performed. An arachnoid cyst of the left
temporal region was found. Diagnosed with Parkinson's disease and prescribed the
neuroleptic tetrabenazine (nitoman). An improvement has come. The patient
refused treatment in a neurological hospital. I went to the dentist, hid the
neurological diagnosis.
The dentist considered the cause of the complaint amalgam fillings, which he
replaced with ceramic inlays. There was a short-term improvement.
Due to the fact that the ceramic lining of the prostheses was chipped, the patient
turned to another doctor who made the plastic lining of the whole-cast prostheses.
Due to the strengthening of the para-functions, this cladding also worn out and
broke off soon.
The patient associated the deterioration of the general condition with purely dental
actions.
In a neurological clinic, clonazepam (rivotril) was prescribed at night, injections of
botulinum toxin (botox) into different parts of the masseter, temporal muscles
proper. A week later, there was a significant reduction in muscle spasm.
Further treatment was carried out in a neurological hospital.

2 Patient Ya., 52 years old, complained of discomfort in the sublingual region with
irradiation to the cheek on the right, a feeling of heaviness at the root of the tongue
and in the submandibular region, said that “the teeth interfere with the tongue,”
“the sky drops,” “the jaw narrows "," you need to raise the bite ", etc.
Objectively: the existing bridges are satisfactory, there is no reason to replace
them. With physiological rest of the lower jaw, the submandibular region on the
left and the lateral surfaces of the tongue rise rhythmically (rotational movements
of the tongue around its longitudinal axis).
Diagnosis (together with a neuropathologist): myofascial pain syndrome of the
medial pterygoid and suprahyoid muscles on both sides with elements of
somatized psychogenic disorders, parafunction of the chewing muscles, bruxism.
It is recommended to take amitrip-tilin 0.01 g 3 times a day for 1.5 months,
baclofen 0.01 g 2 times a day for 2 weeks, glycine 0.1 g 2 times a day and 4 tablets
for night (under the tongue), carry out gymnastics in the mode of post-isometric
relaxation, use the method of biofeedback for the chewing muscles, classes with a
psychologist and psychotherapist.
The patient was offered inpatient treatment in the conditions of the clinical
department of rehabilitation myoneurology. She refused inpatient treatment.
Patient C, 53 years old, an economist, complained of a loose closure of the
dentition, stiffness of the lower jaw when speaking, numbness of the face,
“permanent displacement of the lower jaw to the right”. She associated these
phenomena with poor-quality manufacture of "bridges" prostheses, which were
repeatedly altered. The orthodontist made a "medical device" (similar to the
Vankevich bus), which the patient could not use. Dental status without special
features, prostheses are made satisfactorily. After 2 years, the patient came back
for a consultation. It turned out that the dentist had removed all of the existing
dentures. There is a gross speech disorder that impedes communication and
professional activity.
The neuropathologist diagnosed cranial dystonia with oromandibular dystonia
syndrome (V.L. Golubev).
Treatment with botulinum toxin is recommended. In this case, at the first visit to
the doctor, one should pay attention to the "stiffness of the lower jaw" (according
to the patient). This symptom can be in chronic TMJ arthritis. However, this
diagnosis was not confirmed either clinically or radiologically. The patient had to
be referred immediately for a consultation with a neurologist.