[126219376]
Subjective pt pursued smiledirect invisible aligners for mandibular crowding starting in (b)(6) 2017. In (b)(6) 2017 her left jaw locked closed for 3 days in a row, and she noticed much worse jaw symptoms. She reached out to smiledirect and they recommended seeing a tmj specialist or to email with one of their drs. She visited an urgent care in (b)(6) 2017, was told she had no jaw fractures, and was prescribed a muscle relaxer which didn't help as much as the ibuprofen 800mg q8h x1wk. She described a constant, moderate, aching baseline pain, with moderate to severe, aching, pressure, throbbing pain in her jaw bilaterally [pointing to preauricular and ramus/masseter areas], with occasional ear aches. Her symptoms are worse with hard/chewy food, yawning, rainy/cold weather, chewing gum, clenching/bracing, concentrating on a task, opening wide, and sleeping on her hands which puts pressure on her jaw. Her symptoms are better with soft food, warm compresses only briefly, sleeping on her back or side, and ibuprofen. Assessment myofascial pain and referral bilateral tmj arthralgia left tmj disc displacement with reduction with intermittent lock right tmj disc displacement with reduction. Objective im joints. Mandibular range of motion was grossly intact with mild to moderate tmj and masseter pain on maximal opening and excursive movements, replicated cc auscultation revealed bilateral click palpitation revealed moderate to severe bilateral pain, familiar, musculoskeletal: mild tenderness to palpation of the temporalis muscles, familiar headache, severe tenderness to palpation of the masseter muscles, active pain referral, replicated cc severe tenderness to palpation of the upper quarter muscles, active pain referral, familiar mild to moderate forward head posture.
Patient Sequence No: 1, Text Type: D, B5