Differential Diagnosis for Jaw Positioning Change and Dental Occlusion Issue

The patient presents with a recent change in jaw positioning, denying any trauma, injury, or illness, and complains that his back teeth no longer come together, with only his front teeth meeting. This symptomatology suggests an issue with the temporomandibular joint (TMJ) or the dental occlusion. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Temporomandibular Joint (TMJ) Disorder: This condition affects the joint that connects the jawbone to the skull. Symptoms can include pain, clicking, or locking of the jaw, and changes in the way the upper and lower teeth fit together, which aligns with the patient's complaint of his back teeth not coming together anymore.

• Other Likely Diagnoses

  • Bruxism: Grinding or clenching of the teeth can lead to changes in the occlusion (the way the upper and lower teeth fit together) and jaw positioning due to the excessive force applied to the teeth and jaw.
  • Dental Malocclusion: This refers to a misalignment of the upper and lower teeth. It could be due to various factors, including tooth wear, missing teeth, or orthodontic issues, leading to the back teeth not meeting properly.
  • Myofascial Pain Syndrome: This condition involves pain and inflammation in the muscles that control jaw function, which could lead to changes in jaw positioning and occlusion.

• Do Not Miss Diagnoses

  • Oral Cancer: Although less likely, oral cancer can cause changes in the jaw and dental occlusion, especially if a tumor develops in the jawbone or surrounding tissues.
  • TMJ Dislocation: A condition where the jawbone becomes displaced from its normal position, which could be due to trauma (even minor) or certain movements, and might not always be immediately recognized by the patient as traumatic.
  • Osteonecrosis of the Jaw: A condition characterized by the death of jawbone tissue, often associated with bisphosphonate use or other medications, which could lead to changes in jaw alignment and dental occlusion.

• Rare Diagnoses

  • Eagle Syndrome: A condition characterized by an elongated styloid process or calcified stylohyoid ligament, which can cause facial pain, dental pain, and difficulties in swallowing, and might also affect jaw positioning.
  • Rheumatoid Arthritis or Other Connective Tissue Diseases: These conditions can affect the TMJ, leading to pain, stiffness, and changes in jaw alignment and occlusion.
  • Neuromuscular Disorders: Certain conditions like dystonia can affect the muscles of mastication, leading to abnormal jaw movements and positioning.