Current concepts on temporomandibular disorders

Reviewed by Alex Jacobson

This book was designed to bring together some renowned experts in the field to provide state-of-the-art information about temporomandibular disorders (TMD). The book is divided into 5 parts, the first of which pertains to “Fundamentals,” beginning with “Anatomy of the temporomandibular joint and masticatory muscles.” The next chapter discusses TMD classification and epidemiology, a system that provides an assessment of psychosocial impairment along with physical impairment, the research diagnostic criteria for temporomandibular disorders (RDC/TMD), which is currently being updated. Discussed in chapter 3, “TMD as a chronic pain disorder,” are the general biomedical concepts of TMD, the general biosocial and psychosocial features of chronic TMD pain, and the general principles of pain assessment and management.

The introductory chapter (4) of part II of the book, “Etiology,” relates to the etiopathogenesis of muscle disorders whereby chronic and persistent muscle pain is thought to be due to peripheral and central sensitization processes and structural neuroplastic changes in the brain. Clinical management lies in modulating these neural changes and early intervention. Early intervention of nociceptive input from jaw muscles will help minimize the effects. Chapter 5, “Etiopathogenesis of TMJ disc displacements,” reviews the many etiologic theories on disc displacement, including the bacterial, biomechanical, hormonal, traumatic, and occlusal etiological theories. Chapter 6, “Temporomandibular joint osteoarthritis,” aims to discuss the relevant information pertaining to the fundamental elements, functioning, and malfunctioning of the temporomandibular joint (TMJ), risk factors, and pathogenesis, thereby providing deeper insight into the clinical signs and symptoms, diagnosis, and treatment of TMJ osteoarthritis. The consensus on “Bruxism and temporomandibular disorders” (chapter 7) is debated and yet to be reached on the definition and clinical diagnosis of bruxism. This chapter attempts to focus on the relationship of tooth clenching and grinding with TMD separately. Knowledge about TMD pathophysiology must be substantially improved to give better insight into many facets of these disorders. Chapter 8, “Future perspectives in TMD pathophysiology,” discusses these issues to provide the rationale for the proposal of an integrated model of TMD pathophysiology.

Part III is “Diagnosis”; the first chapter (9) in this section, “Introduction to TMD diagnosis,” outlines the current beliefs about the pathway to TMD diagnosis by following a process of critical reasoning that involves questions such as what to search for, how to diagnose TMD, the rationale for psychological assessment, and differential diagnoses. The focus of chapter 10, “Clinical assessment,” is on the clinical examination; the most reliable protocol is the RDC/TMD. The next chapter (11) deals with the “Psychosocial assessment,” which cites data to show how painful TMD can be, accompanied by several psychosocial disorders, such as anxiety, depression, and somatization, which need to be addressed in the assessment phases, because of their influence on therapeutic outcomes. “Imaging of the temporomandibular joint” (chapter 12) describes the various radiographic techniques such as panoramic radiography, plain radiography, tomography, computed tomography, arthrography, magnetic resonance imaging, ultrasound, and bone scintigraphy. Chapter 13, “Instrumental approach,” discusses the overall reliability, validity, and practical use of various commercial instruments that might aid in the diagnosis of TMD. Described are pressure algometric devices, surface electromyography to detect masticatory muscle pain, and occlusal detection devices to detect occlusal trauma. A few TMD patients also have fibromyalgia (chapter 14) in which an interdisciplinary approach to treatment is recommended. Orofacial pain conditions can arise from numerous sources. The clinician’s aim is to identify the source of the pain. The differential diagnosis of acute and chronic orofacial pain, and the most appropriate and effective management of the condition, are discussed in chapter 15. The characteristics of headache and other craniofacial conditions and the impact of psychiatric comorbidity are described in chapter 16, “Headache and temporomandibular disorders.” Four case studies are cited as examples. Otologic symptoms are more prevalent among TMD patients than matched subjects without TMD. The “Relationship between otologic and TMD symptoms” is debated in chapter 17. It has been suggested that disorders of the masticatory system, such as malocclusions, can influence body posture. Chapter 18, “Malocclusion and body posture,” critically reviews the literature for possible associations between malocclusion and posture to address issues related to the management of such patients. Chapter 19, “Perspectives in clinical diagnosis of temporomandibular disorders,” describes the research that is required to aid clinical decision-making and identify critical areas of future research.

The first chapter in Part IV, “Clinical Management” (chapter 20), discusses the fundamentals of TMD management, the thousands of articles published on the various approaches to the management of TMD patients, the paradoxes of treatment, and recommendations for future research. A number of effective behavioral medicine approaches have been developed to better treat TMD disorders. These are reviewed in chapter 21, “Behavioral treatment approaches to temporomandibular joint and muscle disorders.” Chapter 22, “Physical therapy,” is divided into 3 parts. The first part discusses the relationship of TMD and body posture; the second part is a comprehensive overview of scientific literature; and the third part introduces different physiotherapeutic techniques for the treatment of TMD. The most common and effective drugs used for TMD management include analgesics, nonsteroidal anti-inflammatory drugs, corticosteroids, low-dose antidepressants, anesthetics, anxiolytics, and muscle relaxants. These drugs and the physiopathology of pain and inflammation are discussed in chapter 23, “Pharmacologic management.” In chapter 24, “Occlusal therapy of temporomandibular pain,” the authors review the historical assumptions, concepts, views, and therapeutic approaches to temporomandibular pain and progress to the modern evidence-based view and therapeutic approach. The neurochemical, psychophysiologic, and philosophical foundations of the placebo effect of treatment are explained in a separate chapter (25). “TMJ arthrocentesis” (chapter 26) refers to lavage of the upper joint compartment with liquid, by using needles for inflow and outflow. The technique, indications, and complications are described. TMJ arthrotomy, its rationale, and indications, as well as the surgical approaches and procedures to the TMJ, TMJ replacements, and the future of TMJ surgery are outlined in chapter 27, “TMJ major surgery.” A separate chapter (28) is devoted to the “Prosthetic rehabilitation in the TMD patient.” “Orthodontics and TMD management” (chapter 29) explains the role of the orthodontist in the diagnosis and management of TMD. “The management of bruxism” by means of occlusal interventions, pharmacotherapy, botulinum toxin injections, and behavioral or psychological therapy, and physical therapy is discussed in chapter 30. The next 2 chapters (31 and 32), “Integration of research into clinical practice” and “Ethical and legal considerations,” are informative and uniquely fascinating. The final chapter (33), “Treatment of TMD: think twice,” recommends that treatment of TMD conditions should be restricted as much as possible to noninvasive, reversible approaches.

The editor, together with no less than 45 outstanding world-renowned authors in the field of TMD and orofacial pain, has managed to produce a most informative text, an achievement in itself. Dentists and dental specialists involved in the treatment of TMD almost cannot afford not to read it.

Only gold members can continue reading. Log In or Register to continue

Apr 14, 2017 | Posted by in Orthodontics | Comments Off on Current concepts on temporomandibular disorders
Premium Wordpress Themes by UFO Themes