Orthodontics and temporomandibular disorders

The presumed relationship between occlusal disharmonies and temporomandibular disorders has been the cornerstone of traditional orthodontic thinking about these disorders. Current research, however, indicates that temporomandibular problems are actually medical orthopedic diseases or dysfunctions that have little to do with occlusal morphology or maxillomandibular relationships. Therefore, orthodontists must discard some of their traditional beliefs and practices, replacing them with modern concepts of musculoskeletal pain and dysfunction, in order to provide appropriate care for patients suffering from temporomandibular disorders.     

Common factors in the presentation and management of chronic temporomandibular disorders and chronic overlapping pain disorders

The International Association for the Study of Pain has released a new classification scheme for chronic pain. This classification scheme describes chronic pain as either a symptom of a disease (chronic secondary pain) or the disease itself (chronic primary pain). Chronic temporomandibular disorders have many similarities to other proposed chronic overlapping pain disorders, but are classified and managed by dental practitioners as a localized pain condition of the orofacial region. We review the literature to describe the similarities between chronic temporomandibular disorders and chronic overlapping pain disorders, and discuss how this evolving concept may affect the way that dentists approach the diagnosis and management of chronic temporomandibular disorders.     

Hemicrania continua presenting as temporomandibular joint pain

Patients presenting with unilateral facial pain present a unique diagnostic challenge for dental practitioners. As dentists, we routinely look for maxillofacial pathology, temporomandibular disorders, or odontogenic abscesses as the etiology of pain in these patients. However, several types of the chronic daily headaches may also produce signs and symptoms similar to dental or maxillofacial pathology. One such headache, hemicrania continua, is typically characterized by a continuous, throbbing, unilateral headache and is completely responsive to treatment with indomethacin. In this article we present 2 cases in which initial symptoms suggested temporomandibular disorders but the patients were ultimately diagnosed with hemicrania continua. A brief review of hemicrania continua and its treatment is included. Thoroughly understanding this entity and realizing that it may present as temporomandibular pain will allow us to more readily diagnose the condition and implement effective treatment.     

Headache as a Symptom of Craniomandibular Disorders I: Pathophysiology

Headache is a symptom of many organic and non-organic disorders affecting the craniomandibular system. Knowledgeable dentists may play a vital role in the diagnosis and management of headache patients whose symptoms are attributable to a craniomandibular component. Management of craniomandibular disorders requires an understanding of the dental occlusion, temporomandibular joints and associated musculature, as well as the role of the central nervous system. In order to differentially diagnose head pain of craniomandibular origin from other medical causes, dentists must also possess a fundamental knowledge of pain of vascular, neurologic, psychogenic and neoplastic origin. Medicine and dentistry have an obligation to the patient to better understand all factors potentially responsible for headache and orofacial pain and to make appropriate referrals when indicated.     

Sex differences among dentists regarding eating disorders and secondary prevention practices

BACKGROUND: The purpose of this cross-sectional study was to assess sex differences among dentists pertaining to current behaviors and behavioral beliefs with regard to eating disorders. METHODS: The authors collected data via a self-administered paper-and-pencil questionnaire from a randomized sample of 350 practicing male and female dentists. RESULTS: The results showed a low level of practice regarding secondary prevention (that is, measures leading to early diagnosis and prompt intervention) of eating disorders. The authors found statistically significant differences, with more female than male dentists reporting that they assessed patients for oral cues (P < .001), more female dentists reporting that they provided specific dental care instructions (P = .038) and more female dentists referring patients who have oral signs of eating disorders (P = .028). They also found sex differences with regard to mediating factors. Female dentists had greater knowledge of oral manifestations of eating disorders (P = .001), greater knowledge of physical cues of anorexia nervosa (P < .001), greater perception of the severity of anorexia nervosa (P = .007) and greater knowledge of physical cues of bulimia nervosa (P < .001). CONCLUSIONS: Although the dentist may be the first health care provider to assess oral effects of eating disorders, his or her involvement may be influenced in part by sex and sex-related health beliefs. CLINICAL IMPLICATIONS: Female dentists may be more sensitive to oral cues related to women's health issues. Further research is warranted to explore the mediating factors regarding secondary prevention of eating disorders.     

Interprofessional Collaboration in Dentistry: Role of physiotherapists to improve care and outcomes for chronic pain conditions and sleep disorders

Physiotherapists can manage chronic pain patients by using technical interventions such as mobility, strengthening, manual therapy, or flexibility in a specific and functional manner, being a key component of a multidisciplinary team. Dentists are involved in the management of different chronic pain conditions such as temporomandibular disorders and sleep disorders such as obstructive sleep apnea. However, they are frequently unaware of the benefits of collaborating with physical therapists. In this review, the collaboration of physical therapists and dentists will be explored when managing orofacial pain, headaches, and sleep disorders. The physical therapist is important in the management of these disorders and also in the screening of risk factors.     

Neck pain and temporomandibular dysfunction

Cervical spine disorders (CSD) are common chronic conditions affecting the cervical region and related structures. In this article the coexistence and possible interrelationship between temporomandibular dysfunction (TMD) and CSD is discussed. Our data indicate that a questionnaire is an important aid for distinguishing between CSD patients and subgroups of patients with TMD. Orthopedic tests for the stomatognathic system can be used to discriminate between CSD patients and subgroups of patients with TMD. The orthopedic tests of the cervical spine were shown to be of minor importance in discriminating between patients with TMD and patients with CSD. In more complex cases the cooperation between dentists and 'specialised' physiotherapists can be useful.     

The Relationship of Tinnitus to Craniocervical Mandibular Disorders

Patients with craniocervical mandibular (TMD) disorders can present with tinnitus as a primary or secondary complaint. The embryology and functional anatomy of the middle ear, temporomandibular joint, muscles of mastication and associated tendons, ligaments, blood vessels, nerves and lymphatics was found to be helpful in establishing etiologic concepts which relate tinnitus to these temporomandibular disorders. In addition to etiologic concepts, treatment modalities are described. The authors relate their experiences as well as those of others with different patient populations.     

Post-academic dental specialties 6. Gnathology: profile and competencies of the specialist in temporomandibular disorders and the general dental practitioner

The guiding principle in postgraduate programmes is to enable dentists to build on and extend the competencies acquired in the basic academic programme. This requires the examination and treatment of sufficient numbers of patients. Given the incidence and prevalence of temporomandibular disorders and orofacial pain, basic academic training will be limited to referral or to diagnosing and treating acute and non-complex cases, whereas the specialist in temporomandibular disorders(TMD) will focus especially on chronic temporomandibular disorders and orofacial pain, in a multidisciplinary setting. In case of orofacial pain, the general dental practitioner is the obvious person to determine if there may be odontogenic causes. The specialist in TMD can either advise the general practitioner or coordinate the patient's care him- or herself. In order to be able to perform well within a (partly medical) multidisciplinary setting there is a need for differentiated education, above and beyond the basic academic curriculum. The competencies of the specialist in TMD should comprise care in a broad sense, providing evidence-based care and educating patients, being able to work well within an organization, clinical reasoning and professional development through life-long learning and teaching. The specialist in TMD may either work in private practice or in special dental care clinics.     

Lyme disease misdiagnosed as a temporomandibular joint disorder

Craniomandibular disorders cause many pleomorphic and seemingly unrelated clinical manifestations that mimic other more serious medical problems and thus can present physicians and dentists with a challenge that invites misdiagnosis and improper treatment planning. Conversely, misdiagnosis and ineffective treatment planning are facilitated when serious medical problems manifest a range of signs and symptoms that are clinically similar to temporomandibular joint muscle dysfunction. At times, the patient's response to therapy may be the best method of corroborating a diagnosis, as illustrated in this report of a patient with Lyme disease that was misdiagnosed as a temporomandibular joint disorder. Lyme disease has already reached epidemic proportions in several parts of the United States and its geographic distribution is spreading. Because Lyme disease is a life-threatening illness whose clinical manifestations can mimic temporomandibular joint/myofascial pain-dysfunction, it is the responsibility of every dentist who treats craniomandibular disorders to become familiar with the clinical presentations of Lyme disease and more proficient in its differential diagnosis.     

Diagnosis and treatment of temporomandibular disorders

Current concepts and recommended treatment for temporomandibular disorders (TMDs) and temporomandibular joint pain and dysfunction have evolved over time. This article attempts to distill the current information for this often confusing topic into relevant clinical issues that will allow the general dental practitioner to be better able to diagnose and interpret clinical findings, and institute a therapeutic regimen that will provide needed relief to patients suffering from TMD dysfunction. Current management methods, both surgical and nonsurgical, are reviewed and discussed.     

Observer Performance in Describing Temporomandibular Joint Sounds

Twenty-two dentists and dental students listened to tape recordings of temporomandibular joint sounds from 28 temporomandibular joint patients and classified their observations as no sound, clicking, or crepitation. The interobserver agreement was low since the observers classified only 14% of the patients the same. The intraobserver agreement was higher with a mean of 79%. The divergent opinions about the character of temporomandibular joint sounds indicate that these clinical signs are not as objective as previously postulated.     

Unilateral temporomandibular disorder and asymmetry of occlusal contacts

STATEMENT OF PROBLEM: The relationship between temporomandibular disorders and occlusal tooth contacts is unclear and controversial. PURPOSE: This study assessed whether unilateral temporomandibular disorders were associated with the absence of bilateral symmetry in the number of occlusal contacts. MATERIAL AND METHODS: Fifteen university dental students who had complete natural dentition and normal occlusion and exhibited unilateral signs and symptoms of temporomandibular disorders were compared to 15 age- and sex-matched healthy control subjects. All participants met specific inclusion and exclusion criteria. Occlusal contacts were recorded in the intercuspal position with wax registrations. Dental impressions were made and poured in type I stone. Contacts were classified according to location and intensity. Four experienced dentists using an established protocol made all measurements. Assessment of the reliability of the occlusal registration procedure showed a small (<4%) within-subject variability. Statistical analysis was based on the binomial distribution and nonparametric tests (P < .05). RESULTS: Subjects with unilateral temporomandibular disorders had greater bilateral difference in the number of contacts than controls. The median (95% confidence interval) difference was 3 (2 to 4) and 2 (1 to 2), respectively. In unilateral temporomandibular disorder subjects, the number of occlusal contacts was greater on the side with, rather than without, disorder (median number 20 vs. 16). The median (95% confidence interval) difference between sides with and without unilateral temporomandibular disorders was 3 (2 to 4) for all contacts and 2 (1 to 3) for contacts on the posterior teeth. CONCLUSION: Within the population of this study, a weak association was found between unilateral temporomandibular disorders and asymmetry in the number of occlusal contacts.     

A Study of Dentists' Knowledge and Beliefs Regarding Temporomandibular Disorders in Korea

The purpose of this study was to examine the knowledge and beliefs regarding TMD (temporomandibular disorders) held by practicing dentists in Seoul, the capital and largest city in Korea. Four aspects of TMD (psychophysiological, psychiatric disorders, chronic pain and pathophysiological) were examined. The results indicate that while the role of psychophysiologic factors in the etiology of TMD and the role of psychiatric disorders is relatively widely acknowledged in the practicing community, there is a high level of controversy regarding the pathophysiology of TMD and the appropriate diagnosis and treatment of these chronic conditions. The findings partially duplicate a similar survey of dentists in Seattle, Washington, and one survey done in Kansas in the United States.     

A study of dentists' knowledge and beliefs regarding temporomandibular disorders in Korea

The purpose of this study was to examine the knowledge and beliefs regarding TMD (temporomandibular disorders) held by practicing dentists in Seoul, the capital and largest city in Korea. Four aspects of TMD (psychophysiological, psychiatric disorders, chronic pain and pathophysiological) were examined. The results indicate that while the role of psychophysiologic factors in the etiology of TMD and the role of psychiatric disorders is relatively widely acknowledged in the practicing community, there is a high level of controversy regarding the pathophysiology of TMD and the appropriate diagnosis and treatment of these chronic conditions. The findings partially duplicate a similar survey of dentists in Seattle, Washington, and one survey done in Kansas in the United States.     

Occupation as a potential contributing factor for temporomandibular disorders,bruxism, and cervical muscle pain: a controlled comparative study

The aim of the study was to compare the prevalence of cervical muscle pain (CMP) and myogenic temporomandibular disorders (MFP) among female dentists, high‐tech workers, and a group of subjects employed in other occupations; to investigate the associations among CMP, MFP, and bruxism in those groups; and to evaluate the influence of work‐related stress on MFP and CMP. Evaluation was based on clinical examinations of MFP and CMP and self‐reported questionnaires concerning pain and stress. The diagnosis of sleep bruxism was adapted using the validated diagnostic criteria of the American Academy of Sleep Medicine (International Classification of Sleep Disorders (ICSD‐2), 2005, Westchester, IL), whilst the diagnosis of awake bruxism was made on the basis of a questionnaire. The odds of a subject with MFP experiencing concurrent CMP or bruxism (sleep and/or awake) ranged from 2.603 to 3.077. These results suggest that high‐tech workers and dentists are at greater risk for developing temporomandibular disorders (TMDs) and CMP when compared with general occupation workers, as defined in this study. Furthermore, the associations shown here between TMDs and CMP highlight the importance of palpating neck musculature as part of any routine examination of TMD.     

Diagnosis and therapy of temporomandibular disorders

Temporomandibular disorders is a collective term covering a number of related disorders affecting the temporomandibular joints, masticatory muscles, and related structures. The study reviews the recent knowledge about the diagnosis and complex therapy of temporomandibular disorders on the basis of published scientific literature. The role of general dental practitioner in management of patients with temporomandibular disorders is emphasised. Since a lot of patients turn to them for a first consultation, they should be familiar with the main diagnostic aspects of these disorders. The non-invasive conservative therapeutic possibilities are described in detail and they are suggested in the initial phase of the treatment. The disorders, which usually need further consultations with other specialist, are also described.