Preface

xiii

Introduction

xv

PART I

INITIAL EVALUATION

3

Chapter 1

Patient Interview

7

Chapter 2

Review of the “Initial Patient Questionnaire”

25

Chapter 3

Clinical Examination

33

Range of Motion

34

TMJ Noise

37

TMD Palpations

38

Intraoral Examination

54

Occlusal Changes

54

TMD Pain Caused by a Tooth

55

Tooth Pain without Local Pathology

57

Additional Evaluations

60

Chapter 4

Imaging

63

Plain Radiographs

63

Panoramic Radiograph

64

Axially Corrected Sagittal Tomography

64

Computed Tomography

64

Cone Beam Computed Tomography

65

Magnetic Resonance Imaging

65

Arthrography

66

High-Resolution Ultrasound

66

Imaging Strategies

66

Imaging Recommendations

67

Chapter 5

TMD Diagnostic Categories

71

TMJ Articular Disorders

72

Disc Displacement Disorders

72

Dislocation (Also Known as Subluxation)

76

Inflammatory Disorders

76

Osteoarthritis

76

Ankylosis

77

Fracture

78

Congenital or Developmental Disorders

78

Masticatory Muscle Disorders

78

Myofascial Pain

78

Myositis

79

Myospasm

80

Myofibrotic Contracture

81

Centrally Mediated Myalgia

81

Local Myalgia

81

Neoplasia

82

Chapter 6

Contributing Factors

83

PART II

COMMON ACUTE TMD CONDITIONS AND TREATMENTS

89

Chapter 7

TMD Secondary to Trauma

91

Chapter 8

TMD Secondary to Dental Treatment

95

Preventing Aggravation from Dental Treatment

97

Medial Pterygoid Muscle Pain

98

Inability to Close into Maximum Intercuspation

100

Occlusal Interference Sequelae

102

Obstructive Sleep Apnea Appliances

104

Chapter 9

Lateral Pterygoid Myospasm

107

Chapter 10

Acute TMJ Disc Displacement without Reduction

113

Chapter 11

TMJ Dislocation

127

PART III

OCCLUSAL APPLIANCE THERAPY

131

Chapter 12

Stabilization Appliance

135

Mandibular Positions and Interocclusal Record

138

Physical Variables

142

Full or Partial Coverage

142

Maxillary or Mandibular

145

Hard, Intermediate, or Soft Material

148

Thick or Thin

153

Appliance or Wire Retention

154

Summary of Physical Variables

154

Appliance Adjustments

155

Internal Adjustments

156

Internal Reline

158

External Adjustments

161

External Reline

167

Appliance Repair

171

Appliance Examples

174

Pressure-Cured Mandibular Acrylic Stabilization Appliance

174

Maxillary Acrylic Stabilization Appliance

179

Hard Thermoplastic Stabilization Appliance

180

Impak Stabilization Appliance

184

Dual Laminate Thermoplastic Stabilization Appliance

184

Soft Thermoplastic Stabilization Appliance

186

Appliance Management

189

Chapter 13

Anterior Positioning Appliance

197

Mandibular Position and Interocclusal Record

199

Design and Adjustments

200

Appliance Management

201

PART IV

MULTIDISCIPLINARY TREATMENT APPROACH

205

Chapter 14

Self-Management Therapy

209

Self-Management Instructions

210

Closure Muscle-Stretching Exercise

216

Lateral Pterygoid Muscle-Stretching Exercise

217

Posture Exercises

218

Breaking Daytime Habits

219

Chapter 15

Physical Medicine

227

Muscle Massage

228

Yoga

228

Trigger-Point Compression

229

Trigger-Point Injection

229

Physical Therapy

229

Acupuncture

232

Chiropractics

234

Magnetic Therapy

234

Chapter 16

Cognitive-Behavioral Intervention

239

Breaking Daytime Habits

243

Relaxation

245

Hypnotherapy

246

Biofeedback

246

Stress Management

247

Chapter 17

Pharmacological Management

251

Analgesics

252

Anti-Inflammatory Medications

253

Nonsteroidal Anti-inflammatory Drugs (Ingested Form)

254

Steroidal Anti-Inflammatory Drugs

255

Muscle Relaxants

256

Tricyclic Antidepressants

258

Topical Medications

259

Nutritional Supplements

261

Chapter 18

Other Dental Procedures

265

Occlusal Equilibration

268

Orthodontic-Orthognathic Therapy

270

Prosthodontic Therapy

272

TMJ Surgery and TMJ Implants

273

Chapter 19

Integrating Multidisciplinary Therapies

283

Treatment Summaries and Clinical Implications

283

Occlusal Appliances

284

Self-Management Therapy

284

Lateral Pterygoid Muscle-Stretching Exercise

284

Closure Muscle-Stretching Exercise

284

Posture Exercises

284

Massage and Trigger-Point Compression

285

Yoga

285

Trigger-Point Injections

285

Physical Therapy

285

Acupuncture

286

Chiropractics

286

Magnetic Therapy

286

Breaking Daytime Parafunctional, Muscle-Tightening, or Fatiguing Habits

286

Relaxation

287

Hypnotherapy

287

Biofeedback with Relaxation

288

Stress Management

288

Pharmacological Management

288

Occlusal Therapy

288

TMJ Surgery

289

Integrating Conservative Therapies

290

TMD Refractory to Initial Therapy

292

Long-Term Management

294

PART V

CASE SCENARIOS

299

Case 1

Pulpal Pathosis Mimicking TMD Symptoms

300

Case 2

Chronic Sinusitis

303

Case 3

Chronic Forehead Pain Referred from the Neck

304

Case 4

Myofascial Pain Secondary to Nocturnal Parafunctional Habits

305

Case 5

Tooth Attrition—No Pain

306

Case 6

Myofascial Pain Secondary to Daytime Parafunctional Habits

307

Case 7

Medial Pterygoid Myospasm

308

Case 8

Tense, Depressed, and Poor Sleep as Contributing Factors

309

Case 9

Fibromyalgia as a Contributing Factor

310

Case 10

TMJ Disc Displacements and When to Treat It—No Pain

311

Case 11

TMJ Inflammation

312

Case 12

Intermittent Acute TMJ Disc Displacement without Reduction

313

Case 13

Acute TMJ Disc Displacement without Reduction—Unlocked

314

Case 14

Acute TMJ Disc Displacement without Reduction—Not Unlocked

316

Case 15

Osteitis Causing Inability to Open Wide

318

Case 16

Lateral Pterygoid Myospasm

319

Case 17

Acute Exacerbation of TMD

321

Case 18

Multiple Forms of Head and Neck Pain After Crown Insertion

323

Case 19

Appliance that Positioned Condyles into their “Proper Position”

325

PART VI

FUNDAMENTALS OF CLINICAL STUDIES

329

Designs of and Advice for Performing Clinical Studies

329

Literature Review

329

Study Population

329

Institutional Review Board (IRB) Approval

330

Developing Study’s Parameters

330

Strengthening Study

331

Writing and Submitting Manuscript

331

Practice-Based Research

332

Prominent Clinical Study Designs

333

Case Report

333

Case Series Study

334

Cross-Sectional Study

336

Case-Control Study

336

Cohort Study

337

Nonrandomized Clinical Trial

337

Randomized Controlled Trial

340

Parallel-Group Randomized Clinical Trials

341

Cross-Over Randomized Clinical Trials

341

Other Types of Publications You may Want to Consider

342

Literature Reviews

342

Meta-Analyses

342

Systematic Reviews

343

Considerations in Assessing Clinical Trials

343

Conclusions

344

APPENDICES

349

1

Referral Criteria for Hygienists

351

2

Initial Patient Questionnaire

353

3

TMJ Disc Displacements

357

4

TMD Self-Management Therapies

359

5

Occlusal Appliance Care Instructions

361

6

Closure Muscle-Stretching Exercise

363

7

Posture Improvement Exercises

365

8

Laboratory Occlusal Appliance Instructions

369

9

Example of Dental Record Entries

371

10

Examples of Physical Therapy Consultations

373

11

Examples of Psychology Consultations

375

12

Working with Insurance Companies

377

13

Sources for Additional TMD Information

379

Glossary

383

Index

387