Contemporary Management of Temporomandibular Disorders : Non-Surgical Treatment

This book is a comprehensive, state of the art guide to the contemporary non-surgical treatment of temporomandibular disorders (TMDs) that will help to compensate for the frequent lack of experience and inadequate training among health professionals who encounter patients with jaw joint problems. After an opening section outlining special considerations relating to bruxism and trauma in TMDs, medical management and dental treatment are explained in detail, with coverage of various perspectives such as those of the orthodontist and prosthodontist. Psychiatric considerations and adjunctive therapies are also thoroughly discussed and the importance of a team approach to the management of temporomandibular disorders is highlighted. Complementary volumes are devoted to anatomy, pathophysiology, evaluation, and diagnosis and to total temporomandibular joint replacement and other surgical procedures, respectively. Each book will therefore be of high value for the multidisciplinary team necessary for successful management of TMDs, including dentists, surgeons, primary care doctors, pain doctors, and allied health professionals. Foreword 5 Preface 6 Contents 8 Part I: Special Considerations: Bruxism and Trauma 9 1: Sleep Bruxism and Temporomandibular Disorders 10 1.1 TMD Diagnostics 11 1.2 Diagnosis of Bruxism 11 1.3 Sleep Bruxism and TMD 12 1.3.1 Studies Using Clinical Examination and/or Anamnesis 12 1.3.2 Studies Using Electromyography in a Home Setting 13 1.3.3 Studies Using Polysomnography (PSG) 14 1.3.4 Experimental Studies Using Bruxism Simulation and Studies Using Finite Element Analysis (FEA) 15 1.3.4.1 Experimental Clinical Studies on Bruxism 15 1.3.4.2 Finite Element Analysis 16 1.4 Summary 17 References 17 2: The Role of Trauma and Whiplash Injury in TMD 19 2.1 Definition of Trauma and Role of Injury 19 2.2 Micro- and Macrotrauma 20 2.3 Epidemiology of Trauma 21 2.3.1 Motor Vehicle and Transport Injuries 22 2.3.2 Sports Injuries 22 2.3.3 Head and Neck Injuries 22 2.3.4 Jaw Injuries 22 2.4 Direct Trauma and TMDs 23 2.4.1 Dental and Medical Procedures 23 2.4.2 Yawning and Sustained Jaw Opening 24 2.5 TMD and Whiplash injury 25 2.5.1 Development of TMD After Whiplash Trauma 26 2.6 Consequences of Trauma: Pain and Functional Disturbances 27 2.6.1 The Role of Pain as a Primary Symptom of Injury 28 2.6.2 Nociception and Pain 28 2.6.3 Mechanisms Linking Injury to a Chronic Pain Condition 29 2.7 Models of Injury Underlying Onset of Pain Disorders 30 2.7.1 The Homeostasis Model 30 2.7.2 The Fear-Avoidance Model 31 2.7.3 History of Trauma in Patients with TMD 32 2.8 Considerations for Treatment in Relation to TMD and Trauma 33 2.9 Conclusions 33 References 34 Part II: Medical Treatment 39 3: Medical Management of TMD 40 3.1 Introduction 40 3.2 Nonsteroidal Anti-inflammatory Drugs (NSAIDs) 41 3.2.1 Method of Action and Adverse Effects 42 3.2.2 Effectiveness 43 3.2.3 Dosing Guidelines 43 3.2.4 Aspirin: A Nonselective COX Inhibitor 45 3.3 Opioids 45 3.4 Tumor Necrosis Factor-α Inhibitors and Interleukin-1 Receptor Antagonists 47 3.4.1 Background 47 3.4.2 Etanercept (Enbrel®) 49 3.4.3 Infliximab (Remicade®) 49 3.4.4 Adalimumab (Humira®) 50 3.4.5 Golimumab (Simponi®) 51 3.4.6 Certolizumab Pegol (Cimzia®) 51 3.4.7 Anakinra (Kineret®) 52 3.5 Muscle Relaxants 52 3.6 Tricyclic Antidepressants 53 3.7 Topical Medications 55 3.8 Dietary Supplements 56 3.9 Trigger Point Injections 57 3.9.1 Author’s Technique 58 3.10 Intra-articular Joint Injections 59 3.10.1 Steroids 59 3.10.1.1 Author’s Technique 60 3.10.2 Hyaluronic Acid 61 3.10.3 Opioids 63 3.10.4 Amniotic Fluid 64 3.11 Botulinum Toxin (BTX-A) 65 3.11.1 Clinical History 65 3.11.2 Structure of Botulinum Toxin 66 3.11.3 Peripheral Mechanisms 67 3.11.4 Author’s Technique 68 References 70 Part III: Dental Treatment of Temporomandibular Disorder 80 4: Occlusal Diagnosis and Treatment of TMD 81 4.1 Defining Treatment Goals 81 4.1.1 Functional Occlusion 81 4.1.2 TMJ 82 4.1.3 Three-Dimensional Position of the Mandible 82 4.1.4 Periodontal Tissues 82 4.1.5 Dental and Facial Esthetics 82 4.2 TMJ as a Treatment Goal 82 4.2.1 So-Called CR 82 4.2.2 Is Disc Displacement (DD) a Normal Variation? 84 4.3 Normal TMJ 85 4.3.1 Normal Disc Position 85 4.3.2 Normal Condylar Position Depicted by Imaging 85 4.3.3 Abnormal Disc Position 86 4.3.4 Effects of DD on Condylar Position in the Fossa 88 4.3.5 Research on Changes in Mandibular Position Caused by DD 89 4.4 Establishing the Stages of Disc Displacement 89 4.4.1 DD Is Three-Dimensional 89 4.4.2 Where Is the 12 o’Clock Position on MRI? 89 4.4.3 DD Findings from the Four Images Are Put Together for Staging with the Following Criteria 92 4.5 Progression of DD 94 4.5.1 Continuum of Change in DD 94 4.5.2 Relationship of DD with Signs and Symptoms 94 4.5.3 Trial of DD Mapping on CT Images 96 4.6 CR as a Goal 98 4.7 Recognizing Changes in the TMJ in the Presence of DD 98 4.8 Occlusion Observed in the Mouth 99 4.8.1 So-Called CO 99 4.8.2 How to Find Occlusal Discrepancy During the Initial Examination 102 4.8.3 Mounting the Initial Models in CR on an Articulator Uncovers the Patient’s Premature Contacts That Cannot Be Detected in the Mouth 104 4.9 Stabilization of Mandibular Position 108 4.10 Process of Stabilizing Mandibular Position 108 4.11 Summary of Stabilization Process of the Mandibular Position 110 4.12 Case Example 111 4.12.1 Gathering Information by History and Record Taking 111 4.12.2 Records Taken After Splint Therapy Using a Stabilization-Type Splint 116 4.12.3 Comparison Before and After Stabilization of Mandibular Position 119 4.12.4 Formulation of a Problem List 123 4.12.5 Treatment Plan 123 4.12.6 Posttreatment Records 124 References 128 5: TMD and Occlusion 131 5.1 Overview 132 5.2 Diagnosis 132 5.3 Temporomandibular Joint and Occlusion Determinants 133 5.4 Occlusion’s Role in TMD 135 5.5 Occlusal Evaluation and Treatment Planning 137 5.6 Initial TMD Patient Preparation for Comprehensive Treatment 139 5.7 Clinical Example of Treatment Goals 141 References 152 6: Oral Motor Treatment of TMD 153 6.1 Introduction 153 6.2 Orofacial Functions 154 6.2.1 TMD and Orofacial Myofunctional Status 156 6.3 Interview and Exams 157 6.3.1 Complementary Exams 159 6.3.1.1 Surface Electromyography (sEMG) 159 6.3.1.2 Mandibular Kinematics 159 6.3.1.3 Tongue and Lip Strength 159 6.4 Treatment 160 6.4.1 Explaining TMD and Treatment to the Patients and Providing Guidance 161 6.4.2 How to Minimize or Eliminate the Symptoms 161 6.4.3 Orofacial Motor Exercises 162 6.4.3.1 Preparation for Precise Movements and Orofacial Functions 162 6.4.3.2 Mobility Exercises 163 6.4.3.3 Force and Resistance Exercises 164 6.4.3.4 Coordination Exercises 165 6.4.4 Function Training 165 6.4.4.1 Respiration 165 6.4.4.2 Mastication 165 6.4.4.3 Swallowing 166 6.4.4.4 Speech 166 References 166 Part IV: Psychiatric Considerations and Adjunctive Therapies 170 7: Adjunctive Therapies for Temporomandibular Disorders 171 7.1 Introduction 172 7.2 Physical Therapy and Temporomandibular Disorders 172 7.3 Scientific Evidence for Physical Therapy Modalities 173 7.4 Manual Therapies 175 7.5 Exercise Programs 177 7.6 Trigger Point Dry Needling 179 7.7 Low-Level Laser Therapy 180 7.8 Therapeutic Ultrasound 181 7.9 Transcutaneous Electrical Neural Stimulation (TENS) 181 7.10 Neuroscience Education 182 7.11 Chiropractic Introduction 182 7.12 Chiropractic and TMD 183 7.13 Conclusion 193 References 193 8: Treating the TMD/Chronic Pain Patient: Psychiatry and Psychology 200 8.1 Chronic Pain from a Psychiatric/Psychological Perspective 200 8.2 Characterization of the Problem 201 8.3 Pain Psychology Workflow from Initial Encounter to Diagnosis and Treatment 201 8.3.1 Chief Complaint 201 8.3.2 History of Present Illness 202 8.3.3 Additional Assessment Information 203 8.3.4 Assessment Tools and Data Collection 203 8.3.5 Typical Diagnostic Assessment 204 8.4 Treatment Tool Box 205 8.4.1 Behavioral Approaches 205 8.4.2 Operant Behavior Training 205 8.4.3 Biofeedback 206 8.4.4 Cognitive Behavioral Therapy (CBT) 206 8.4.5 Acceptance-Based Approaches 207 8.4.6 Self-Help 207 8.5 Outcomes and Evidence 207 8.6 Ramifications of Comorbid Psychiatric Illness and Chronic Pain 208 8.6.1 Evidence Supports a Strong Clinical Relationship Between Psychiatric Illness and Chronic Pain 208 8.6.2 Evidence Supports Strong Neuroanatomical Overlap Between Pain and Mood 209 8.6.3 Antidepressants Target Separate Pathways in a Temporally Differential Manner to Affect Both Pain and Psychiatric Symptoms 210 References 212 Front Matter ....Pages i-ix Front Matter ....Pages 1-1 Sleep Bruxism and Temporomandibular Disorders (Marc Schmitter)....Pages 3-11 The Role of Trauma and Whiplash Injury in TMD (Sonia Sharma, Richard Ohrbach, Birgitta Häggman-Henrikson)....Pages 13-32 Front Matter ....Pages 33-33 Medical Management of TMD (Rebeka G. Silva, Valeria Gerloni, S. Thaddeus Connelly)....Pages 35-74 Front Matter ....Pages 75-75 Occlusal Diagnosis and Treatment of TMD (Kazumi Ikeda)....Pages 77-126 TMD and Occlusion (Michael Jacobs)....Pages 127-148 Oral Motor Treatment of TMD (Cláudia Maria de Felício)....Pages 149-165 Front Matter ....Pages 167-167 Adjunctive Therapies for Temporomandibular Disorders (César Fernández-de-las-Peñas, Kimberly Bensen)....Pages 169-197 Treating the TMD/Chronic Pain Patient: Psychiatry and Psychology (Sue Gritzner, Valerie Jackson, Irina Strigo, David Spiegel)....Pages 199-214