Fully updated with the latest information in the field, this comprehensive book provides a practical guide to diagnosing and managing temporomandibular disorders in the dental practice. Written in an accessible, user-friendly style, it offers a simplified approach to the basic concepts and management decision points for the most commonly observed temporomandibular conditions, integrating the latest advances and advice throughout. Quick Consult, Focal Point, and Technical Tip boxes provide quick access to relevant information, and study results are summarized in graphs for ease of comprehension.
Manual of Temporomandibular Disorders, Fourth Edition examines an array of medical and dental conditions that affect the temporomandibular joint (TMJ), masticatory muscles, and contiguous structures. It presents evidence-based, clinically practical information to help dentists diagnose TMD accurately, rule out disorders that mimic TMD, and provide effective therapy for most patients.
Special features include:
- Frequently Asked Questions
- Quick Consults, Technical Tips, and Focal Points
- Information on disorders that mimic TMD and factors that warrant referral
- Extensive color photographs and line drawings
- A companion website providing helpful examples and patient handouts
Manual of Temporomandibular Disorders, Fourth Edition is a must-have how-to manual for general dentists, dental students, and residents involved in this area of practice.
Table of Contents
Preface xiii
About the Companion Website xv
Introduction 1
References 3
Part I Initial Evaluation 5
References 7
1 Patient Interview 9
Summary 25
References 25
2 Review of the “Initial Patient Questionnaire” 29
3 Clinical Examination 35
3.1 Range of Motion 36
3.2 TMJ Noise 39
3.3 TMD Palpations 40
3.4 Intraoral Examination 57
3.4.1 Occlusal Changes 57
3.4.2 Temporomandibular Disorder Pain Caused by a Tooth 58
3.4.3 Tooth Pain Without Local Pathology 61
3.5 Additional Evaluations 63
References 65
4 Imaging 69
4.1 Plain Radiographs 70
4.2 Panoramic Radiograph 70
4.3 Axially Corrected Sagittal Tomography 71
4.4 CT 71
4.5 CBCT 72
4.6 MRI 72
4.7 Arthrography 72
4.8 Ultrasound 72
4.9 Imaging Strategies 73
4.10 Imaging Recommendations 73
References 76
5 TMD Diagnostic Categories 79
5.1 TMJ Disorders 80
5.1.1 Joint Pain 80
5.1.1.1 Arthralgia 80
5.1.1.2 Arthritis 80
5.1.2 Joint Disorders 80
5.1.2.1 Disc-Condyle Complex Disorders 80
5.1.2.2 Other Hypomobility Disorders 85
5.1.2.3 Hypermobility Disorders 86
5.1.3 Joint Diseases 87
5.1.3.1 Degenerative Joint Disease 87
5.1.3.2 Condylysis/Idiopathic Condylar Resorption 87
5.1.3.3 Osteochondritis Dissecans 87
5.1.3.4 Osteonecrosis 87
5.1.3.5 Systemic Arthritides 87
5.1.3.6 Neoplasm 88
5.1.3.7 Synovial Chondromatosis 88
5.1.4 Fractures 88
5.1.5 Congenital/Developmental Disorders 88
5.1.5.1 Aplasia 88
5.1.5.2 Hypoplasia 88
5.1.5.3 Hyperplasia 88
5.2 Masticatory Muscle Disorders 88
5.2.1 Muscle Pain Limited to the Orofacial Region 88
5.2.1.1 Myalgia 88
5.2.1.2 Tendonitis 89
5.2.1.3 Myositis 89
5.2.1.4 Spasm 90
5.2.2 Contracture 90
5.2.3 Hypertrophy 91
5.2.4 Neoplasm 91
5.2.5 Movement Disorders 91
5.2.5.1 Orofacial Dyskinesia 91
5.2.5.2 Oromandibular Dystonia 91
5.2.6 Masticatory Muscle Pain Attributed to Systemic/Central Disorders 91
5.2.6.1 Fibromyalgia 91
5.3 Headache Disorders 91
5.3.1 Headache Attributed to TMD 91
5.4 Associated Structures 91
5.4.1 Coronoid Hyperplasia 91
References 92
6 Contributing Factors 95
References 99
Part II Common Acute TMD Conditions and Therapies 101
7 TMD Secondary to Trauma 103
References 106
8 TMD Secondary to Dental Treatment 107
8.1 Preventing Aggravation from Dental Treatment 110
8.2 Medial Pterygoid Muscle Pain 112
8.3 Inability to Close into MI 114
8.4 Occlusal Interference Sequelae 116
8.5 OSA Appliances 118
References 119
9 Lateral Pterygoid Spasm 123
References 127
10 Intermittent and Continuous Forms of TMJ Disc Displacement Without Reduction with Limited Opening 129
10.1 Intermittent Disorder (Disc Displacement with Reduction with Intermittent Locking) 131
10.2 Continuous Disorder (Disc Displacement Without Reduction with Limited Opening, Also Known as Closed Lock) 134
References 140
11 TMJ Subluxation and Luxation 145
References 148
Part III Occlusal Appliance Therapy 149
References 151
12 Stabilization Appliance 153
12.1 Mandibular Positions and Interocclusal Record 155
12.2 Physical Variables 159
12.2.1 Full or Partial Coverage 159
12.2.2 Maxillary or Mandibular 160
12.2.3 Hard, Intermediate, or Soft Material 162
12.2.4 Thick or Thin 168
12.2.5 Appliance or Clasp Retention 169
12.2.6 Summary of Physical Variables 170
12.3 Appliance Adjustments 171
12.3.1 Internal Adjustments 171
12.3.2 Internal Reline 174
12.3.3 External Adjustments 176
12.3.4 External Reline 182
12.3.5 Appliance Repair 185
12.4 Appliance Examples 188
12.4.1 Pressure‐Cured Mandibular Acrylic Stabilization Appliance 188
12.4.2 Maxillary Acrylic Stabilization Appliance 191
12.4.3 Hard Thermomolded Stabilization Appliance 192
12.4.4 Impak Stabilization Appliance 195
12.4.5 Dual Laminate Thermomolded Stabilization Appliance 196
12.4.6 Soft Thermomolded Stabilization Appliance 197
12.5 Appliance Management 200
References 205
13 Anterior Positioning Appliance 209
13.1 Mandibular Position and Interocclusal Record 211
13.2 Design and Adjustments 212
13.3 Appliance Management 213
References 216
Part IV Multidisciplinary Management Approach 219
References 221
14 Self‐Management Therapy 223
14.1 Self‐Management Instructions 224
14.2 Closure Muscle‐Stretching Exercise 230
14.3 Lateral Pterygoid Muscle‐Stretching Exercise 231
14.4 Posture Exercises 233
14.5 Controlling Awake Behaviors 234
References 238
15 Physical Medicine 241
15.1 Muscle Massage 242
15.2 Yoga 242
15.3 Trigger‐Point Compression 243
15.4 Trigger‐Point Injection 243
15.5 Botulinum Toxin Injections 244
15.6 Physical Therapy 244
15.7 Acupuncture 248
15.8 Chiropractics 249
References 250
16 Cognitive‐Behavioral Intervention 255
16.1 Controlling Awake Behaviors 259
16.2 Relaxation 261
16.3 Hypnotherapy (Hypnosis) 262
16.4 Biofeedback‐Assisted Relaxation 263
16.5 Stress Management 264
References 265
17 Pharmacological Management 269
17.1 Analgesics 270
17.2 Anti‐inflammatory Medications 271
17.2.1 Nonsteroidal Anti‐inflammatory Drugs (Ingested Form) 271
17.2.2 Steroidal Anti‐inflammatory Drugs 273
17.3 Muscle Relaxants 274
17.4 Anticonvulsant 275
17.5 Tricyclic Antidepressants 276
17.6 Topical Medications 278
17.6.1 OTC Topical Medications 278
17.6.2 Prescription Topical Medications 280
17.7 Nutritional Supplements 283
References 285
18 Other Dental Procedures 291
18.1 Occlusal Equilibration 294
18.2 Orthodontic-Orthognathic Therapy 296
18.3 Prosthodontic Therapy 297
18.4 TMJ Surgery and Implants 299
References 303
19 Integrating Multidisciplinary Therapies 309
19.1 Management Summaries and Clinical Implications 310
19.1.1 Self‐Management Therapy 310
19.1.2 Massage and Trigger‐Point Compression 310
19.1.3 Lateral Pterygoid Muscle‐Stretching Exercise 310
19.1.4 Closure Muscle‐Stretching Exercise 310
19.1.5 Posture Exercises 311
19.1.6 Occlusal Appliances 311
19.1.7 Physical Therapy 311
19.1.8 Yoga 312
19.1.9 Trigger‐Point Injections 312
19.1.10 Acupuncture 312
19.1.11 Chiropractics 312
19.1.12 Controlling Awake Parafunctional, Muscle‐Tightening, or Fatiguing Behaviors 313
19.1.13 Relaxation 313
19.1.14 Hypnotherapy (Hypnosis) 313
19.1.15 Biofeedback‐Assisted Relaxation 314
19.1.16 Stress Management 314
19.1.17 Pharmacological Management 314
19.1.18 Occlusal Therapy 315
19.1.19 TMJ Surgery 315
19.2 Integrating Conservative Therapies 316
19.3 TMD Refractory to Initial Therapy 320
19.4 Long‐Term Management 321
References 322
Part V Case Scenarios 327
V.1 Case 1: Symptomatic Irreversible Pulpitis Mimicking TMD Symptoms 329
V.2 Case 2: Tooth Pain: No TMD Pain 331
V.3 Case 3: Chronic Sinusitis 332
V.4 Case 4: Chronic Forehead Pain Referred from the Neck 333
V.5 Case 5: Myalgia Secondary to Sleep Parafunctional Behaviors 335
V.6 Case 6: Tooth Attrition: No Pain 336
V.7 Case 7: Myalgia Secondary to Awake Parafunctional Behaviors 337
V.8 Case 8: Medial Pterygoid Spasm 338
V.9 Case 9: Personal Stressors and Sleep Disturbances as Contributing Factors 339
V.10 Case 10: Fibromyalgia as a Contributing Factor 340
V.11 Case 11: TMJ Disc-Condyle Complex Disorders and When to Provide Therapy: no Pain 341
V.12 Case 12: TMJ Arthralgia 342
V.13 Case 13: TMJ Disc Displacement with Reduction with Intermittent Locking 343
V.14 Case 14: TMJ Disc Displacement Without Reduction with Limited Opening: Unlocked 345
V.15 Case 15: TMJ Disc Displacement Without Reduction with Limited Opening: Not Unlocked 346
V.16 Case 16: Osteitis Causing Inability to Open Wide 348
V.17 Case 17: Lateral Pterygoid Spasm 350
V.18 Case 18: Acute Exacerbation of TMD 352
V.19 Case 19: Multiple Forms of Head and Neck Pain After Crown Insertion 354
V.20 Case 20: Appliance That Positioned Condyles into Their “Proper Position” 355
References 357
Part VI Fundamentals of Clinical Studies 359
VI.1 Prominent Clinical Study Designs 359
VI.1.1 Case Report 359
VI.1.2 Case Series Study 360
VI.1.3 Cross‐Sectional Study 361
VI.1.4 Case‐Control Study 362
VI.1.5 Cohort Study 362
VI.1.6 Nonrandomized Clinical Trial 363
VI.1.7 Randomized Controlled Trial (RCT) 365
VI.2 Other Types of Publications 367
VI.2.1 Literature Reviews 367
VI.2.2 Systematic Reviews 367
VI.2.3 Meta‐Analyses 367
VI.2.4 Clinical Practice Guidelines 368
VI.3 Considerations in Assessing Clinical Trials 368
VI.4 Conclusions 368
References 369
Glossary 373
Index 377
