Manual of Temporomandibular Disorders

Manual of Temporomandibular Disorders, Third Edition, provides comprehensive, evidence-based information on temporomandibular disorders (TMD). Focusing on clinically relevant information throughout, the book allows dentists to diagnose TMD accurately, rule out disorders that mimic TMD, and provide effective therapy for most patients.

Useful features, such as frequently asked questions, quick consults, technical tips, and focal points are integrated to help the clinician find precise answers with ease. Case scenarios provide the reader with a way to enhance their clinical reasoning skills, with a focus on solving TMD problems at chairside.

Offering comprehensive coverage in a highly-illustrated, compact package, Manual of Temporomandibular Disorders is the ideal source for dentists dealing patients suffering from TMD.

Edward F. Wright, DDS, MS, MAGD, is a professor at the University of Texas Health Science Center-San Antonio (UTHSCSA). He completed a one-year general dentistry residency and the University of Minnesota’s two-year TMJ and Craniofacial Pain Fellowship. He taught TMD diagnosis and treatment to more than 100 U.S. Air Force residents in general dentistry, orthodontics, periodontics, and prosthodontics. Upon retiring from the Armed Forces, he completed a two-year research fellowship in TMD diagnosis and treatment at the South Texas Veterans Health Care System and taught TMD diagnosis and treatment to their general dentistry residents. He is now UTHSCSA’s Course Director for their predoctoral dental students’ TMD Course and Dental Anatomy and Occlusion Course, and teaches TMD to the school’s general dentistry, orthodontics, periodontics, and prosthodontics residents. Dr. Wright is the primary author of more than 30 journal articles.

Preface

Introduction

Part I Initial Evaluation 

Chapter 1 Patient Interview

Summary

References

Chapter 2 Review of the “Initial Patient Questionnaire”

Chapter 3 Clinical Examination

Range of Motion

TMJ Noise

TMD Palpations

Intraoral Examination

Occlusal Changes

TMD Pain Caused by a Tooth

Tooth Pain without Local Pathology

Additional Evaluations

References

Chapter 4 Imaging

Plain Radiographs

Panoramic Radiograph

Axially Corrected Sagittal Tomography 

Computed Tomography

Cone Beam Computed Tomography

Magnetic Resonance Imaging

Arthrography

High-Resolution Ultrasound

Imaging Strategies

Imaging Recommendations

References

Chapter 5 TMD Diagnostic Categories

TMJ Disorders

Joint Pain

Joint Disorders

Joint Diseases

Fractures 

Congenital/Developmental Disorders 

Masticatory Muscle Disorders

Muscle Pain Limited to the Orofacial Region

Contracture

Hypertrophy

Neoplasm

Movement Disorders

Masticatory Muscle Pain Attributed to Systemic/Central Disorders

Headache Disorders

Headache Attributed to TMD

Associated Structures

Coronoid Hyperplasia

References

Chapter 6 Contributing Factors

References

Part II Common Acute TMD Conditions and Treatments

Chapter 7 TMD Secondary to Trauma

References

Chapter 8 TMD Secondary to Dental Treatment

Preventing Aggravation from Dental Treatment

Medial Pterygoid Muscle Pain

Inability to Close into Maximum Intercuspation

Occlusal Interference Sequelae

Obstructive Sleep Apnea Appliances

References

Chapter 9 Lateral Pterygoid Spasm

References

Chapter 10 Intermittent and Continuous Forms of TMJ Disc Displacement without Reduction with Limited Opening

Intermittent Disorder (Disc Displacement with Reduction with Intermittent Locking)

Continuous Disorder (Disc Displacement without Reduction with Limited Opening, Also Known as Closed Lock)

References

Chapter 11 TMJ Subluxation and Luxation

References

Part III Occlusal Appliance Therapy

Chapter 12 Stabilization Appliance

Mandibular Positions and Interocclusal Record

Physical Variables

Full or Partial Coverage

Maxillary or Mandibular

Hard, Intermediate, or Soft Material

Thick or Thin

Appliance or Clasp Retention

Summary of Physical Variables

Appliance Adjustments

Internal Adjustments

Internal Reline

External Adjustments

External Reline

Appliance Repair

Appliance Examples

Pressure-Cured Mandibular Acrylic Stabilization Appliance

Maxillary Acrylic Stabilization Appliance

Hard Thermoplastic Stabilization Appliance

Impak Stabilization Appliance

Dual Laminate Thermoplastic Stabilization Appliance

Soft Thermoplastic Stabilization Appliance

Appliance Management

References

Chapter 13 Anterior Positioning Appliance

Mandibular Position and Interocclusal Record

Design and Adjustments

Appliance Management

References

Part IV Multidisciplinary Treatment Approach

Chapter 14 Self-Management Therapy

Self-Management Instructions

Closure Muscle-Stretching Exercise

Lateral Pterygoid Muscle-Stretching Exercise

Posture Exercises

Breaking Daytime Habits

References

Chapter 15 Physical Medicine

Muscle Massage

Yoga

Trigger-Point Compression

Trigger-Point Injection

Physical Therapy

Acupuncture

Chiropractics

Magnetic Therapy

References

Chapter 16 Cognitive-Behavioral Intervention

Breaking Daytime Habits

Relaxation

Hypnotherapy

Biofeedback Assisted Relaxation

Stress Management

References

Chapter 17 Pharmacological Management

Analgesics

Anti-Inflammatory Medications

Nonsteroidal Anti-Inflammatory Drugs (Ingested Form)

Steroidal Anti-Inflammatory Drugs

Muscle Relaxants

Tricyclic Antidepressants

Topical Medications

Over-the-Counter Topical Medications

Prescription Topical Medications

Nutritional Supplements

References

Chapter 18 Other Dental Procedures

Occlusal Equilibration

Orthodontic–Orthognathic Therapy

Prosthodontic Therapy

TMJ Surgery and Implants

References

Chapter 19 Integrating Multidisciplinary Therapies

Treatment Summaries and Clinical Implications

Self-Management Therapy

Massage and Trigger-Point Compression

Lateral Pterygoid Muscle-Stretching Exercise

Closure Muscle-Stretching Exercise

Posture Exercises

Occlusal Appliances

Physical Therapy

Yoga

Trigger-Point Injections

Acupuncture

Chiropractics

Magnetic Therapy

Breaking Daytime Parafunctional, Muscle-Tightening, or Fatiguing Habits

Relaxation

Hypnotherapy (Hypnosis)

Biofeedback-Assisted Relaxation

Stress Management

Pharmacological Management

Occlusal Therapy

TMJ Surgery

Integrating Conservative Therapies

TMD Refractory to Initial Therapy

Long-Term Management

References

Part V Case Scenarios

Case 1: Pulpal Pathosis Mmicking TMD Symptoms

Case 2: Tooth Pain: No TMD Pain

Case 3: Chronic Sinusitis

Case 4: Chronic Forehead Pain Referred from the Neck

Case 5: Myalgia Secondary to Nocturnal Parafunctional Habits

Case 6: Tooth Attrition: No Pain

Case 7: Myalgia Secondary to Daytime Parafunctional Habits

Case 8: Medial Pterygoid Spasm

Case 9: Tension, Depression, and Poor Sleep as Contributing Factors

Case 10: Fibromyalgia as a Contributing Factor

Case 11: TMJ Disc Displacements and When to Treat Them: No Pain

Case 12: TMJ Arthralgia

Case 13: TMJ Disc Displacement with Reduction with Intermittent Locking

Case 14: TMJ Disc Displacement without Reduction with Limited Opening: Unlocked

Case 15: TMJ Disc Displacement without Reduction with Limited Opening: Not Unlocked

Case 16: Osteitis Causing Inability to Open Wide

Case 17: Lateral Pterygoid Spasm

Case 18: Acute Exacerbation of TMD

Case 19: Multiple Forms of Head and Neck Pain after Crown Insertion

Case 20: Appliance That Positioned Condyles into Their “Proper Position”

References

Part VI Fundamentals of Clinical Studies

Designs of and Advice for Performing Clinical Studies

Literature Review

Study Population

Institutional Review Board (IRB) Approval

Developing Study’s Parameters

Strengthening Your Study

Writing and Submitting Manuscript

Practice-Based Research

Prominent Clinical Study Designs

Case Report

Case Series Study

Cross-Sectional Study

Case-Control Study

Cohort Study

Nonrandomized Clinical Trial

Randomized Controlled Trial

Other Types of Publications You May Want to Consider

Literature Reviews

Systematic Reviews

Meta-Analyses

Considerations in Assessing Clinical Trials

Conclusions

References

Appendices

Files on Accompanying CD

Appendices

Appendices in Spanish

TMD Course Presentations

TMD Course Manual

Appendix 1 Referral Criteria for Hygienists

Appendix 2 Initial Patient Questionnaire

Appendix 3 TMJ Disc–Condyle Complex Disorders

Appendix 4 TMD Self-Management Therapies

Appendix 5 Occlusal Appliance Care Instructions

Appendix 6 Closure Muscle-Stretching Exercise

Appendix 7 Posture Improvement Exercises

Instructions

Exercises

Appendix 8 Laboratory Stabilization Appliance Instructions

Maxillary or Mandibular Impak Stabilization Appliance

Maxillary or Mandibular 0.15-in. Soft Thermoplastic Appliance or Dual Laminate Thermoplastic Stabilization Appliance

Maxillary or Mandibular 2-mm Hard Thermoplastic Appliance or Acrylic Stabilization Appliance

Appendix 9 Example of Dental Record Entries

Initial Exam

Insertion Appointment

Follow-Up

Follow-Up

Appendix 10 Examples of Physical Therapy Referral

Appendix 11 Examples of Psychology Referral

Appendix 12 Working with Insurance Companies

Appendix 13 Sources for Additional TMD Information

Patient Brochures and Book

Patient Advocacy Group

TMD Practice Management Businesses

Practitioners with TMD Expertise and Fellowship Programs

Professional TMD Organizations

TMD Textbooks

TMD Journals

Glossary

Index

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