Temporomandibular Disorders: A Problem-Based Approach

Preface to the Second Edition ix

Acknowledgements xi

About the Companion Website xiii

1 About the Book 1

About temporomandibular disorders: what is a ‘TMD’? 1

About the book 2

Chapter 2: Clinical aspects of anatomy, function, pathology, and classification 3

Chapter 3: Articulatory system examination 3

Chapter 4: I’ve got ‘TMJ’ 3

Chapter 5: I’ve got a clicking joint 3

Chapter 6: I’ve got a locking joint 3

Chapter 7: I’ve got a grating joint 3

Chapter 8: You’ve changed my bite 4

Chapter 9: I’ve got pain in my face 4

Chapter 10: I’ve got a dislocated jaw 4

Chapter 11: My teeth are worn 4

Chapter 12: I’ve got a headache 4

Chapter 13: I’ve got whiplash 4

Chapter 14: What’s of use to me in practice? 5

Chapter 15: You and the lawyer 5

Chapter 16: The referral letter 5

Chapter 17: How to make a splint 5

Chapter 18: Bruxism: Current knowledge of aetiology and management 5

Chapter 19: Splint therapy for the management of TMD patients: An evidence-based approach 5

Chapter 20: Patient information 6

Appendix I: Flowcharts 6

Appendix II: Glossary of terms 6

Appendix III: Short answer questions 6

2 Clinical Aspects of Anatomy, Function, Pathology, and Classification 7

The joint anatomy, histology, structure, capsule, synovial membrane, and fluid, ligaments 7

The intra-articular disc (meniscus) 11

The bones of the temporomandibular joint 15

Mandibular (jaw/masticatory) muscles 16

Classification and Pathology 25

Diagnoses of TMDs 29

Further Reading 31

3 Articulatory System Examination 32

Examination of the temporomandibular joints 32

Mandibular (masticatory) muscle tenderness 39

Further Reading 50

4 I’ve Got ‘TMJ’! 52

History 52

Examination 53

Special tests 55

Differential diagnosis 55

Management 56

5 I’ve Got a Clicking Joint 64

History 64

Examination 65

Other special tests 67

Treatment 74

The patient journey 79

6 I’ve Got a Locking Joint 82

History 82

Examination 1 83

Diagnosis 85

Treatment 86

TMJ locking 88

Conclusion 90

7 I’ve Got a Grating Joint 91

Examination 91

Diagnosis 92

Treatment 92

Final treatment plan 95

8 You’ve Changed My Bite 101

History 101

Examination 104

Treatment 104

Discussion 106

Conclusion 111

Further Reading 112

9 I’ve Got Pain in My Face 114

History 114

Examination 115

Differential diagnosis 116

Treatment 121

Questions to ask patients regarding pain in general 122

Further Reading 123

10 I’ve Got a Dislocated Jaw 125

Examination 126

Likely diagnoses 126

Management 127

11 My Teeth Are Worn 132

History 132

Examination 133

Diagnosis 135

Treatment 135

Important considerations in tooth surface loss 136

Further reading 147

12 I’ve Got a Headache 148

Examination 149

Radiographs 149

Articulatory system exam 150

Likely diagnosis 151

Management 153

Patient journey 154

Further Reading 155

13 I’ve Got Whiplash 156

Examination 157

Record-keeping 158

Are TMD and whiplash related? 159

Likely diagnosis 161

Management 161

14 What’s of Use to Me in Practice? 164

Counselling and reassurance 165

Drug therapy 165

Physiotherapy 166

Splint therapy 168

Mouth prop 171

Occlusal adjustments 171

Does orthodontic treatment cause TMD? 175

Restorative treatment, the dentist, and TMD 176

The use of a facebow and semi-adjustable articulators 177

Radiographs 178

Further referral 178

15 You and the Lawyer 182

Case scenario 1: note and record-keeping 182

Case scenario 2: a medical report request 185

Case scenario 3: a disgruntled patient 188

Further Reading 191

16 The Referral Letter 192

Details 192

History 192

Request 194

Further Reading 194

17 How to Make a Splint 195

How do you make a stabilisation splint? 195

Fitting a stabilisation splint 205

How do you make an anterior repositioning splint? 211

Bite registration 213

Further reading 217

18 Bruxism: Current Knowledge of Aetiology and Management 218

Aetiology of bruxism 218

Definition of bruxism 219

Bruxism and TMD 220

Why bruxism (parafunction) is potentially damaging? 221

How much evidence about the efficacy of botulinum toxins on bruxism? 221

How can bruxism be managed? 222

Further reading 223

19 Splint Therapy for the Management of TMD Patients: An Evidence-Based Discussion 224

Stabilisation splint (SS) 225

Anterior repositioning splint (ARPS) 228

Mandibular advancement/snoring appliances 231

20 Patient Information 235

Stabilisation splint 235

Anterior repositioning splint 236

Use and care of occlusal bite splint 236

General advice for patients with a TMD 238

Exercise programme for patients with TMD 239

Appendix I Flowcharts 241

Appendix II Glossary of Terms 253

Further Reading 274

Appendix III Short Answer Questions 275

Index 277