Manual of Temporomandibular Disorders

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