Tmd/ dental courses

Treating Temporomandibular Disorders
-An enigma yet unresolved.
INDIAN DENTAL
ACADEMY
Leader in continuing Dental
Education
.
www.indiandentalacademy.com

cannot treat dysfunction without the knowledge of functio
_JPOwww.indiandentalacademy.com

Targeting the Etiology-
Can a troubled patient receive a rational therapy??

Etiology
•Occlusal disharmony
•Condylar malposition
•Over closed vertical
dimension
•Neuromuscular
imbalance.
•Psychological factors.

One disease, so many
healers
Oral diagnostician Oral Surgeons
Prosthodontist Orthodontist
Many treatments offered ,but no cur

Are the above etiological factors alone or
in combination truly the cause of TMD ??
Why is one person with the same clinical
finding symptomatic & another is not ??
If occlusion was the prime cause of TMD
,then why are all edentulous patients not
symptomatic?? www.indiandentalacademy.com

Hybrid concept of etiology – The ‘biopsychosocial’ Model
Psychological status
-stress, anxiety,
depression,
mood swings
TMD
Okeson JP .Bell’s Orofacial Pain, ed.5 .1995 : 475-47
Hybrid concept of etiology – The ‘biopsychosocial’ Model
Biological problem
-Activation of pain
pathway, pain
threshold
Social framework
-relations with family,
friends.
- Work environment.

How do I assess the
variables in my
symptomatic
patient??

Functional
anatomy
Precipitating
factors
M
anagem
ent
Jointmechanics
Pathophysiology
TMD- Ney! Not my cup of tea.

Most published studies investigating TMD’s are not based
on sound evidence-based research methodology.
Emotional stress an important contributing factor is difficult
to control or eliminate.
Cause & effect relationship between Occlusion & TMD’s is
complex one.
Molecular & cellular research of joint & muscle pain will give
birth to tissue targeted therapies & perhaps the ultimate
cure to TMD.
tohler CS, Sessle BJ .J Orofac pain 2006 ; 4 : 238-245.

TMD –Key to management *.
 A ‘benign’ musculoskeletal disorder likely
to be reversible by simple measures.
 Most are extracapsular (myofascial) rather than
intracapsular (derangement & / or degeneration).
 Even when degeneration has occurred ,a good
response to conservative therapy is likely.
 Simple measures (arthrocentesis, arthroscopy)
is the choice over traditional open- joint operations.
*Charles S. Green, J Orofac pain :2001; 15: 93-107.

PRIME OBJECTIVE IN MANAGING
TMD’S :
Keeping the patient’s welfare
as the top-most priority ,control
the signs & symptoms through
good conservative care avoiding
aggressive or irreversible
treatment irrespective of the
myogenous & / or arthrogenous
diagnosis.

No. of patients : 117
Patient pool: Acute localized pain to a vague
persistent chronic pain
Age Group: 20-40 years
Sex: Females (3:1)
Diagnosis: Simple myalgia- 60%
MPDS- 25 %
Internal derangement – 15%
Evaluation of Pts. with TMD’s at MDCRC :Jan.’07 - Dec.’08

Professional approach to managing TMJ at
MDCRC :
Professional therapy: # Flat plane Occlusal splints
# Medications: NSAID’s, muscle-
relaxants, anti-anxiety drugs.
# Stress Management.
# Psychological Counseling.
Home Care Instructions: # Adequate Rest
# Avoiding unnecessary joint
maneuvers.
# Moist heat application.

Step 1
Physical therapy Modality:
Aim :
To reduce the pain & regain the original length.
Indication:
Myospasms, internal-
derangement
Gentle manual massage.
 Vapo-coolant spray
 Thermograph
 TENS therapy.

A detailed case history & clinical examination are essential
components of managing TMJ.
Step 2
Reversible Occlusal therapy
Aim-
 Joint stabilization
 Redistribute forces
 Protect dentition
Indication –
 MPDS
 In parafunctional activity
 Centrally mediated myalgia.
 Internal derangements.

Step 3
Pharmacological therapy
Aim-
To disrupt the cyclic effects of deep pain
inputs by promoting analgesia, relaxation
& inducing sleep.
Indications-
All type of painful joint conditions.
Medications:# Anti-inflammatory analgesics.
# Muscle-relaxants
# Local anesthetics.
# Anti-anxiety drugs &
# Tricyclic Antidepressants.

Step 4
Psychological Councelling.
Employ a step wise patient centered approach of management
Dr. Charles S. Green
Aim-
 Patient awareness
 Restricting use of jaw
 Encourage relaxation therapy
 Psychiatric consultation in
deep pain inputs.

Patients with milder & localized symptomsPatients with milder & localized symptoms
responded to our uttermostresponded to our uttermost satisfaction.satisfaction.
Patients with more chronic persistent painPatients with more chronic persistent pain
neededneeded repeated recalls & reassurancesrepeated recalls & reassurances..
Patients with strong psychological implicationsPatients with strong psychological implications
--psychiatric consultationspsychiatric consultations were sought out.were sought out.
A race well run, is a race half won !!.www.indiandentalacademy.com

Conclusion,
One cannot use the word ‘cure’ in the
absence of the knowledge of mechanism
causing the disease, i.e. its etiology. But
in situations like TMD quest for
symptom relief is shaped by the skills,
experience & intuition of the doctor
until specific tissue-targeted therapies

THANK YOU
SEE YOU AT INDORE IN 2009

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