A critical review of Dr. Charles S. Greene's article titled "Managing the Care of Patients with Temporomandibular Disorders: a new Guideline for Care" and a revision of the American Association for Dental Research's 1996 policy statement on temporomandibular disorders, approved by the AADR Council in March 2010, published in the Journal of the American Dental Association September 2010.

Dr. Charles Greene's article, "Managing the Care of Patients with TMDs A New Guideline for Care," and the American Association for Dental Research's (AADR) 2010 Policy Statement on Temporomandibular Disorders, published in the Journal of the American Dental Association (JADA) September 2010, are reviewed in detail. The concept that all temporomandibular disorders (TMDs) should be lumped into one policy statement for care is inappropriate. TMDs are a collection of disorders that are treated differently, and the concept that TMDs must only be managed within a biopsychosocial model of care is inappropriate. TMDs are usually a musculoskeletal orthopedic disorder, as defined by the AADR. TMD orthopedic care that is peer-reviewed and evidence-based is available and appropriate for some TMDs. Organized dentistry, including the American Dental Association, and mainstream texts on TMDs, support the use of orthopedics in the treatment of some TMDs. TMDs are not psychological or social disorders. Informed consent requires that alternative care is discussed with patients. Standard of care is a legal concept that is usually decided by a court of law and not decided by a policy statement, position paper, guidelines or parameters of care handed down by professional organizations. The 2010 AADR Policy Statement on TMD is not the standard of care in the United States. Whether a patient needs care for a TMD is not decided by a diagnostic test, but by whether the patient has significant pain, dysfunction and/or a negative change in quality of life from a TMD and they want care. Some TMDs need timely invasive and irreversible care.

Myofascial pain associated to trigger points: A literature review. Part 2: Differential diagnosis and treatment

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus requiredin order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment (AU)

Disfunción craneomandibular: integración de la instrumentación bioelectrónica en su diagnóstico y terapéutica / Cranio-mandibular dysfunction: integration of bio-electronic instruments for diagnosis and therapy

El odontólogo recibe frecuentemente la consulta de pacientes con diagnóstico de disfunción craneomandibular, disfunción temporomandibular o simplemente pacientes de ATM (SIC), cuyos síntomas podrían ser el resultado de una o múltiples entidades concomitantes que requieren un diagnóstico específico y diferencial. El dolor en el área de la articulación temporomandibular (A.T.M.) puede deberse a uno o una combinación de diversos síndromes clínicos: capsulitis crónica, artritis reumatoidea, patologías musculoesqueléticas, afecciones miogénicas, Síndrome de Ernest, neuralgia occipital menor que irradia allí y otras enfermedades sistémicas. Por otra parte, el cuadro de disfunción craneomandibular (D.C.M.) -que es su nombre correcto- suele ser tratado como sinónimo de bruxismo -actividad parafuncional que se produce como consecuencia de un aumento del tono muscular fundamentalmente de músculos maseteros, temporales y pterigoideos internos-, lo cual es un error, si bien ambas entidades pueden coexistir. El presente artículo tiene como objetivos: a) utilizando instrumentación bioelectrónica, hacer una revisión y actualización sobre la fisiopatología, el cuadro clínico, los diagnósticos diferenciales, el concepto de sistema estomatognático" y el abordaje diagnóstico, pronóstico y terapéutico de la D.C.M. desde la concepción de la odontología neuromuscular y b) resaltar la importancia de un tratamiento interdisciplinario entre odontólogos, médicos expertos en medicina del dolor y otras especialidades médicas para un eficaz diagnóstico y tratamiento de nuestros pacientes; como la D.C.M. es una patología de origen multifactorial, su detección y terapéutica oportuna requiere de toda la artillería que tenemos a nuestra disposición. (AU)

Disfunción craneomandibular: integración de la instrumentación bioelectrónica en su diagnóstico y terapéutica / Cranio-mandibular dysfunction: integration of bio-electronic instruments for diagnosis and therapy

El odontólogo recibe frecuentemente la consulta de pacientes con diagnóstico de disfunción craneomandibular, disfunción temporomandibular o simplemente pacientes de ATM (SIC), cuyos síntomas podrían ser el resultado de una o múltiples entidades concomitantes que requieren un diagnóstico específico y diferencial. El dolor en el área de la articulación temporomandibular (A.T.M.) puede deberse a uno o una combinación de diversos síndromes clínicos: capsulitis crónica, artritis reumatoidea, patologías musculoesqueléticas, afecciones miogénicas, Síndrome de Ernest, neuralgia occipital menor que irradia allí y otras enfermedades sistémicas. Por otra parte, el cuadro de disfunción craneomandibular (D.C.M.) -que es su nombre correcto- suele ser tratado como sinónimo de bruxismo -actividad parafuncional que se produce como consecuencia de un aumento del tono muscular fundamentalmente de músculos maseteros, temporales y pterigoideos internos-, lo cual es un error, si bien ambas entidades pueden coexistir. El presente artículo tiene como objetivos: a) utilizando instrumentación bioelectrónica, hacer una revisión y actualización sobre la fisiopatología, el cuadro clínico, los diagnósticos diferenciales, el concepto de sistema estomatognático" y el abordaje diagnóstico, pronóstico y terapéutico de la D.C.M. desde la concepción de la odontología neuromuscular y b) resaltar la importancia de un tratamiento interdisciplinario entre odontólogos, médicos expertos en medicina del dolor y otras especialidades médicas para un eficaz diagnóstico y tratamiento de nuestros pacientes; como la D.C.M. es una patología de origen multifactorial, su detección y terapéutica oportuna requiere de toda la artillería que tenemos a nuestra disposición.

[Clinical aspects of cranio-mandibular disorders. III. Principles of elective therapy]. / La clinica dei disordini cranio-mandibolari. Parte III: principi di approccio terapeutico elettivo.

The therapeutic approaches on 406 patients of both sexes, agent between 9 and 78 (mean age 30.47) and suffering from cranio-mandibular disorders, have been analyzed, in order to evaluate the more frequent measures of treatment and to improve the management of pain and dysfunction of the stomatognathic system. Having confirmed the multifactorial aetiology, an individual treatment plan was worked out. Of the initial therapies, active gymnastics (63.58%), bland aspecific drugs (21.02%), assisted relaxation practices (7.17%) were of particular importance. As occlusion measures, stabilisation splint (44.61%) had precise instruction for use; in case of mandibular dislocation, a repositioning splint was constructed in articulator, in order to achieve a new therapeutic position (30.51%); sometimes, only a vertical dimension increase of previous prosthesis was made (14.35%). The specific symptom profiles of the diagnostic subgroups in which the sample was subdivided induced to adopt considerably different procedures, due to the basic pathology. The final therapy considered above all prosthetic (35.64%) and orthodontic (25.12%) rehabilitations, whether structural changes were necessary; moreover occlusal adjustment (5.64%); only few cases (2.05%) required a surgical consultation. A deliberate choice of conservative approach was evident in a remarkable number of patients (26.15%), treated in an absolutely reversible way.

The role of bioelectronic instruments in the management of TMD.

Temporomandibular disorders (TMD) comprise a group of conditions that can affect the form and function of the temporomandibular joint (TMJ), masticatory muscles and dental apparatus. Proper management of TMD by the dentist requires accurate appraisal of the status of the patient's dentition, TMJ and associated neuromuscular apparatus. Certain predefined standards or parameters of function/dysfunction are accepted by the profession. Electronic instrumentation provides objective measurement of many of these biological phenomena, and thus can be used throughout treatment for critical analyses that monitor and enhance treatment efficacy. A treatment protocol for TMD is presented that uses electronic instrumentation to establish a neuromuscular occlusion.

Passive mandibular border positions and their relationships with signs and symptoms of craniomandibular disorder / Movimentos mandibulares máximos e suas relações com sinais e sintomas da disfunção craniomandibular

Linear measurements of passive mandibular border positions and angular measurements of passive opening were recorded in a group of patients with craniomandibular disorders. The relationship between signs and symptoms of craniomandibular disorders and abnormal capacity of movement were studied. There was significant association of some signs and symptoms related to the temporomandibular joint and abnormal vertical and horizontal excursions. On the other hand, there was only one relationship between occlusal factors and abnormal passive mandibular border positions

Eletroestimulação nervosa transcutânea no tratamento das disfunções craniomandibulares / Transcutaneous nervous electronstimulation to treat craniomandibular disorders

A proposta do trabalho é apresentar ao Cirurgião-Dentista mais uma forma auxiliar de tratamento para as disfunções craniomandibulares, através do uso do eletroestimulador nervoso transcutâneo (MIOTENS 14)