Whiplash-associated temporomandibular disorders: a review article.

Data from the literature on temporomandibular disorder (TMD) amplification or exacerbation in whiplash injuries is quite discordant. Substantial controversy exists regarding the incidence, prevalence, proposed mechanism of injury, clinical characteristics, and prognosis of TMDs due to whiplash.This article describes this controversy and presents findings from contemporary literature.

Temporomandibular joint anatomy, function and clinical relevance.

The articulatory system comprises the temporomandibular joints (TMJs), intra-articular discs, mandibular/jaw muscles and occlusion. In the simplest terms, the TMJ is the articulation between the upper and lower jaws. The teeth form the contacts between the upper and lower jaws and the muscles are the motors that move the mandible. This system is unique in that the TMJs are paired; any stimulus that affects one joint or any other single part of the articulatory system can have a 'knock-on effect' in the rest of the system.It is important to have a good understanding of anatomy, not only to be able to differentiate between what is physiological and what is pathological, but also to understand the objectives of some treatment options. Sound knowledge of anatomy is essential and an appreciation of the anatomical features associated with the TMJ can serve as a foundation for understanding the clinical management of temporomandibular disorders.This article reviews the functional anatomical features of the articulatory system with a look at the clinical significance of this anatomy.

Temporomandibular Joint Osteoarthrosis: A Review of Clinical Aspects and Management.

The symptoms of TMJ Osteoarthrosis/Osteoarthritis(TMJ OA) are characteristic and in most cases specific to the disorder. There is, however, an overlap of symptoms with other TMDs.Treatment of TMJ OA is generally directed towards management of the symptoms as the temporomandibular joint does retain the capacity throughout life to repair and remodel. Non-conservative and invasive treatment is only rarely necessary.It should be remembered that the mandibular condyle retains the capacity to repair and remodel throughout life and patients should be encouraged to bear this in mind. Conservative measures are usually sufficient to treat symptoms and a period of time should be allowed to elapse before undertaking a more aggressive treatment plan, which, in the overwhelming majority of patients, will not be necessary. This disorder should be approached on the terms of 'a quality of life issue' and treatment should be directed towards patient needs.

Occlusion and Temporomandibular Disorders: A Long-Standing Controversy in Dentistry.

The relationship between temporomandibular disorders (TMDs) and occlusion remains controversial. Some authors believe that occlusion is the primary factor in the onset of TMD symptoms, whereas others feel that occlusion has no role in this at all. The majority of reasoning behind causation is based upon anecdotal rather than scientific evidence. Existing evidence in the literature supports the absence of a disease-specific association. This article describes this controversy and provides the reader with findings from contemporary literature.

Conservative temporomandibular disorder management: what DO I do? -- frequently asked questions.

UNLABELLED: There are many myths and fallacies surrounding the conservative or non-surgical management of patients with temporomandibular disorders (TMD).This paper is not a treatise on splint design and does not champion any one particular treatment philosophy. It is, however, produced as the outcome of many years of lecturing and talking to fellow practitioners and represents the most frequently asked questions and common misconceptions encountered by the authors, who have addressed the topics raised with the intention of helping to avoid pitfalls. The common symptoms encountered in general dental practice are pain, either from muscles or the temporomandibular joint (TMJ) itself, limitation or deviation of mandibular movement, and joint sounds, and the authors have attempted to separate fallacy and fact. When appropriate examples are given. There are general treatment guidelines but, while some methods apply to an individual, there is no panacea - individual patient treatment needs vary. CLINICAL RELEVANCE: It is important that all treatments delivered to a TMD patient should be evidenced-based and should always be in the patient's best interests. Many treatment modalities are proposed that do not fulfil these parameters and can lead to confusion in management. A reference and reading list will be given which will direct the reader to an evidence-based approach to treatment. Some treatment suggestions are founded on the extensive clinical experience of the authors. There will not always be evidence from a randomized, controlled clinical trial to substantiate support for a specific treatment, but the reader should be directed by what the majority of clinicians would undertake as a responsible approach.

Silicone impression materials and latex gloves. Is interaction fact or fallacy?

UNLABELLED: This review will explore the mechanism of delayed setting and inhibition of polyvinyl siloxane impression material by latex and examine the evidence for and against this phenomenon. Clinical implications are discussed and recommendations for clinical practice made. CLINICAL RELEVANCE: The production of accurate polyvinyl siloxane impressions in the fabrication of indirect restorations/prostheses is vital for a good clinical outcome.

Effect of temporal bone resection on temporomandibular joint function: a quality of life study.

OBJECTIVES: Temporal bone resection for carcinoma may affect quality of life (QOL) and result in temporomandibular joint (TMJ) disorders. The aims of this study were to 1) assess TMJ function after temporal bone resection, and 2) assess the impact of TMJ dysfunction on QOL. STUDY DESIGN: Chart and patient review and QOL study. SETTING: Tertiary referral center (Manchester Royal Infirmary). SUBJECTS AND METHODS: Thirty patients who had undergone temporal bone resection were identified. Thirteen patients were alive and were included in the study. All patients were submitted to a clinical examination to identify TMJ disorders and determine facial nerve function, and they all answered the University of Washington QOL (UW-QOL) questionnaire (version 4). RESULTS: Eight patients had TMJ disorders with reduced mobility in either direction and/or significant pain. Main factors affecting QOL were pain (P = 0.001), appearance (P = 0.001), and anxiety (P = 0.000). Neither facial nerve palsy nor TMJ disorders affected QOL. The responses to the UW-QOL questionnaire showed that 69 percent of our patients had a good QOL. A total of 61.53 percent of our patients had TMJ dysfunction presenting as restriction of jaw mobility with or without pain. CONCLUSION: TMJ dysfunction is present in a significant number of patients after temporal bone resection, resulting in longstanding problems, which should be addressed accordingly. Poor QOL results from ongoing pain and psycho-social disturbance.

Change in the number of occlusal contacts following splint therapy in patients with a temporomandibular disorder (TMD).

The mean number of occlusal contacts before and after occlusal appliance therapy were compared in three temporomandibular disorder groups and one control group. Only patients with a successful treatment outcome were considered in the statistical analysis. Statistically significant changes were seen in the disc displacement with reduction group, which was managed with anterior repositioning splint: the mean number of contacts increased 3 months after weaning off the splint. If the disc is out of position then the number of occlusal contacts appears to be reduced. It would therefore appear to be sound advice not to make permanent and irreversible adjustment to the occlusion in the presence of disc displacement as when the disc is repositioned occlusal contacts will change.

TMD current concepts: 2. Imaging and treatment options. An update.

UNLABELLED: The second part of this series addresses the need for imaging and explores treatment concepts of temporomandibular disorders. TMD management in general dental practice is widely regarded as being a contentious subject with several differing and often diametrically opposed viewpoints being aired, not only in relation to aetiology and diagnosis, but also in relation to treatment. This uncertainty often prompts the dentist to refer for secondary care. Another recurring issue is the lack of adequate remuneration in the general dental services for management of the patients, for example by splint therapy. CLINICAL RELEVANCE: Sound up-to-date knowledge of all aspects of TMD, a commonly encountered condition, is essential.

TMD current concepts: 1. An update.

UNLABELLED: This, the first of two articles, addresses current concepts of aetiology, diagnosis and management of temporomandibular disorders (TMD). The aim is to direct the reader toward a more evidence-based approach; specific treatment regimes can be accessed elsewhere. The concept of these articles is to encourage the reader to think about the wider ramifications of TMD, with specific relevance to their management in general dental practice. This article addresses current controversial concepts, including occlusion, tinnitus, hearing, speech defects and bruxism. The second part addresses the need for imaging and explores treatment concepts. TMD management in general dental practice is widely regarded as being a contentious subject, with several differing and often diametrically opposed viewpoints being aired, not only in relation to aetiology and diagnosis but also in relation to treatment. This uncertainty often prompts the dentist to refer for secondary care. Another recurring issue is the lack of adequate remuneration in the general dental services for management of the patients, for example by splint therapy. CLINICAL RELEVANCE: Sound, up-to-date knowledge in the treatment of TMD is essential.

Treatment of temporomandibular disorder in a viola player--a case report.

UNLABELLED: Viola and violin players seem to be predisposed to TMD. This case report illustrates an example where this occupation caused problems and required treatment. The case was managed with a modified Anterior Repositioning Splint (ARPS) that the patient wore while playing. CLINICAL RELEVANCE: Temporomandibular disorders (TMD) are common within the population. Certain factors can predispose or make one more susceptible. This case report highlights viola players who are predisposed to TMD.

The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial.

OBJECTIVES: To compare the effect of real acupuncture and sham acupuncture in the treatment of temporomandibulat joint myofascial pain, in order to establish the true efficacy of acupuncture. METHODS: A double blind randomised controlled trial conducted in the TMD Clinic, at the School of Dentistry, The University of Manchester. Twenty-seven patients were assigned to one of two treatment groups. Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention. Both the assessor and the patient were blinded regarding the group allocation. Baseline assessment of the outcome variables was made prior to the first treatment session, and was repeated following the last treatment. RESULTS: The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP than those of sham acupuncture, and the majority of these reached a level of statistical significance. CONCLUSION: Acupuncture had a positive influence on the signs and symptoms of TMJ MP. In addition, this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints.

Inter-examiner and intra-examiner reliability of the measurement of marginal bone loss around oral implants.

The purpose of this study was to test whether a handheld magnifier could be used as an accurate instrument to examine the periapical radiographs and measure the marginal bone levels around dental implants system. A radiologic evaluation of marginal bone loss around 11 Astra Tech (Astra Tech AB, Mölndal, Sweden) oral implants was performed. A total of 22-recorded readings of mesial and distal bone loss were performed using a handheld magnifier with a graticule. There were 3 independent examiners who determined radiographic bone assessment. Thevalues of interclass correlation coefficient for the agreement between pairs of examiners showed a relatively high agreement (0.993 for A vs B, 0.995 for B vs C, and 0.995 for A vs C) and the same for intra-examiner reliability result (0.998 for B vs B). These results showed that a handheld magnifier could be used as a simple, reliable, and reproducible method for measuring bone loss around oral implants.

Reliability of recording static and dynamic occlusal contact marks using transparent acetate sheet.

STATEMENT OF PROBLEM: Inaccuracy in the transfer of information between clinician and technician regarding occlusal contacts can cause problems when fabricating indirect restorations, which can result in frustration for the dentist, technician, and patient. Few studies have considered the reproducibility of recording marked occlusal contacts. PURPOSE: This study aimed to test the reproducibility of a quick and simple means of recording marked occlusal contacts. MATERIAL AND METHODS: The static and dynamic occlusal contacts of 29 subjects, with no missing functional units, were marked using articulating paper. Three clinicians with varying clinical experience (3-10 years after graduation from dental school) were asked to independently record the marked occlusal contacts using a transparent acetate sheet. The results were analyzed for Kappa agreement. RESULTS: For the static occlusion, Kappa values of agreement between pairs of examiners were 0.88, 0.86, and 0.85, respectively, all indicating "almost perfect agreement." For the dynamic occlusion, the range of Kappa agreement between pairs of examiners produced a median of 0.91, 0.88, and 0.85, respectively, indicating almost perfect strength of agreement. CONCLUSIONS: The results suggest that marking occlusal contacts on a transparent acetate sheet provides a simple means of recording static and dynamic occlusal contacts with a high degree of reproducibility.

Stabilization splint therapy for the treatment of temporomandibular myofascial pain: a systematic review.

The aim of this review is to establish the effectiveness of stabilization splint (SS) therapy in reducing symptoms in patients with myofascial pain. Searching of electronic databases, handsearching of relevant key journals, and screening of reference lists of included studies were undertaken. There was no language restriction, and unpublished research was sought. The selection criteria were randomized controlled trials comparing splint therapy to either no treatment or another active treatment. Data extraction and validity assessment were carried out independently and in duplicate. Studies were grouped according to treatment type. Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only twelve met the inclusion criteria. There is insufficient evidence either for or against the use of stabilization splint therapy over other active interventions for the treatment of temporomandibular myofascial pain. However, it appears that stabilization splint therapy may be beneficial for reducing pain severity at rest and on palpation and depression when compared to no treatment. The authors suggested the need for well conducted RCTs that pay attention to method of allocation, blind outcome assessment, sample size, and duration of follow-up. Various measures were adopted to assess the outcomes of treatment. Standardization of the methods used to measure outcomes of the treatment of myofascial pain should be established in future RCTs.

'Occlusal sketch'; a reliable technique for technicians to check that the occlusion of models is correct?

The aim of this study was to determine whether the occlusal sketch technique can be used as a reliable means of verifying the occlusal contacts on articulated casts. Occlusal markings were made on 30 sets of upper and lower dentate casts and these were recorded using the 'occlusal sketch' technique. Fifteen out of the total 30 pairs of casts were deliberately corrupted by the clinician so that they no longer matched the record on the 'occlusal sketch'. Three dental technicians were asked to judge in which of the 30 casts the occlusal contacts differed from those represented by the occlusal sketch. The results showed almost perfect agreement between the technicians in correctly identifying which casts had marked occlusal contacts which differed from those recorded on the occlusal sketch. The occlusal sketch provides a reliable way of communicating occlusal contacts that occur in a case, between clinician and technician.