Evidence-Based Treatment of TMJ Dysfunction

Category: Gnathology

Instructor(s): JEFFREY P. OKESON, Ambra Michelotti, Gary D. Klasser, Ulrich Lotzmann, Lawrence Gottesman

Course structure: Lessons: 8 lessons | Duration: 14 h 13 min

Course overview

The course introduces evidence-based methods of diagnosing and treatment of TMD, muscle and craniomandibular dysfunctions.
Lecturers will discuss in detail:
– Principles and methods for diagnosing TMD
– Differential diagnosis of muscle and joint pain
– An interdisciplinary approach to the management of TMJ disorders
– Relationship between the bruxism and TMD.
Course Objectives:
– Review risk factors for temporomandibular disorders
– Review TMD diagnosis and differential diagnosis protocols in an evidence-based approach
– Review TMD and orofacial pain treatment protocols
– Review relationship between general somatic pathology and TMJ diseases
– Review relationship between the bruxism and TMD.

Curriculum

Intro to TMD and Orofacial Pain Treatment

• Lesson program:
• – The problem of musculoskeletal dysfunction: definition
• – Diagnostic difficulties of musculoskeletal dysfunction
• – Differential diagnosis of muscle and joint pain
• – Classification of temporomandibular disorders
• – Classification of orofacial pain
• – Pain in the mandible as a sign of myocardial infarction
• – Principles of effective treatment
• – The concept of convergence and divergence
• – Pain zone or pain source: differentiation rules
• – Trigger zones
• – Causes of musculoskeletal dysfunction:
• Relationship between occlusion and musculoskeletal dysfunction
• Trauma
• Emotional stress
• Parafunctions
• Deeply localized pain.
• – Etiology of muscle pain
• – Bruxism and muscle pain: correlation
• – Delayed muscle soreness syndrome
• – Intra-articular pain: types and etiology
• – Principles of treatment of TMJ diseases.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.

Temporomandibular Disorders: Clinical Examination and Differential Diagnosis

• Lesson program:
• – What is pain?
• – Biopsychosocial model: components
• – Neuromatrix theory
• – Classification of orofacial pain
• – Musculoskeletal dysfunction: definition
• – Epidemiology of musculoskeletal pain
• – Etiology of musculoskeletal disorders
• – Rules for choosing treatment tactics
• – Factors of development of musculoskeletal dysfunction:
• Predisposing factors
• Initiators
• Aggravating factors.
• – The concept of primary and heterotopic pain
• – Anamnesis collection and examination: LOQFDIV-survey
• – Clinical examination:
• Otoscopy
• Range of motion in the cervical spine
• Palpation of muscles and joints
• Palpation of the lymph nodes
• Provocative tests
• Movement of the lower jaw
• Intraoral examination
• X-ray diagnostics
• Serological examination
• Local anaesthesia.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.

TMJ and Muscle Dysfunctions: Diagnostic and Treatment Protocols

• Lesson program:
• – Musculoskeletal dysfunction: definition
• – Classification systems for musculoskeletal dysfunctions:
• RDC-TMD
• DC-TMD
• Extended DC-TMD.
• – Masticatory muscles: a model of pain formation
• – Causes of muscle dysfunction
• – Local muscle soreness: causes
• – Myospasm of the masticatory muscles
• – Myofascial pain: causes
• – Source of pain and localization
• – Constant continuous muscle pain
• – Fibromyalgia: diagnostics
• – TMJ diseases:
• Disorders of the condyle-disc complex
• Inflammatory disorders.
• – The role of ligaments in the development of diseases
• – Displacement of the articular disc with and without reduction
• – Inflammatory disorders: etiology
• – Osteoarthritis: manifestations and key points of treatment
• – Invasive treatment: indications
• – Principles of treatment of TMJ dysfunctions
• – Manual therapy
• – Multiple "P" approach.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.

TMD Diagnosis in an Evidence-Based Approach

• Lesson program:
• – Classification of orofacial pain
• – Determination of temporomandibular disorders
• – Diagnostic groups of temporomandibular disorders
• – Risk factors for temporomandibular disorders:
• Macrotrauma: types and correlation with musculoskeletal disorders
• Pathophysiological factors
• Psychoemotional factors
• Anatomical factors.
• – Occlusion and temporomandibular disorders: relationship
• – Classification of temporomandibular disorders
• – Bio-psycho-social model
• – Diagnostic criteria:
• Anamnesis
• Localization
• Modified function
• Familiar pain
• Radiating pain.
• – Musculoskeletal pain:
• Myalgia
• Myofascial pain
• Arthralgia.
• – Palpation of muscles and TMJ
• – TMJ dysfunction: types and characteristics
• – Clinical examination: standardized method
• – Diagnostic procedures:
• Patient intake
• Clinical examination
• Diagnostic tests
• Making a diagnosis.
• – Characteristics of pain
• – SMILES approach
• – MRI for TMJ dysfunctions.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.

Potential Treatments for TMD

• Lesson program:
• – The concept of patient-oriented treatment
• – Criteria for the diagnosis of musculoskeletal pain
• – Disease-oriented principle
• – Tactics of treatment of musculoskeletal disorders
• – Step-by-step treatment model
• – Behavioral therapy: indications and stages
• – Self-massage: technique
• – Control of parafunctional behavior
• – Physical therapy protocol: types of exercises and methods of performance
• – Arthralgia: causes, diagnosis, treatment
• – Displacement of the articular disc with reduction: tactics
• – Reduction of the articular disc: methodology
• – Dislocation and subluxation: diagnosis and treatment
• – Occlusal splints: indications
• – Consequences of self-treatment with occlusive splints
• – Comprehensive treatment: benefits
• – Mechanism of action of the occlusal splint
• – Placebo effect in the treatment of musculoskeletal disorders.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.

General Somatic Pathology and Diseases of the TMJ: An Integrated Approach to Diagnosis and Treatment

• Lesson program:
• – Components of orofacial pain
• – Small fiber neuropathy (SFPN)
• – Concomitant pathology:
• Genetic factors
• Purchased factors.
• – Diagnosis of neuropathy: trepan-biopsy
• – Genetic testing in dentistry
• – Retromyalgia: principles of diagnosis:
• Match test
• Joint Hypermobility test.
• – Chiari malformation: clinic
• – Myofascial pain syndrome: diagnosis
• – Principles of treatment of polyneuropathy
• – Paraneoplastic syndrome.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.

Functional Diagnostics. Norm and Pathology

• Lesson program:
• – Craniomandibular dysfunction:
• Definition
• Symptoms
• Etiology.
• – Forms of craniomandibular dysfunction:
• Compensated
• Uncompensated.
• – Pathology of occlusion: role in the development of craniomandibular dysfunction
• – Parafunctions: occlusal and nonocclusal
• – Demastication, Attriction, Abfraction and Erosion: Significance
• – Methods of functional analysis
• – Three-dimensional registration of movements of the lower jaw
• – Options for functional analysis:
• Quick Check
• Functional analysis I
• Functional analysis II.
• – Objectives of functional analysis
• – Posture: influence on the development of pathology
• – Anatomy and function of the TMJ
• – Examination of the TMJ: palpation technique
• – The main pain areas of the TMJ
• – Temporomandibular joint noises: crunch, click and crepitus
• – Disc displacement: reposition technique
• – Jaw muscle pain: localization and diagnostics
• – Examination of masticatory muscles.
• Recommended for: General dentists, Orthodontists, Prosthetists, Gnathologists.

Pre-Treatment with Occlusal Splints

• Lesson program:
• – The role of occlusion for establishing craniomandibular dysfunction:
• Premature contacts
• Parafunctions.
• – Strategies for the treatment of CMD:
• Etiological
• Symptomatic.
• – Indications for occlusive therapy
• – Selective grinding of teeth: a technique
• – Positioning of the occlusal splint: on the upper or lower jaw?
• – Types of occlusal splints:
• Reflex
• Stabilization
• Reposition
• Distraction
• Decompression
• Verticalization.
• – The main therapeutic tasks of occlusal splints
• – Method of registration of occlusal contacts
• – Manual therapy in the treatment of CMD.
• Recommended for: Orthodontists, Prosthetists, Gnathologists, General dentists.