Temporomandibular disorders and orofacial pain: up-to-date treatment protocols

Temporomandibular disorders and orofacial pain: up-to-date treatment protocols

Category: Functional Dentistry

Instructor(s): Jeffrey P. Okeson, Jean-Daniel Orthlieb, David Angelo, Ambra Michelotti

Course structure: Lessons: 13 lessons | Duration: 12 h 16 min

Course overview

Up-to-date solutions and advanced treatment methods for Temporomandibular Disorders (TMD) will be showcased by leading experts in functional dentistry from around the world, including Jeffrey Okeson, David Angelo, Jean-Daniel Orthlieb, and Ambra Michelotti — in one online course!

During the course, you will learn about:

Course lessons

Lesson 1: Diagnosis of TMD and orofacial pain

• Muscle pain and TMJ pain: differential diagnosis
• Classification of TMD
• Types of heterotypic pain
• Diagnostic criteria for referred pain
• How to identify pain disorders that are likely to respond positively to your therapy from those that will not
• How to differentiate TMD from other sources of orofacial pain
• The relationship between occlusion and temporomandibular disorders
• Adaptability of the maxillofacial system
• Deep localized pain.

Lesson 2: Etiological factors of TMD

• Effect of stress on orofacial pain
• Post Traumatic Stress Disorder (PTSD)
• Prolonged stress: impact on the human body
• Effect of occlusion on muscle pain
• An acute changes in the occlusal condition
• Chronic response from occlusal alteration.

Lesson 3: Orthopedically stable occlusal interrelationship

• The most favorable and orthopedically stable interrelationship between occlusion and the condylar position for orthodontic-prosthodontic therapy
• The concept of musculoskeletally stable position
• Determination of TMJ stability
• The bilateral mandibular manipulation technique
• Condylar stability vs occlusal stability
• Effect of occlusion on TMD.

Lesson 4: The mechanisms of development of orofacial pain

• Muscle pain as a consequence of anatomical variation
• Obstructive sleep apnea syndrome and bruxism: relationship and mutual influence
• Rhythmic muscle activity and pain
• Delayed onset of local muscle soreness
• Spasm: definition.

Lesson 5: Principles of orofacial pain treatment

• Model of muscle pain development
• Spastic activity of the masticatory muscles
• Botox in the treatment of muscle pain
• When to refer a patient to a related specialist
• Local myalgia:
• definition
• etiology
• clinical symptoms
• treatment tactics.
• The importance of the patient's psychological state in the treatment of orofacial pain
• Application of a stabilizing splints
• Indications for stabilizing equipment.

Lesson 6: Occlusal equipment in the treatment of TMD

• Bruxism and its relationship with occlusion
• The appropriate use of occlusal appliance therapy for muscle pain and joint pain
• The importance of doctor-patient interaction in the treatment of TMD
• When does an occlusal appliance reduce the patient’s TMD symptoms?
• Placebo effect in the treatment of TMD.

Lesson 7: Intracapsular TMJ problems: treatment

• Anatomical and pathophysiological basis for intracapsular TMJ problems
• TMJ ligaments: structure, functions
• Articular disc displacement with reduction: clinical manifestations
• Articular disc displacement without reduction: clinical symptoms and tactics
• Principles of treatment of intracapsular disorder.

Lesson 8: Problems in the treatment of orofacial pain and TMD. Q&A session

• Increasing contacts and their effect on muscle pain
• The use of Botox for local myalgia
• Mandibular Advancement Devices (MAD)
• Taking impressions of patients with significant limitations in mouth opening
• Damage to the inferior alveolar nerve: possibilities of regeneration
• Hard splints vs soft splints: research and results
• Questions about using Bruxchecker
• Differential diagnosis of TMD
• Habits that affect TMD.

Lesson 9: Principles of TMD diagnosis. Options for hypomobility and hypermobility of TMJ

• Diagnosis of TMDs
• Etiological risk factors in the development of TMD
• Clinical examination: external examination, assessment of muscle and TMJ
• Additional examination methods
• TMDs: definition and diagnosis
• Types of TMDs and principles of their diagnosis
• The use of Botox in the treatment of TMD
• Adhesions: diagnosis and treatment tactics
• Ankylosis: types, diagnosis and treatment options
• Dislocations and subluxations of the TMJ
• Technique for lower jaw reduction
• Degenerative changes of the TMJ:
• osteoarthrosis
• osteoarthritis
• resorption of condyles
• osteonecrosis
• neoplasm
• synovial chondromatosis
• aplasia and hypoplasia of the condyle.
• Muscle pain:
• myalgia
• tendonitis
• spasm
• myositis.
• Coronoid hyperplasia.

Lesson 10: Minimally invasive treatment methods: botulinum therapy and arthrocentesis. Arthroscopy

• Functional disk vs non-functional disk
• Normal anatomy and physiology of the TMJ
• Botulinum therapy in the treatment of TMD
• Identifying pain points and preparing for Botox injections: video demonstration
• Physiotherapy and speech therapy in patients after botulinum therapy: timing and recommendations
• Arthrocentesis: technique of execution, anatomical landmarks
• Complications during arthrocentesis
• Indications for arthrocentesis
• Clinical examples of arthrocentesis in patients of different ages
• Arthroscopy: advantages of the technique
• Types of arthroscopy and their characteristics
• Video demonstrations and descriptions of various types of arthroscopy
• Long-term results of arthroscopy
• Bilateral arthroscopy
• Complications of arthroscopy
• Video demonstration of repairing disk perforation.

Lesson 11: Treatment of TMD: open surgery

• Indications for open TMJ surgery: absolute and relative
• Surgical access for operations on the TMJ: types of incisions
• Author's method for creating surgical access RHITHNI
• Discectomy technique
• Technique of eminectomy
• Tactics of patient management before, during and after orthodontic treatment
• TMJ reconstruction: types of prostheses
• Alloplastic replacement of the TMJ in growing patients.

Lesson 12: Indications for occlusal corrections in TMDs patients. Techniques for restoring occlusion for TMDs

• Indications and contraindications of occlusal corrections in TMDs patients
• The influence of occlusion on the occurrence of TMD
• Restoration of occlusion in patients with and without TMDs
• Occlusal approach in the treatment of TMD: disadvantages of the technique
• Academic guidelines in the treatment of patients with TMD
• Diagnostic criteria for TMDs
• Definition of musculo-articular dysfunction
• Signs of TMDs "SAD"
• 2D and 3D etiopathogenetic model
• A clear classification of TMDs
• Secondary TMDs
• Basic functions of occlusion
• Criteria for stability and instability of occlusion
• Creation of maximum intercuspation
• Algorithm for choosing the TMD treatment method
• Evolution of opinions in the treatment of TMD
• Occlusion-TMD: modern concepts
• Specific categories of occlusion pathology
• Optimization of occlusal function on clinical example
• Occlusal dysesthesia: definition and treatment strategies
• Treatment of patients with TMD and no dental problems
• Treatment of patients with TMD and dental problems
• Overtreatment: pros and cons, recommendations
• Recommendations for the treatment of patients with TMD.

Lesson 13: Etiological factors and principles of treatment of TMDs. Occlusal splint: when, why and how

• TMD: signs and symptoms
• Patient-centered approach: key principles
• Etiopathogenesis of TMD
• Treatment guidelines for patients with TMD
• Role of psychosocial factors in the development and treatment of TMD
• Comorbidities influencing the development of TMD
• Management tactics for patients with TMD
• Cognitive-behavioral therapy
• Physical therapy and a set of home exercises
• Control of parafunctional behavior
• Self-management effect
• Placebo and nocebo effects: research and recommendations
• Jaw exercises to reduce pain in patient with TMD
• The Rocabado technique
• Indications and contraindications for the occlusal splints
• Google, social media, ChatGPT: their role in patient education
• Consequences of using non-dentist-prescribed occlusal splints
• Mistakes in the application of occlusal splints
• Potential mechanism of action of occlusal splints
• Protocol for using occlusal splints
• Digital protocol for fabricating occlusal splints: advantages, disadvantages, protocol
• Guidelines for managing patients with TMD before, during, and after orthodontic treatment.

Who is this course for?

This online course is designed for dentists and dental professionals interested in functional dentistry, clinical decision-making and evidence-informed dental practice.