: Hans Jürgen Schindler, Jens Christoph Türp
: Occlusal Splints for Painful Craniomandibular Dysfunction
: Quintessence Publishing Co Inc USA
: 9781647241360
: 1
: CHF 139.90
:
: Zahnheilkunde
: English
: 183
: DRM
: PC/MAC/eReader/Tablet
: ePUB
Therapy for painful craniomandibular dysfunction (CMD) is a field of dentistry that is quite different from traditional subjects in dental medicine (eg, periodontics, restorative dentistry, or oral surgery). In these subject areas, innovation essentially means adapting clinical procedures to new technologies, such as the use of digital resources. However, better basic treatment of CMD cases cannot be achieved simply by better technique but by a new way of thinking that emphasizes patients, their suffering, and what they tell their dentists. Therefore, this book offers a clear guide to help practitioners address the issue of CMD in theory and practice and provide their CMD patients with the best possible treatment. The book is split into two parts: first a practical guide to the basic treatment of CMD patients, followed by chapters that build on that basic knowledge by exploring scientific and theoretical principles in more depth. The two parts complement each other to form a rounded and complete picture. A series of detailed charts, diagrams, and sample forms are included to supplement the important history-taking section, and chapters on splint fabrication and rehabilitation include step-by-step photographs. The book concludes with chapters on neurobiology to discuss CMDs and their treatment at an anatomical level for a more thorough understanding.

Hans Jürgen Schindler, Prof Dr Med Dent, is a professor in the Department of Prosthodontics at the University of Würzburg, Germany, and senior researcher at the Institute of Mechanics, Karlsruhe Institute of Technology, Karlsruhe, Germany.

1

INTRODUCTION

Jens C. Türp

Craniomandibular Dysfunction

Terminology

Technical terms must be clarified to avoid misconceptions and misunderstandings, especially when describing the factors relating to function. In particular, a distinction must be made between “dysfunction of the masticatory system,” “craniomandibular dysfunction,” and “myoarthropathy of the masticatory system”; these terms should not be considered synonymous. In 2016, the German Society for Functional Diagnostics and Therapy published proposed definitions for these and other important terms for the first time.1

Dysfunction of the masticatory system

Dysfunction of the masticatory system refers to a “short- or long-term disturbance of the homeostasis or economy of the masticatory system caused by any structurally or functionally substantiated deviation from normal function, such as functional deficits due to trauma, injury to the structural integrity, and functional/parafunctional stress, including deviations that justify prosthodontic, orthodontic, or surgical measures.”1

Craniomandibular dysfunction

Craniomandibular dysfunction (CMD) is classified as “a specific functional disorder that affects the muscles of mastication, the temporomandibular joints (TMJs), and/or the occlusion.”1 Clinically, CMD encompasses the areas of pain and/or dysfunction.

Pain is manifest as:

  • Masticatory muscle pain
  • TMJ pain
  • Toothache of (para)functional origin

Dysfunction can appear in the form of:

  • Painful or nonpainful limitation of movement of the mandible (aspect aimed at mandibular movements)
  • Hypermobility or incoordination of the mandible (aspect aimed at mandibular movements)
  • Painful or nonpainful intra-articular dysfunction (aspect aimed at the TMJ)
  • Premature contacts interfering with function and gliding obstacles (aspect aimed at the occlusion)

CMD is a collective term that encompasses symptoms not in need of treatment and symptoms that do need treatment. In principle, there is always a need for treatment when pain is present; in the case of dysfunction, the need for treatment is dependent on the severity of the dysfunction.

Myoarthropathy of the masticatory system

Myoarthropathy of the masticatory system (MAP), a term introduced in 1970 by Tübingen dentist Willi Schulte,2 denotes a subgroup of craniomandibular dysfunction. It refers to symptoms and findings affecting the muscles of mastication, the TMJs, or associated tissue structures; it does not take into consideration the occlusion. This term equates to the term “temporomandibular disorder (TMD).” If pain is involved, these symptoms can be summarized under the heading “myoarthropathic pain.”

Etiology

Numerous mechanisms have previously been held responsible for the etiology of myofascial pains of the muscles of mastication and pains in the TMJs. Nociceptive pain is currently the underlying basis of models for these musculoskeletal symptoms. This nociceptive pain can be triggered by overloading of the tissue and promoted by a number of disposing factors. Microtrauma and local ischemia3—together with their structural and functional counterparts, such as activated osteoarthritis,4 the myofascial trigger point,5 local muscle fatigue, and aching muscles6—essentially serve as overarching pathophysiologic explanatory models. Common to these hypotheses is the assumption that, at the end of the causal chain, afferent nerve fibers and tissue cells release protons7 and other endogenous algesic substances (eg, glutamate, substance P, bradykinin, histamine, prostaglandin E, serotonin, potassiu