Charles S. Greene

Long-term status of TMJ clicking in patients with myofascial pain and dysfunction

This study evaluated the long-term changes in TMJ clicking and general TM disorder symptoms in 190 subjects originally treated by conservative, nonsurgical modalities that were not specifically directed to the problems of TMJ noise or disk derangement. The findings are detailed and support the concept that if the symptoms of pain and dysfunction in patients with clicking can be treated successfully by conservative, nonsurgical modalities, it is generally not necessary to correct the internal derangement with surgery.

Oral appliances in the management of temporomandibular disorders

Various types of oral appliances (OAs) have been used for over half a century to treat temporomandibular disorders (TMDs), but there has been considerable debate about how OAs should be designed, how they should be used, and what they actually do therapeutically. However, there is enough information in the scientific literature at this time to reach some evidence-based conclusions about these issues. The main focus of this review is on the materials and designs of various OAs in terms of their proposed mechanisms of action and their claimed clinical objectives. Based on current scientific evidence, an analysis is presented regarding the role that OAs can or cannot play in the management of TMDs. Finally, the concept that OAs may be an effective treatment modality for some TMDs owing to their potential for acting as an elaborate placebo rather than any specific therapeutic mechanism is considered.

Temporomandibular Disorders: Moving from a Dentally Based to a Medically Based Model

INTRODUCTION The year 2000 marks the end of a century in which many I traditional dental concepts were subjected for the first time to some type of systematic inquiry. This kind of investigation produces results that differ considerably from the results of Discovery experiments (such as those often described in this section of JDR), in which new diseases or new diagnostic modalities are brought to light. This essay describes the background of nearly 40 years of systematic inquiry into the subject of temporomandibular disorders (TMD), much of which was directed at questioning the validity of the traditional concepts in this field, and how this eventually changed the clinical management of patients. It also recounts the struggle to persuade the dental profession to move from the past into the modem arena ofTMD diagnosis and treatment.

Etiology of temporomandibular disorders

This article discusses the subject of causation (etiology) as it has been applied to the field of temporomandibular disorders (TMD). These disorders have been the focus of considerable disagreement about what constitutes proper diagnosis and treatment, and it is clear that the main basis for these controversies has been conflicting views about the etiology of the various disorders. Many earlier theories emphasized dental morphological factors of malocclusion, occlusal dysharmony, and bad mandibular alignment as being primarily responsible for the development of TMD symptoms. Certain versions of these dental/skeletal concepts have long been a part of the belief system of the orthodontic specialty, leading to some special orthodontic protocols for managing TM disorders. Today, it is generally agreed that the etiology of TM disorders includes a multifactorial combination of physical and psychosocial factors, with some of them being either poorly understood or difficult to assess. In most cases, there are no special occlusal or orthodontic factors to be considered, and therefore occlusion-changing procedures are not generally required for successful treatment. This means that contemporary orthodontists must face the same challenge as all their other dental colleagues: to learn about modern concepts of diagnosis and treatment for all types of orofacial pain patients, and then to use currently recommended protocols for pain management and musculoskeletal therapy for those patients who have temporomandibular disorders.

Temporomandibular disorders in the geriatric population

Contrary to popular assumptions that temporomandibular disorders may become more prevalent with increasing age, a review of the literature shows that this is clearly not the case. Instead, it seems that most objective signs of temporomandibular disorders, namely clicking, tender joints and muscles, crooked opening, limited movement, and so forth, are found either less often in the elderly or at approximately the same rate in all adult age groups. Subjective complaints, however, decrease as populations get older, and the demand for treatment declines accordingly.

Technological methods in the diagnosis and treatment of temporomandibular disorders.

Although there have been numerous technological devices introduced for the diagnosis and treatment of temporomandibular disorders, many are either ineffective or are research tools without direct clinical application. This article reviews the various modalities and makes recommendations regarding their effectiveness based on the available clinical and scientific evidence.

Osteoarthrosis as the Cause of Craniomandibular Pain and Dysfunction: A Unifying Concept

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