Fully updated with the latest information in the field, this comprehensive book provides a practical guide to diagnosing and managing temporomandibular disorders in the dental practice. Written in an accessible, user-friendly style, it offers a simplified approach to the basic concepts and management decision points for the most commonly observed temporomandibular conditions, integrating the latest advances and advice throughout. Quick Consult, Focal Point, and Technical Tip boxes provide quick access to relevant information, and study results are summarized in graphs for ease of comprehension.

Manual of Temporomandibular Disorders, Fourth Edition examines an array of medical and dental conditions that affect the temporomandibular joint (TMJ), masticatory muscles, and contiguous structures. It presents evidence-based, clinically practical information to help dentists diagnose TMD accurately, rule out disorders that mimic TMD, and provide effective therapy for most patients.

Special features include:

• Frequently Asked Questions
• Quick Consults, Technical Tips, and Focal Points
• Information on disorders that mimic TMD and factors that warrant referral
• Extensive color photographs and line drawings
• A companion website providing helpful examples and patient handouts

Manual of Temporomandibular Disorders, Fourth Edition is a must-have how-to manual for general dentists, dental students, and residents involved in this area of practice.

Preface

About the Companion Website

Introduction

Part I Initial Evaluation

Chapter 1 Patient Interview

Summary

References

Chapter 2 Review of the “Initial Patient Questionnaire”

Chapter 3 Clinical Examination

Range of Motion

TMJ Noise

TMD Palpations

Intraoral Examination

Occlusal Changes

TMD Pain Caused by a Tooth

Tooth Pain without Local Pathology

Additional Evaluations

References

Chapter 4 Imaging

Plain Radiographs

Panoramic Radiograph

Axially Corrected Sagittal Tomography

Computed Tomography (CT)

Cone Beam Computed Tomography (CBCT)

Magnetic Resonance Imaging (MRI)

Arthrography

Ultrasound

Imaging Strategies

Imaging Recommendations

References

Chapter 5 TMD Diagnostic Categories

TMJ Disorders

Joint Pain

Joint Disorders

Joint Diseases

Fractures

Congenital/Developmental Disorders

Masticatory Muscle Disorders

Muscle Pain Limited to the Orofacial Region

Contracture

Hypertrophy

Neoplasm

Movement Disorders

Masticatory Muscle Pain Attributed to Systemic/Central Disorders

Headache Disorders

Headache Attributed to TMD

Associated Structures

Coronoid Hyperplasia

References

Chapter 6 Contributing Factors

References

Part II Common Acute TMD Conditions and Treatments

Chapter 7 TMD Secondary to Trauma

References

Chapter 8 TMD Secondary to Dental Treatment

Preventing Aggravation from Dental Treatment

Medial Pterygoid Muscle Pain

Inability to Close into Maximum Intercuspation

Occlusal Interference Sequelae

Obstructive Sleep Apnea Appliances

References

Chapter 9 Lateral Pterygoid Spasm

References

Chapter 10 Intermittent and Continuous Forms of TMJ Disc Displacement without Reduction with Limited Opening

Intermittent Disorder (Disc Displacement with Reduction with Intermittent Locking)

Continuous Disorder (Disc Displacement without Reduction with Limited Opening, Also Known as Closed Lock)

References

Chapter 11 TMJ Subluxation and Luxation

References

Part III Occlusal Appliance Therapy

Chapter 12 Stabilization Appliance

Mandibular Positions and Interocclusal Record

Physical Variables

Full or Partial Coverage

Maxillary or Mandibular

Hard, Intermediate, or Soft Material

Thick or Thin

Appliance or Clasp Retention

Summary of Physical Variables

Appliance Adjustments

Internal Adjustments

Internal Reline

External Adjustments

External Reline

Appliance Repair

Appliance Examples

Pressure-Cured Mandibular Acrylic Stabilization Appliance

Maxillary Acrylic Stabilization Appliance

Hard Thermomolded Stabilization Appliance

Impak Stabilization Appliance

Dual Laminate Thermomolded Stabilization Appliance

Soft Thermomolded Stabilization Appliance

Appliance Management

References

Chapter 13 Anterior Positioning Appliance

Mandibular Position and Interocclusal Record

Design and Adjustments

Appliance Management

References

Part IV Multidisciplinary Management Approach

Chapter 14 Self-Management Therapy

Self-Management Instructions

Closure Muscle-Stretching Exercise

Lateral Pterygoid Muscle-Stretching Exercise

Posture Exercises

Controlling Awake Behaviors

References

Chapter 15 Physical Medicine

Muscle Massage

Yoga

Trigger-Point Compression

Trigger-Point Injection

Botulinum ToxinPhysical Therapy

Acupuncture

Chiropractics

References

Chapter 16 Cognitive-Behavioral Intervention

Controlling Awake Behaviors Relaxation

Hypnotherapy (Hypnosis)

Biofeedback Assisted Relaxation

Stress Management

References

Chapter 17 Pharmacological Management

Analgesics

Anti-Inflammatory Medications

Nonsteroidal Anti-Inflammatory Drugs (Ingested Form)

Steroidal Anti-Inflammatory Drugs

Muscle Relaxants

Anticonvulsants

Tricyclic Antidepressants

Topical Medications

Over-the-Counter Topical Medications

Prescription Topical Medications

Nutritional Supplements

References

Chapter 18 Other Dental Procedures

Occlusal Equilibration

Orthodontic–Orthognathic Therapy

Prosthodontic Therapy

TMJ Surgery and Implants

References

Chapter 19 Integrating Multidisciplinary Therapies

Management Summaries and Clinical Implications

Self-Management Therapy

Massage and Trigger-Point Compression

Lateral Pterygoid Muscle-Stretching Exercise

Closure Muscle-Stretching Exercise

Posture Exercises

Occlusal Appliances

Physical Therapy

Yoga

Trigger-Point Injections

Acupuncture

Chiropractics

Magnetic Therapy

Controlling Awake Parafunctional, Muscle-Tightening, or Fatiguing Behaviors

Relaxation

Hypnotherapy (Hypnosis)

Biofeedback-Assisted Relaxation

Stress Management

Pharmacological Management

Occlusal Therapy

TMJ Surgery

Integrating Conservative Therapies

TMD Refractory to Initial Therapy

Long-Term Management

References

Part V Case Scenarios

Case 1: Symptomatic Irreversible Pulpitis Mimicking TMD Symptoms

Case 2: Tooth Pain: No TMD Pain

Case 3: Chronic Sinusitis

Case 4: Chronic Forehead Pain Referred from the Neck

Case 5: Myalgia Secondary to Sleep Parafunctional Behaviors

Case 6: Tooth Attrition: No Pain

Case 7: Myalgia Secondary to Awake Parafunctional Behaviors

Case 8: Medial Pterygoid Spasm

Case 9: Personal Stressors and Sleep Disturbances as Contributing Factors

Case 10: Fibromyalgia as a Contributing Factor

Case 11: TMJ Disc-Condyle Complex Disorders and When to Provide Therapy: No Pain

Case 12: TMJ Arthralgia

Case 13: TMJ Disc Displacement with Reduction with Intermittent Locking

Case 14: TMJ Disc Displacement without Reduction with Limited Opening: Unlocked

Case 15: TMJ Disc Displacement without Reduction with Limited Opening: Not Unlocked

Case 16: Osteitis Causing Inability to Open Wide

Case 17: Lateral Pterygoid Spasm

Case 18: Acute Exacerbation of TMD

Case 19: Multiple Forms of Head and Neck Pain after Crown Insertion

Case 20: Appliance That Positioned Condyles into Their “Proper Position”

References

Part VI Fundamentals of Clinical Studies

Prominent Clinical Study Designs

Case Report

Case Series Study

Cross-sectional Study

Case-control Study

Cohort Study

Nonrandomized Clinical Trial

Randomized Controlled Trial (RCT)

Parallel-Group Randomized Clinical Trials

Cross-Over Randomized Clinical Trials

Other Types of Publications Literature Reviews

Systematic Reviews

Meta-analyses

Clinical Practice Guidelines

Considerations in Assessing Clinical Trials

Conclusions

References

Appendices on Website

Appendix 1 Referral Criteria for Hygienists

Appendix 2 Initial Patient Questionnaire

Appendix 3 TMJ Disc–Condyle Complex Disorders

Appendix 4 TMD Self-Management Therapies

Appendix 5 Occlusal Appliance Care Instructions

Appendix 6 Closure Muscle-Stretching Exercise

Appendix 7 Posture Improvement Exercises

Instructions

Exercises

Appendix 8 Laboratory Stabilization Appliance Instructions

Maxillary or Mandibular Impak Stabilization Appliance

Maxillary or Mandibular 0.15-in. Soft Thermoplastic Appliance or Dual Laminate Thermoplastic Stabilization Appliance

Maxillary or Mandibular 2-mm Hard Thermoplastic Appliance or Acrylic Stabilization Appliance

Appendix 9 Example of Dental Record Entries

Initial Exam

Insertion Appointment

Follow-Up

Follow-Up

Appendix 10 Examples of Physical Therapy Referral

Appendix 11 Examples of Psychology Referral

Appendix 12 Sources for Additional TMD Information

Patient Brochures and Book

Patient Advocacy Group

TMD Practice Management Businesses

Practitioners with TMD Expertise and Fellowship Programs

Professional TMD Organizations

TMD Textbooks

TMD Journals

Glossary

Index

Edward F. Wright, DDS, MS, is a Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center-San Antonio (UTHSCSA) in San Antonio, Texas, USA.

Gary D. Klasser, DMD, is a Professor in the Department of Diagnostic Sciences at Louisiana State University, School of Dentistry, as well as the Director of the LSU Orofacial Pain Continuum in New Orleans, Louisiana, USA.