Temporomandibular Disorders

M. Ziad Al-Ani is Senior Lecturer at Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK.Robin J.M. Gray was a Specialist in Oral Surgery and Director of Manchester Dental Specialists. He was formerly Senior Lecturer and Coordinator of TMD Clinical Teaching and Research Services at the Department of Dental Medicine and Surgery, University Dental Hospital of Manchester, Manchester, UK.

• Preface to the Second Edition ixAcknowledgements xiAbout the Companion Website xiii1 About the Book 1About temporomandibular disorders: what is a ‘TMD’? 1About the book 2Chapter 2: Clinical aspects of anatomy, function, pathology, and classification 3Chapter 3: Articulatory system examination 3Chapter 4: I’ve got ‘TMJ’ 3Chapter 5: I’ve got a clicking joint 3Chapter 6: I’ve got a locking joint 3Chapter 7: I’ve got a grating joint 3Chapter 8: You’ve changed my bite 4Chapter 9: I’ve got pain in my face 4Chapter 10: I’ve got a dislocated jaw 4Chapter 11: My teeth are worn 4Chapter 12: I’ve got a headache 4Chapter 13: I’ve got whiplash 4Chapter 14: What’s of use to me in practice? 5Chapter 15: You and the lawyer 5Chapter 16: The referral letter 5Chapter 17: How to make a splint 5Chapter 18: Bruxism: Current knowledge of aetiology and management 5Chapter 19: Splint therapy for the management of TMD patients: An evidence-based approach 5Chapter 20: Patient information 6Appendix I: Flowcharts 6Appendix II: Glossary of terms 6Appendix III: Short answer questions 62 Clinical Aspects of Anatomy, Function, Pathology, and Classification 7The joint anatomy, histology, structure, capsule, synovial membrane, and fluid, ligaments 7The intra-articular disc (meniscus) 11The bones of the temporomandibular joint 15Mandibular (jaw/masticatory) muscles 16Classification and Pathology 25Diagnoses of TMDs 29Further Reading 313 Articulatory System Examination 32Examination of the temporomandibular joints 32Mandibular (masticatory) muscle tenderness 39Further Reading 504 I’ve Got ‘TMJ’! 52History 52Examination 53Special tests 55Differential diagnosis 55Management 565 I’ve Got a Clicking Joint 64History 64Examination 65Other special tests 67Treatment 74The patient journey 796 I’ve Got a Locking Joint 82History 82Examination 1 83Diagnosis 85Treatment 86TMJ locking 88Conclusion 907 I’ve Got a Grating Joint 91Examination 91Diagnosis 92Treatment 92Final treatment plan 958 You’ve Changed My Bite 101History 101Examination 104Treatment 104Discussion 106Conclusion 111Further Reading 1129 I’ve Got Pain in My Face 114History 114Examination 115Differential diagnosis 116Treatment 121Questions to ask patients regarding pain in general 122Further Reading 12310 I’ve Got a Dislocated Jaw 125Examination 126Likely diagnoses 126Management 12711 My Teeth Are Worn 132History 132Examination 133Diagnosis 135Treatment 135Important considerations in tooth surface loss 136Further reading 14712 I’ve Got a Headache 148Examination 149Radiographs 149Articulatory system exam 150Likely diagnosis 151Management 153Patient journey 154Further Reading 15513 I’ve Got Whiplash 156Examination 157Record-keeping 158Are TMD and whiplash related? 159Likely diagnosis 161Management 16114 What’s of Use to Me in Practice? 164Counselling and reassurance 165Drug therapy 165Physiotherapy 166Splint therapy 168Mouth prop 171Occlusal adjustments 171Does orthodontic treatment cause TMD? 175Restorative treatment, the dentist, and TMD 176The use of a facebow and semi-adjustable articulators 177Radiographs 178Further referral 17815 You and the Lawyer 182Case scenario 1: note and record-keeping 182Case scenario 2: a medical report request 185Case scenario 3: a disgruntled patient 188Further Reading 19116 The Referral Letter 192Details 192History 192Request 194Further Reading 19417 How to Make a Splint 195How do you make a stabilisation splint? 195Fitting a stabilisation splint 205How do you make an anterior repositioning splint? 211Bite registration 213Further reading 21718 Bruxism: Current Knowledge of Aetiology and Management 218Aetiology of bruxism 218Definition of bruxism 219Bruxism and TMD 220Why bruxism (parafunction) is potentially damaging? 221How much evidence about the efficacy of botulinum toxins on bruxism? 221How can bruxism be managed? 222Further reading 22319 Splint Therapy for the Management of TMD Patients: An Evidence-Based Discussion 224Stabilisation splint (SS) 225Anterior repositioning splint (ARPS) 228Mandibular advancement/snoring appliances 23120 Patient Information 235Stabilisation splint 235Anterior repositioning splint 236Use and care of occlusal bite splint 236General advice for patients with a TMD 238Exercise programme for patients with TMD 239Appendix I Flowcharts 241Appendix II Glossary of Terms 253Further Reading 274Appendix III Short Answer Questions 275Index 277