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Temporomandibular Disorders: A Problem-Based Approach by Ziad Al-Ani, Robin Gray (Paperback, 2011)

Like this presentation? Why not share! In addition, it is important to stress throughout the TMD course that, in the modern orofacial pain community, these disorders are currently being studied and managed in a medical orthopedic framework; this represents a significant departure from a traditional dental model.

In addition, TMD patients today are being managed in a biopsychosocial paradigm, and some especially chronic patients have significant psychosocial issues that must also be dealt with. Finally, many chronic TMD patients suffer from various comorbid pain conditions fibromyalgia, irritable bowel syndrome, interstitial cystitis, and so on , and these conditions impact both the diagnosis and the management of chronic TMD problems.

Temporomandibular disorders: the past, present, and future

In addition to the TMD course topics presented in the Table , it would be desirable to follow that course with a series of focused discussions about TMD issues that arise in orthodontic practices. These discussions should be conducted in a problem-based learning format, so that the residents could search for relevant materials and be prepared for an open dialog with their instructors. A number of TMD and occlusion issues frequently arise in most orthodontic programs as well as in outside practice, and the residents should be prepared to deal with them when they do occur.

To develop critical thinking skills, a debate format could be used to address many of the issues related to orthodontics, functional occlusion, condyle position, and TMD.

A list of suggested topics is presented below. How has the orthodontic literature changed over the years in regard to TMD and orthodontic relationships? The evolution of thinking about the relationship between these topics parallels what has happened in other disciplines within the dental profession.

A review of these historical concepts in orthodontics will help new graduates to appreciate the spectrum of professional opinions they will encounter as they enter practice. The topic of occlusal hyper-awareness also known as phantom bite has generally been neglected in orthodontic training programs. A recent article reported the results of a survey of practicing orthodontists in the United States about their experiences with patients complaining of occlusal awareness and discomfort.


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The responses to that survey indicated that most orthodontists were either unaware of this condition or uncertain about how to deal with these patients. Many of these patients either have already had orthodontic treatment or are requesting it as a solution for their problem.

Appropriate responses to these situations can be complicated, and dealing with such problems might produce significant amounts of anxiety in both patients and dentists.

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However, some additional time is required to have in-depth discussions about how to react to positive findings from those screenings. This should include the following topics: What constitutes a minor finding vs a major TMD sign or symptom? Who should manage the TMD problem if it requires treatment? What cautions are suggested for the orthodontic management of such patients? How should orthodontists react to and deal with TMD problems that arise during their treatments? Who is responsible for managing these situations?