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Conservative temporomandibular disorder management: what DO i do? – frequently asked questions Robin JM Gray Ziad Al-Ani Dental Update 2024 40:9, 707-709.
Authors
Robin JMGray
BDS, MDS, PhD, MFGDP, FHEA, FDS RCS(Ed)
Former Senior Lecturer in Dental Medicine and Surgery, University of Manchester Dental School, Specialist in Oral Surgery, Glasgow Dental Hospital and School, Glasgow, UK
There are many myths and fallacies surrounding the conservative or non-surgical management of patients with temporomandibular disorders (TMD). This paper is not a treatise on splint design and does not champion any one particular treatment philosophy. It is, however, produced as the outcome of many years of lecturing and talking to fellow practitioners and represents the most frequently asked questions and common misconceptions encountered by the authors, who have addressed the topics raised with the intention of helping to avoid pitfalls.
The common symptoms encountered in general dental practice are pain, either from muscles or the temporomandibular joint (TMJ) itself, limitation or deviation of mandibular movement, and joint sounds, and the authors have attempted to separate fallacy and fact. When appropriate examples are given.
There are general treatment guidelines but, while some methods apply to an individual, there is no panacea – individual patient treatment needs vary.
Clinical Relevance: It is important that all treatments delivered to a TMD patient should be evidenced-based and should always be in the patient's best interests. Many treatment modalities are proposed that do not fulfil these parameters and can lead to confusion in management. A reference and reading list will be given which will direct the reader to an evidence-based approach to treatment. Some treatment suggestions are founded on the extensive clinical experience of the authors. There will not always be evidence from a randomized, controlled clinical trial to substantiate support for a specific treatment, but the reader should be directed by what the majority of clinicians would undertake as a responsible approach.
Article
The objective of this ‘Question and Answer’ paper is to address questions on temporomandibular disorder (TMD) management and suggest simple examination and treatment guidelines for TMD patients that, while not being overly complicated, should enable the dentist to elicit all relevant information.
It is important to remember that, with TMD patients, ‘the one approach for all’ idea is not appropriate. It is, however, preferable to work to a set examination protocol, so that any findings are meaningful not only to you as practitioner, for future reference, but also to another clinician who might become involved in the patient's management. Ideally, all findings should be recorded in a manner that can be added to subsequently.
It is not appropriate to give a ‘pro-forma’ for a clinical examination in the form of a document in this paper as such information can readily be accessed elsewhere. As many practices are now computerized, a simple menu can readily be adapted from other sources for everyday use.
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