Evidence-based treatment of TMJ dysfunction

– Classification of orofacial pain; – Determination of temporomandibular disorders; – Diagnostic groups of temporomandibular disorders; – Risk factors for temporomandibular disorders:

- Macrotrauma: types and correlation with musculoskeletal disorders, - Pathophysiological factors, - Psychoemotional factors, - Anatomical factors;

– Occlusion and temporomandibular disorders: relationship; – Classification of temporomandibular disorders; – Bio-psycho-social model; – Diagnostic criteria:

- Anamnesis, - Localization, - Modified function, - Familiar pain, - Radiating pain;

– Musculoskeletal pain:

- Myalgia, - Myofascial pain, - Arthralgia,

– Palpation of muscles and TMJ; – TMJ dysfunction: types and characteristics; – Clinical examination: standardized method; – Diagnostic procedures:

- Patient intake, - Clinical examination, - Diagnostic tests, - Making a diagnosis;

– Characteristics of pain; – SMILES approach; – MRI for TMJ dysfunctions.

– The problem of musculoskeletal dysfunction: definition; – Diagnostic difficulties of musculoskeletal dysfunction; – Differential diagnosis of muscle and joint pain; – Classification of temporomandibular disorders; – Classification of orofacial pain; – Pain in the mandible as a sign of myocardial infarction; – Principles of effective treatment; – The concept of convergence and divergence; – Pain zone or pain source: differentiation rules; – Trigger zones; – Causes of musculoskeletal dysfunction:

- Relationship between occlusion and musculoskeletal dysfunction, - Trauma, - Emotional stress, - Parafunctions, - Deeply localized pain;

– Etiology of muscle pain; – Bruxism and muscle pain: correlation; – Delayed muscle soreness syndrome; – Intra-articular pain: types and etiology; – Principles of treatment of TMJ diseases.

– The concept of patient-oriented treatment – Criteria for the diagnosis of musculoskeletal pain – Disease-oriented principle – Tactics of treatment of musculoskeletal disorders – Step-by-step treatment model – Behavioral therapy: indications and stages – Self-massage: technique – Control of parafunctional behavior – Physical therapy protocol: types of exercises and methods of performance – Arthralgia: causes, diagnosis, treatment; – Displacement of the articular disc with reduction: tactics; – Reduction of the articular disc: methodology; – Dislocation and subluxation: diagnosis and treatment; – Occlusal splints: indications; – Consequences of self-treatment with occlusive splints; – Comprehensive treatment: benefits; – Mechanism of action of the occlusal splint; – Placebo effect in the treatment of musculoskeletal disorders.

– What is pain? – Biopsychosocial model: components – Neuromatrix theory – Classification of orofacial pain – Musculoskeletal dysfunction: definition – Epidemiology of musculoskeletal pain – Etiology of musculoskeletal disorders – Rules for choosing treatment tactics – Factors of development of musculoskeletal dysfunction

- Predisposing factors - Initiators - Aggravating factors

– The concept of primary and heterotopic pain – Anamnesis collection and examination: LOQFDIV-survey – Clinical examination:

- Otoscopy - Range of motion in the cervical spine - Palpation of muscles and joints - Palpation of the lymph nodes - Provocative tests - Movement of the lower jaw - Intraoral examination - X-ray diagnostics - Serological examination - Local anaesthesia

This lecture is focussing mainly on the clinical examination of the TMJ, muscles and occlusion.

Besides a thorough case history a treatment-oriented functional diagnostics is trying to answer the following questions:

– What kind of structural lesions do the patient have?

– Where are these lesions located?

– Are there any musculoskeletal impediments that could prevent a successful treatment.

– Why does the patients have these symptoms?

– Are there dental causes that can be eliminated?

– Clinical examination techniques to help answer these questions will be demonstrated.

1. The indication, occlusal design and handling will be discussed for

– relaxation splint;

– stabilization splint;

– reposition splint;

– decompression splint;

– verticalization splint.

2. Given the indication is correct occlusal splints can be mighty tools in the pre-treatment of craniomandibular disorders.

3. The primary advantage of the occlusal splint over other types of occlusal treatment is that the occlusion can be altered without making it necessary to then irreversiblymodify the patient`s dentition.

4.This lecture will not only focus on the preconditions for a successful therapy using different types of occlusal splints, but will also discuss the limitations and problems of this kind of occlusion-related treatment.

– Musculoskeletal dysfunction: definition – Classification systems for musculoskeletal dysfunctions:

- RDC-TMD - DC-TMD - Extended DC-TMD

– Masticatory muscles: a model of pain formation – Causes of muscle dysfunction – Local muscle soreness: causes – Myospasm of the masticatory muscles – Myofascial pain: causes – Source of pain and localization – Constant continuous muscle pain – Fibromyalgia: diagnostics – TMJ diseases:

- Disorders of the condyle-disc complex - Inflammatory disorders

– The role of ligaments in the development of diseases – Displacement of the articular disc with and without reduction – Inflammatory disorders: etiology – Osteoarthritis: manifestations and key points of treatment – Invasive treatment: indications – Principles of treatment of TMJ dysfunctions – Manual therapy – Multiple "P" approach

– Components of orofacial pain;

– Small fiber neuropathy (SFPN);

– Concomitant pathology:

- Genetic factors,

- Purchased factors.

– Diagnosis of neuropathy: trepan-biopsy;

– Genetic testing in dentistry;

– Retromyalgia: principles of diagnosis:

- Match test,

- Joint Hypermobility test.

– Chiari malformation: clinic;

– Myofascial pain syndrome: diagnosis;

– Principles of treatment of polyneuropathy;

– Paraneoplastic syndrome.