Diagnostic and therapeutic-restorative procedures for masticatory dysfunctions

Abstract

Temporomandibular disorders (TMD) or craniomandibular disorders, respectively, involve diseases of the teeth and periodontia as well as the masticatory muscles, temporomandibular joints and associated structures. It has been shown in recent years that psychological, social and general medical influences are of enormous importance in the etiology of TMD in addition to anatomical, physiological, parafunctional and other biological causes. This signifies that therapists confronted with TMD should already include at an early stage other specialists such as pain therapists, neurologists, ENT physicians, psychotherapists and physiotherapists. Patients need to be referred to dentists specializing in TMD when ENT examinations yield no pathological findings. The treatment of TMD is subdivided into the following steps that are always related to underlying diagnoses: informing patients, self-observation, relaxation therapy, behavioral therapy, physiotherapy, drug therapy, therapeutic local anesthesia, splint therapy, and, if necessary, prosthetic and/or orthodontic therapy to restore a stable occlusion.

Keywords: biopsychosocial disease; functional diagnostics; functional therapy; temporomandibular disorders; tinnitus.

Table 1. Selection of acute and chronic non-otogenic diseases in the orofacial region that may cause ear pain

Table 2. Classification in three main groups and their typical symptoms

Table 3. Secondary and differential diagnoses

Figure 1. Eagle-syndrome - elongation of the styloid process

Figure 2. Chart for diagnostic und therapeutic procedures for patients with otalgia

Figure 3. Screening schema (modified after Jäger 1997)

1) Neither diagnostics nor therapy required 2) Diagnostics required 3) Diagnostics and therapy required

Figure 4. „Krogh-Poulsen" head patterns for patient drawings of the site, spreading and referral of pain, as well as for areas that are painful when palpated

Figure 5. Palpation of the m. masseter

Figure 6. Palpation of the anterior digastric muscle

Figure 7. Palpation of the TMJ

Figure 8. Anterior open bite

Figure 9. Patient showing a significant horizontal overlap of the maxillary anterior teeth (overjet)

Figure 10. Palpation of the infraorbital nerve as part of the brief cranial nerve examination

Figure 11. Examination of the head mobility

Figure 12. Palpation of the sternocleidomastoid

Figure 13. Palpation of the trapezius muscle

Figure 14. Manual traction provocation test of the left TMJ

Figure 15. Computed tomography (CT): Osteoarthrosis on both sides after fracture of the collum mandibulae

Figure 16. Magnetic resonance imaging (MRI) of the TMJ: anterior disc dislocation without reduction and structural changes in the posterior part of the disc

Figure 17. Red dot on a watch to improve the awareness regarding parafunctions like clenching. (Clenching Awareness Training).

Figure 18. Physiotherapeutic treatment

Figure 19. Interceptor (Schulte): Example for a reflex appliance

Figure 20. Stabilization appliance in the upper jaw

Figure 21. Anterior repositioning appliance

Figure 22. Patient with symptoms of TMD and a malocclusion

Figure 23. Stabilization appliance in the upper jaw

Figure 24. Patient during orthodontic treatment

Figure 25. Prosthetic reconstruction and restoration of the occlusion