by Clayton A. Chan, DDS, MICCMO
EDITORIAL:
I believe our profession in general lacks and awareness of understanding of occlusal signaling influences to the associated cranio-orofacial structures.
The TMD community recognizes that TMD encompasses a group of musculoskeletal, neuromuscular and occlusal conditions that involve the TMJ’s, the masticatory muscles and all associated tissues. What are the associated tissues that dentist can influence?
Published guidelines for diagnosis and management of TMD (JADA: Managing the Patients with TMD Disorders: A New Guideline for Care – Charles S. Greene, Journal of American Dental Association, September 2010;141;1086-1088) and related musculoskeletal disorders and professional responsibilities recognizes that TMD investigation and treatment will only be initiated after any specific odontogenic basis for the patient’s complaint has been ruled out. Canadian Guidelines of the Royal College of Dental Surgeons of Ontario (Guidelines:Diagnosis & Management of Temporomandibular Disorders & Related Musculoskeletal Disorders, August 2002) also considered overlapping conditions and are addressed by virtue of the suggested approach to history and clinical assessment for those patients with a history of temporomandibular disorders to include: Med history, pain (localized facial/jaw pain, earaches, headaches, neck, shoulder, back, limitation of mandibular movement, joint notes, altered sensations, tinnitus, perceived hearing loss, related cognitive losses or affective disorders, sleep disturbance, related emotional or mood changes, duration of each symptoms, relationship of onset to specific events (trauma injuries,…), parafunctional habits (bruxism, clenching….) previous treatments for the patient’s complaints and its effectiveness, etc. (Canadians are very inclusive…)
According to the American Society of Temporomandibular Joint Surgeons guidelines includes “…a detailed history, head and neck evaluation, and general physical examination when indicated, are essential.”
The American Academy of Pediatric Dentistry (AAPD – Guidelines on Acquired Temporomandibular Disorders in Infants, Children, and Adolesents, Review Council on Clinical Affairs, Reference Manual, Vol. 33: No. 6, 11/12, 2010) recognizes that TMJ disorders is a “functional disturbance of the masticatory system”, which includes masticatory muscles, degenerative and inflammatory TMJ disorders, and TMJ disc displacements and acknowledges medical conditions to mimic TMD including trigeminal neuralgia, CNS lesions, odontogenic pain, sinus pain, ontological pain, developmental abnormalities, neoplasias, paratid diseases, vascular diseases, myofacial pain, cervical muscle dysfunction and Eagle’s syndrome.
When treating the masticatory system I believe we have an ethical obligation to acknowledge occlusions connection to these TMD related issues and do everything possible within our scope of care to eliminate the pathologic influences of pain relating to the neck (SCMs, scalenes) and shoulders (trapezius and associated tissues) stemming from abnormal occlusal signaling. Prudent referral to supportive physio-therapists, chiropractors (AO, NUCCA), osteopathic physicians, sacral occipital therapists and MD/DO physicians. who are involved in upper cervical treatment should be a part of the Craniofacial/ Orofacial/ Musculoskeletal Neuromuscular TMD team to also help treat and rule out pathologies outside the dentist scope of care.
When they have done all they could it is only prudent for the dentist to implement their honed skills and understanding in resolving the remaining seemingly unresolvable pain issues which this forum has often referred to. Who else is qualified to deal with these often unrecognized occlusal signaling influences if we don’t?
Leader in Neuromuscular Dentistry – Objective Measurements and Evaluation
