DentaltownUK February 2018 - 37

orthodontics, nor was there a correlation
between disc position, clicking and TMD.
It was proposed that tooth extraction
for orthodontic purposes and orthognathic
treatment could force the condyle distally
and trap the disc anteriorly,17 but recent
evidence showed that the frequency of TMD
symptoms is similar in the cohort treated
with or without extraction.18-20 The latest
Cochrane review by Luther et al.21 concluded
that there is insufficient research data to
make any claim of a relationship between
active orthodontic intervention and TMD.

Orthodontic management
of patients presenting signs and
symptoms of TMD before or who
develop them during treatment
The available evidence suggests that
orthodontic treatment does not cause TMD; it
could be present or appear during treatment,
however, and therefore certain protocols
should be followed.
During the pretreatment phase, a comprehensive assessment of the TMJ should be
noted, and updated at 6-month intervals.22 If
a patient already has TMD, then he should
be informed that orthodontic treatment has
no influence on its progression.
If the TMD is severe and acute, it is
better not to commence orthodontic treatment until the condition is stabilised using
a conservative treatment under supervision
of a specialist.23,24 This is important because
patients who suffer from TMD may develop
reversible abnormal path of closure and
mandibular position which is misleading
for orthodontic diagnosis.25
If a patient develops signs and symptoms
of TMD during treatment, then a number of
steps can be taken. Initially it is important
to reassure the patient that TMD is not
necessarily a progressive problem and for
many, symptoms spontaneously improve
over time.

Table 1: Specific treatment approaches for TMD
Treatment approach

Example

Patient education
and self-care 27,28

Habit awareness and modification

Home physiotherapy
programme 29,30,31

*
*
*
*

Cognitive behavioural
intervention 28,32

* Stress management
* Counselling
* Hypnosis

Pharmacology

*
*
*
*

Non-Steroidal Anti-inflammatory Drugs (NSAID) 33
Benzodiazepines 34
Corticosteroids 35
Hypnotics/Anxiolytics/Tricyclic antidepressants 36

Splint therapy 37-39

*
*
*
*
*

Soft splints
Localised occlusal interference splint
Anterior bite plane
Anterior repositioning splint
Stabilisation splint

Occlusal equilibration 27

Removal of nonworking side contacts by selective
grinding. However, there are contradictory
findings in terms of the effectiveness of occlusal
adjustment in the management or prevention of
TMD. 40,41

TMJ surgery

1. Closed surgical procedures42
* Arthocentesis
* Arthroscopy
2. Open surgery 27
* Diskoplasty
* Disk repositioning and repair
* Arthroplasty including high condylectomy,
diskectomy (meniscectomy) with or without
replacement. 27,43

Massage and exercise therapy
Short-wave diathermy therapy
Ultrasound therapy
Laser therapy

dentaltownuk.com \\ FEBRUARY 2018

37


http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK February 2018

Cover
Mike Gow: Contracts & the Hit Man
Howard Speaks
Message Board: Predictable Marginal Ridge
Dr. Harry Singh’s Financial Freedom Formula
Private Removable Prosthetics
Message Board: Large Composite Restorations
Quiz: Name that Oral Lesion!
The Boxing Dentist
Don't Make Assumptions
A Combined Digital Orthodontic and Restorative Approach
To Fill or Restore?
Back to Birmingham: BDC & Dentistry Show 2018
Temporomandibular Joint
Spin Me Right Round: Crown Preparations
Through the Keyhole-Dr. Alif Moosajee
Wish List-Dr. Yogi B. Savania
DentaltownUK February 2018 - Cover
DentaltownUK February 2018 - Cover2
DentaltownUK February 2018 - 3
DentaltownUK February 2018 - 4
DentaltownUK February 2018 - Mike Gow: Contracts & the Hit Man
DentaltownUK February 2018 - Howard Speaks
DentaltownUK February 2018 - 7
DentaltownUK February 2018 - 8
DentaltownUK February 2018 - 9
DentaltownUK February 2018 - Message Board: Predictable Marginal Ridge
DentaltownUK February 2018 - Dr. Harry Singh’s Financial Freedom Formula
DentaltownUK February 2018 - 12
DentaltownUK February 2018 - 13
DentaltownUK February 2018 - Private Removable Prosthetics
DentaltownUK February 2018 - 15
DentaltownUK February 2018 - Message Board: Large Composite Restorations
DentaltownUK February 2018 - 17
DentaltownUK February 2018 - Quiz: Name that Oral Lesion!
DentaltownUK February 2018 - 19
DentaltownUK February 2018 - 20
DentaltownUK February 2018 - 21
DentaltownUK February 2018 - 22
DentaltownUK February 2018 - The Boxing Dentist
DentaltownUK February 2018 - 24
DentaltownUK February 2018 - 25
DentaltownUK February 2018 - 26
DentaltownUK February 2018 - 27
DentaltownUK February 2018 - Don't Make Assumptions
DentaltownUK February 2018 - 29
DentaltownUK February 2018 - A Combined Digital Orthodontic and Restorative Approach
DentaltownUK February 2018 - 31
DentaltownUK February 2018 - To Fill or Restore?
DentaltownUK February 2018 - 33
DentaltownUK February 2018 - Back to Birmingham: BDC & Dentistry Show 2018
DentaltownUK February 2018 - 35
DentaltownUK February 2018 - Temporomandibular Joint
DentaltownUK February 2018 - 37
DentaltownUK February 2018 - 38
DentaltownUK February 2018 - Spin Me Right Round: Crown Preparations
DentaltownUK February 2018 - 40
DentaltownUK February 2018 - 41
DentaltownUK February 2018 - Through the Keyhole-Dr. Alif Moosajee
DentaltownUK February 2018 - 43
DentaltownUK February 2018 - 44
DentaltownUK February 2018 - 45
DentaltownUK February 2018 - 46
DentaltownUK February 2018 - 47
DentaltownUK February 2018 - 48
DentaltownUK February 2018 - 49
DentaltownUK February 2018 - Wish List-Dr. Yogi B. Savania
DentaltownUK February 2018 - Cover3
DentaltownUK February 2018 - Cover4
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