Contemporary Management of Temporomandibular Disorders Non-Surgical Treatment S. Thaddeus Connelly Gianluca Martino Tartaglia Rebeka G. Silva Editors 123 Contemporary Management of Temporomandibular Disorders S. Thaddeus Connelly Gianluca Martino Tartaglia Rebeka G. Silva Editors Contemporary Management of Temporomandibular Disorders Non-Surgical Treatment Editors S. Thaddeus Connelly Gianluca Martino Tartaglia Oral and Maxillofacial Surgery Department of Biomedical Sciences San Francisco VA Health Care System for Health, Functional Anatomy University of California San Francisco Research Center (FARC) San Francisco, CA Universita degli Studi di Milano USA Functional Anatomy Research Center Milano Private Practice, Dental Implant and Italy Oral Surgery of San Francisco San Francisco, CA USA Rebeka G. Silva Oral and Maxillofacial Surgery San Francisco VA Health Care System University of California San Francisco San Francisco, CA USA Private Practice, Dental Implant and Oral Surgery of San Francisco San Francisco, CA USA ISBN 978-3-319-99911-1 ISBN 978-3-319-99912-8 (eBook) https://doi.org/10.1007/978-3-319-99912-8 Library of Congress Control Number: 2019930089 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword All human beings have mechanisms of adaptation that allow them to react to the changes that occur both in their external environment and in their internal environ- ment. When these mechanisms are overcome, people develop what we know as disease. Temporomandibular disorders (TMD) are a musculoskeletal disease that can partially or globally affect the different structures that constitute the cranio-cervico- mandibular unit. Therefore, one of the most important challenges in clinical practice is to carry out a careful anamnesis, the clinical examination, and when necessary, carry out complementary exams that allow one to achieve a correct diagnosis regard- ing the causes and mechanisms determining that the individual’s capacity for adap- tation has been exceeded, generating the disease that we know by the name of TMD. Therefore, it is clear that the most important phase in the management of TMD is diagnosis. For many years, teaching in different dental schools was based on the fact that muscles, joints, and occlusal problems were the main causes of TMD (Axis I). However, in the early 1990s, several authors emphasized the importance of psycho- social factors (Axis II) in the genesis of TMD. Actually, there is currently a consen- sus that the cause of TMD is multifactorial, and that is the reason why in Volume II the relationship between bruxism during sleep and TMD (Chap. 1) and the relation- ship between trauma and whiplash injury in TMD (Chap. 2) are analyzed. Based on the importance of considering the state of Axis I and Axis II in the diagnosis of the patient with TMD, Part III of this volume discusses management with respect to the dental treatment of TMD, and Parts II and IV discusses treatment with respect to the medical and adjunctive therapies for the management of TMD. I invite readers to enjoy the careful material prepared by the authors of this Volume II, which is based on solid scientific evidence and fruitful clinical experi- ence achieved through many years of professional practice. Faculty of Medicine Rodolfo Miralles Biomedical Sciences Institute, University of Chile Santiago, Chile v Preface The editors and contributors to this text find the study of temporomandibular joint disorders to be strikingly interesting and interlinked with many other fields, such as rheumatology, imaging, pain management, mental health, neuroscience, rehabilita- tion, dentistry, and surgery. We are all innovators in our own way, striving to bring to the field morsels of information arising from clinical and laboratory experience and research. No doubt, however, that many clinicians are convinced that TMD is a black hole, a field that is shrouded in mystery from which some patients emerge and others are lost in an endless loop of pain medication and soft diets. Volume II will hopefully inspire creativity in the diagnosis and care of TMD patients and will inform many types of healthcare providers. The three editors of this book met in Barcelona, Spain, in 2016 to attend the TMJ Bioengineering Conference. In this beautiful and historic city, we heard incredible presentations and met an international group of surgeons, clinicians, and scientists. Many papers were presented by eminent speakers, and it was in this amazing European venue that the idea of collecting much of this incredible knowledge into a new contemporary text began to take shape. It is our desire that the reader learns and appreciates the temporomandibular joint for its complex beauty and biomechanics and gains an appreciation of the different modes of treatment. Our patient outcomes highlight the need for furthering our understanding of the mysteries of the temporo- mandibular joint. Volume II focuses on the nonsurgical treatment of temporomandibular disorders. Part I informs us about the important role of bruxism and trauma in the development or perpetuation of TMD. Part II is concerned with medical treatment. Here we look at the role of various classic and specialty drugs that can be utilized in treatment. Part III reviews occlusion and its impact on temporomandibular disorders from both an orthodontic and prosthodontic perspective. We also present the orofacial evalua- tion of the TMD patient, which includes information on complementary exams, exercises, and function training. In Part IV, adjunctive therapies are discussed, which can significantly improve treatment outcomes. These topics include physical therapy, dry needling, laser, ultrasound, TENS, and chiropractic. We end this vol- ume with the topic of psychiatric considerations for TMD and chronic pain patients. All TMD clinicians, surgeons and nonsurgeons, will recognize the impact that pain and dysfunction has upon a patient’s mental health and his or her recovery trajectory. vii viii Preface The editors and the authors of the chapters herein hope that the valuable informa- tion presented will help you grow your knowledge base and improve your ability to successfully treat a wide variety of TMD disorders. San Francisco, CA, USA S. Thaddeus Connelly Milano, Italy Gianluca Martino Tartaglia San Francisco, CA, USA Rebeka G. Silva Contents Part I S pecial Considerations: Bruxism and Trauma 1 Sleep Bruxism and Temporomandibular Disorders . . . . . . . . . . . . . . . 3 Marc Schmitter 2 The Role of Trauma and Whiplash Injury in TMD . . . . . . . . . . . . . . . . 13 Sonia Sharma, Richard Ohrbach, and Birgitta Häggman-Henrikson Part II Medical Treatment 3 Medical Management of TMD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Rebeka G. Silva, Valeria Gerloni, and S. Thaddeus Connelly Part III Dental Treatment of Temporomandibular Disorder 4 Occlusal Diagnosis and Treatment of TMD . . . . . . . . . . . . . . . . . . . . . . 77 Kazumi Ikeda 5 TMD and Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Michael Jacobs 6 Oral Motor Treatment of TMD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Cláudia Maria de Felício Part IV P sychiatric Considerations and Adjunctive Therapies 7 Adjunctive Therapies for Temporomandibular Disorders . . . . . . . . . . 169 César Fernández-de-las-Peñas and Kimberly Bensen 8 Treating the TMD/Chronic Pain Patient: Psychiatry and Psychology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Sue Gritzner, Valerie Jackson, Irina Strigo, and David Spiegel ix Part I Special Considerations: Bruxism and Trauma Sleep Bruxism and Temporomandibular 1 Disorders Marc Schmitter Abstract TMDs have a multifactorial etiology: besides others, psychosocial and genetic aspects, habits, trauma, and bruxism have been proposed to cause and/or per- petuate TMD. This chapter will explore how investigators have attempted to diagnose and quantify bruxism and determine its relationship to temporoman- dibular disorders. Temporomandibular disorder (TMD) is a collective term for a heterogeneous group of disorders of the temporomandibular joint (TMJ) and related muscles [1]. In the orofacial region, TMD is the most common cause of non-dental and noninfectious pain [2]. The most common complaint of patients with TMD is myofascial pain (MP) of the masticatory muscles [3]. MP in the orofacial area often occurs in con- junction with widespread pain throughout the body [4]. TMDs have a multifactorial etiology: psychosocial and genetic predispositions, habits, trauma and bruxism, and others have been proposed to cause and/or perpetuate TMD. This chapter will explore how investigators have attempted to diagnose and quantify bruxism and determine its relationship to temporomandibular joint disorders. Bruxism is defined as “a repetitive jaw muscle activity characterized by clench- ing or grinding of the teeth and/or by bracing or thrusting of the mandible” [5]. Bruxism has two circadian manifestations: it can occur during sleep (sleep bruxism) or during wakefulness (awake bruxism). According to a recent consensus paper, bruxism can be classified as “possible” (self-report), “probable” (self-report plus clinical examination), or “definite” (self-report plus clinical examination, plus poly- somnographic recording) [5]. M. Schmitter (*) Department of Prosthodontics, University of Wurzburg, Wurzburg, Germany e-mail: [email protected] © Springer Nature Switzerland AG 2019 3 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99912-8_1