Journal of Craniomandibular Function, 03/2010

The objective of this study was to evaluate the genderrelated prevalence of TMD in elderly subjects. Within the interdisciplinary longitudinal study "ILSE," a subsample of 102 male and 96 female subjects (born 1930-32) were examined. An assessment of temporomandibular disorders based exclusively on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), without imaging, was added to the dental record of every subject. Four calibrated examiners performed the examination. Disc displacement without reduction was observed in 8.8% of the men and 12.5% of the women. Osteoarthrosis was observed in 4.9% of the men and 8.3% of the women. Osteoarthritis, arthralgia, and disc displacement with reduction could not be detected in the clinical examination. Although slightly more women had disc displacement without reduction or osteoarthrosis, no statistically significant differences between the genders could be detected (P = 0.246 and P = 0.271, respectively). The prevalence of joint-related TMD in this age group was low compared with results from studies performed using the Helkimo index. Keywords: TMD, osteoarthrosis, disc displacement, arthralgia, gender

Transcutaneaous electrical nerve stimulation (TENS) is an electrophysical therapeutic procedure in which electrical impulses are applied to stimulate the sensory and motor nerves under the skin. TENS has been used in the therapy of craniomandibular dysfunctions (CMD) for decades now, beginning with the introduction of the Myomonitor (Myotronics, Seattle, WA, USA). The German Society for Functional Diagnostics and Therapy (DGFDT) recently published a review regarding TENS application in the treatment of functional diseases of the craniomandibular system, pointing out case reports with encouraging results in terms of normalization of muscle function and reduction of myogenic pain. However, there is still some controversy about the employment of TENS in CMD treatment, and the current results of the clinical trials investigating the use of electrophysical techniques in CMD treatment are not homogeneous. In the recent past, the neurophysiological effects of TENS have been a main focus of studies based on animal tests. The results of these studies are an important aspect in the efficacy assessment of TENS. Keywords: TENS, CMD, literature survey, pain inhibition, neurophysiology

Odontalgia can have a variety of causes1-6. This article deals with the case of a 41-year-old female patient with strong apical pain at the maxillary left second premolar that even led to a temporary disability to work. After a pretreatment of the painful situation elsewhere over several months, including a revision of the root canal filling at said tooth that had previously been unremarkable over many years, followed by an apicectomy and subsequent extraction of this premolar, the patient presented in the author's office. The patient wanted to have clarified whether an inflammation at the maxillary left first molar could be causing the pain. The pain site the patient complained about could not be verified, clinically, to be causing the condition. A functional diagnosis revealed a trigger point at the upper anterior edge of the left superficial masseter muscle as the primary site of pain, from which the pain was radiating. A hyperbalance between the maxillary left second molar and the mandibular left second molar could be established as the cause for the tenseness of this muscle, which felt hard and tendinous. After an adjustment of the occlusal interferences with direct composite restorations, adjunctive detoning physiotherapy and a relaxation scheme, the patient was without pain within a period of 5 weeks. Keywords: CMD, craniomandibular dysfunction, referred pain, heterotopic pain, trigger point, muscle palpation, manual exploration, malocclusion, hyperbalance, direct composite restorations

In the course of CMD treatment, the position of the mandible is frequently adjusted and then stabilized with occlusal splints. To transfer this therapeutic position of the mandible from the splint to the dental arches, and thus to a reconstruction that will be fabricated, is a technically difficult and demanding procedure. The treatment protocol presented in this article can be implemented in any dental practice without much equipment or many instruments, and ensures a reliable transfer of the therapeutic position of the mandible. Keywords: repositioning splint, therapeutic position of the mandible, bonded composite build-ups