Manual of Temporomandibular Disorders

Edward F. Wright, DDS, MS, MAGD, is a professor at the University of Texas Health Science Center-San Antonio (UTHSCSA). He completed a one-year general dentistry residency and the University of Minnesota s two-year TMJ and Craniofacial Pain Fellowship. He taught TMD diagnosis and treatment to more than 100 U.S. Air Force residents in general dentistry, orthodontics, periodontics, and prosthodontics. Upon retiring from the Armed Forces, he completed a two-year research fellowship in TMD diagnosis and treatment at the South Texas Veterans Health Care System and taught TMD diagnosis and treatment to their general dentistry residents. He is now UTHSCSA s Course Director for their predoctoral dental students TMD Course and Dental Anatomy and Occlusion Course, and teaches TMD to the school s general dentistry, orthodontics, periodontics, and prosthodontics residents. Dr. Wright is the primary author of more than 30 journal articles.

Preface xv Introduction 1 Part I Initial Evaluation 5 Chapter 1 Patient Interview 11 Chapter 2 Review of the Initial Patient Questionnaire 31 Chapter 3 Clinical Examination 39 Chapter 4 Imaging 71 Chapter 5 TMD Diagnostic Categories 81 Chapter 6 Contributing Factors 97 Part II Common Acute TMD Conditions and Treatments 103 Chapter 7 TMD Secondary to Trauma 105 Chapter 8 TMD Secondary to Dental Treatment 109 Chapter 9 Lateral Pterygoid Spasm 125 Chapter 10 Intermittent and Continuous Forms of TMJ Disc Displacement without Reduction with Limited Opening 131 Chapter 11 TMJ Subluxation and Luxation 145 Part III Occlusal Appliance Therapy 149 Chapter 12 Stabilization Appliance 153 Chapter 13 Anterior Positioning Appliance 213 Part IV Multidisciplinary Treatment Approach 223 Chapter 14 Self-Management Th erapy 229 Chapter 15 Physical Medicine 247 Chapter 16 Cognitive-Behavioral Intervention 261 Chapter 17 Pharmacological Management 275 Chapter 18 Other Dental Procedures 295 Chapter 19 Integrating Multidisciplinary Therapies 313 Part V Case Scenarios 331 Case 1: Pulpal Pathosis Mimicking TMD Symptoms 333 Case 2: Tooth Pain: No TMD Pain 335 Case 3: Chronic Sinusitis 336 Case 4: Chronic Forehead Pain Referred from the Neck 337 Case 5: Myalgia Secondary to Nocturnal Parafunctional Habits 339 Case 6: Tooth Attrition: No Pain 340 Case 7: Myalgia Secondary to Daytime Parafunctional Habits 341 Case 8: Medial Pterygoid Spasm 342 Case 9: Tension, Depression, and Poor Sleep as Contributing Factors 343 Case 10: Fibromyalgia as a Contributing Factor 344 Case 11: TMJ Disc Displacements and When to Treat Th em: No Pain 345 Case 12: TMJ Arthralgia 346 Case 13: TMJ Disc Displacement with Reduction with Intermittent Locking 347 Case 14: TMJ Disc Displacement without Reduction with Limited Opening: Unlocked 349 Case 15: TMJ Disc Displacement without Reduction with Limited Opening: Not Unlocked 350 Case 16: Osteitis Causing Inability to Open Wide 353 Case 17: Lateral Pterygoid Spasm 354 Case 18: Acute Exacerbation of TMD 357 Case 19: Multiple Forms of Head and Neck Pain after Crown Insertion 359 Case 20: Appliance Th at Positioned Condyles into Th eir Proper Position 360 References 362 Part VI Fundamentals of Clinical Studies 365 Appendices 385 Glossary 419 Index 423