Docteur en Chirurgie Dentaire
Maître de Conférences des Universités –Université de Paris –
Praticien Hospitalier, Faculté de Chirurgie Dentaire, Université Paris René Descartes
Responsable de la consultation de prise en charge de la douleur et troublesfonctionnels orofaciaux – Hôpital Charles Foix Ivry sur Seine
Ancien Président du Collège National d’Occlusodontologie (CNO)
Past president de European Academy of Cranio-mandibular Disorders (EACD)
Membre de l’International Association for Study of Pain (IASP)
The management of TMD is often reduced to splint therapy or orthopedic device. This well-known therapeutic is an effective way to reduce articular and muscle pain, to improve the functional area of mandibular movement and to protect TMJ and teeth during bruxism episodes.
Yet, this device presents some limits and risks when it is not well managed. Indeed, with orthesis device, the patient is not considered as the main actor of change. He is not involved as he should be, if we refer to thepatient-centered medicine concept. It is clear, advice, stress management, the decreasing of contributing factors such as abuse of medicines and drugs are the best ways to reduce pain symptoms.
In case of TMJ cracking sounds that may suggest bone remodeling or arthrosis, TMJ/CBCT is the best way to monitor the evolution of arthrosis. The management of arthrosis is based on the use of anti-inflammatories during painful periods and on optimization of molar contacts in ICP using sometimes splint devices for daily and night periods.
Tongue dysfunction can be considered as a contributing factor of TMD and in this case, splint therapy is not easy to do.
TMJ clicking sounds without pain are often the main reason for consultation; they are anxiogenic but rarely deleterious.
So the management will be limited to physiotherapy performed by a physiotherapist or the patient himself. Consequently, this non invasive treatment is the best way to improve manducatory apparatus rehabilitation which has recently been validated. Pain relief and the increase in mandibular and cervical mobility are obtained with such treatment.
It is now well-known that the functional rehabilitation of the manducatory apparatus does not need invasive occlusal therapy. Once the inflammatory episode is over, the best is obtained through the exploration and use of the functional are by physiotherapy. Dental treatment will be engaged when pain condition has been reduced and anxiety and depression disorders managed.
Sleep disorders, peripheric apneas, tongue disorders and bruxism are considered as the most common comorbidities or contributing factors of TMD and other orofacial pain. It proves necessary to screen these conditions as soon as possible to reduce medical nomadism and opinion conflicts that also contribute to chronic pain condition.
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