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Educational Brochures on Chronic Overlapping Pain Conditions

This brochure addresses what are Chronic Overlapping Pain Conditions (COPCs), how COPCs are diagnosed, the complexity of the chronic pain experience, and how to work with your health care provider to develop a treatment plan. It is available by postal ma

Study Highlights TMD Evidence and Current Practice Gaps

The TMJ Association has long championed the need for strong evidence-based demonstrations of the safety and efficacy of TMD diagnostics and treatments. Sad to say, as the following journal article indicates, even among a network of research-oriented practices, dental providers are still resorting to such TMD treatments as occlusal adjustments in which teeth are irreversibly moved, ground down, or in other ways altered, a treatment for which there is no scientific evidence of efficacy.

Beware of Ticks and Lyme Disease

We are currently in the peak season for Lyme disease. Each year at this time we highlight this topic because we have heard from a number of patients over the years who were misdiagnosed and underwent unnecessary TMD treatments when they actually had Lyme

#*!"@!**! ... May Help Your Pain... and Improve Strength!

Our headline is adopting the comic strip convention of using symbols to denote swear words because we are intrigued by a report that swearing may have some health benefits.

Predictors of Opioid Efficacy for Chronic Pain Patients

Opioids are increasingly used for treatment of chronic pain. However, they are only effective in a subset of patients and have multiple side effects. Thus, studies using biomarkers for response are highly warranted.

Overdiagnosis and Unnecessary Therapy

  • Mar 2, 2017

We grateful to Dr. Daniel Laskin, Adjunct Clinical Professor and Chairman Emeritus at Virginia Commonwealth University School of Dentistry, Oral and Maxillofacial Surgery, for summarizing the following article for our readers.
  
Many dental practitioners continue to use radiographic or magnetic resonance imaging (MRI) findings in the temporomandibular joint (TMJ) as the sole means of establishing that there is pathology present that requires treatment. These findings include the position of the intra-articular disc in relation to the mandibular condyle, the location of the condyle relative to the glenoid fossa, the depth of the glenoid fossa, and flattening of the condylar surface. In this study the MRIs of two groups of asymptomatic general population individuals differing in age by 20 years were analyzed for these factors.

In both groups, condylar position was characterized by great variability. Whereas those dentists who use condylar position as a criterion of pathology believe that the condyle should be centered in the glenoid fossa, this study found only 49% of the subjects had condyles in that position and, of these, an absolute centric position was present in less than 4%. In females, a posterior position was present in 52%, while in men, 57% were in a centric position. Neither age nor gender had any influence on location of the condyle.

In three-fourths of the subjects the intra-articular disc, described in textbooks as normally having its posterior band at the twelve o'clock position, was in a more forward position. This anterior location was twice as frequent in females as in males, in conjunction with the more common finding of TMJ clicking in women. The depth of the fossa was decreased in both age groups.

Based on the findings in this study, it is evident that eccentric condylar position is not an indicator of an abnormal TMJ and should not be used as a reason for treatment. Moreover, it is clear that one cannot rely solely on imaging evidence of an anteriorly positioned disc as an indicator of joint pathology and that it must be accompanied by clinical symptoms of TMJ pain and/or limitation of jaw movement for this to be considered. Painless clicking alone is also not an indication for treatment. Although the authors did not specifically study changes in the condylar surface, they do discuss this issue and point out that although loss of normal contour and flattening of the condyle may be an indication of osteoarthritis, it also may represent a normal sign of aging and/or adaptive remodeling and require no treatment.

Disc displacement, eccentric condylar position, osteoarthritis - misnomers for variations of normality? Results and interpretations from an MRI study in two age cohorts. Turp JC, Schlenker A, Schroder J, Schmitter M. BMC Oral Health (2016) 16: 124.  
TMJ Disorders

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