Wednesday, August 24, 2011

Temporomandibular Disorders: A Position Paper of the International College of Cranio-Mandibular Orthopedics (ICCMO)

Cooper, B: The  Journal of Craniomandibular Practice. July 2011, vol 29,No.3, pp. 237-244

Purpose: Two principal schools of thought regarding the etiology and optimal treatment of temporomandibular disorders exist; one physical/functional, the other biopsychosocial. This position paper establishes the scientific basis for the physical/functional. 

The ICCMO Position: Temporomandibular disorders (TMD) comprise a group of musculoskeletal disorders, affecting alterations in the structure and/or function of the temporomandibular joints (TMJ), masticatory muscles, dentition and supporting structures. The initial TMD diagnosis is based on history, clinical examination and imaging, if indicated. Diagnosis is greatly enhanced with physiologic measurement devices, providing objective measurements of the functional status of the masticatory system: TMJs, muscles and dental occlusion. The American Alliance of TMD organizations represent thousands of clinicians involved in the treatment of TMD. The ten basic principles of the Alliance include the following statement: Dental occlusion may have a significant role in TMD; as a cause, precipitant and /or perpetuating factor. Therefore, it can be stated that the overwhelming majority of dentists treating TMD believe dental occlusion plays a major role in predisposition, precipitation and perpetuation. While our membership believes that occlusal treatments most frequently resolve TMD, it is recognized that TMD can be multi faceted and may exist with co-morbid physical or emotional factors that may require therapy by appropriate providers. The International College of Cranio-Mandibular Orthopedics (ICCMO), composed of academic and clinical dentists, believes that TMD has a primary physical/functional basis. Initial conservative and reversible TMD treatment employing a therapeutic neuromuscular orthosis that incorporates relaxed, healthy masticatory muscle function and a stable occlusion is most often successful. This is accomplished using objective measurement technologies and ultra low frequency transcutaneous electrical neural stimulation (TENS). 

Extensive literature substantiates the scientific validity of the physical/functional basis of TMD, efficacy of measurement devices and TENS and their use as aids in diagnosis and in establishing a therapeutic neuromuscular dental occlusion. Clinical Implications: A scientifically valid basis for TMD diagnosis and treatment is presented aiding in therapy.

The overwhelming majority of dentists worldwide, treating thousands of patients annually, and whose patients had not previously experienced resolution of their painful and/or dysfunctional symptoms support the conclusions reached by a large number of studies that TMD is a physical/functional disorder most often resulting from the mal-relationship among the dental occlusion, masticatory muscles, and TM joint function.11-34,39,164 They find that their patients are most often conservatively and successfully treatable initially with reversible occlusal orthosis therapy. Members of ICCMO adhere to this principal and treat to establish a healthy craniomandibular relationship through the use of a physiologically balanced neuromuscular occlusion that is in harmony with relaxed, healthy masticatory muscles with improved function and properly functioning TM joints. This achieves a stable, physiologically sound dental and craniomandibular position that does not cause noxious neural input to the central nervous system with resultant  adaptive/accommodative function and behavior. In addition to its use in the treatment of patients with TMD, the neuromuscular occlusal philosophy can be successfully applied to all forms of dental treatment that involve major alteration of dental occlusion, including orthodontics, full arch or full mouth reconstruction and complete dentures. Successful treatment of temporomandibular disorders using neuromuscular occlusion techniques is directed towards elimination of the cause of the disease, not just symptom relief. If the cause is not successfully identified and treated, the acute physical/physiological form of TMD may unfortunately degenerate into a chronic pain condition, rarely cured, and at best, attempted to be managed with pharmacologic and other medical/ behavioral therapies. Such symptom- only oriented treatment can adversely affect the patients’ ability to work or have normal social interactions, resulting in an overall reduction in quality of life. Published research data demonstrate that the establishment of a neuromuscular therapeutic occlusion provides improved mandibular and masticatory function in a large group of TMD patients with notably significant reduction or resolution of symptoms.39,152

The International College of Cranio- Mandibular Orthopedics supports the consensus among its members and thousands of neuromuscular dentists worldwide that TMD has a primary physical/functional component that is most often successfully treated with neuromuscular dental occlusion therapy, based on objective measurements.

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