Multidisciplinary team in temporomandibular disorders

Abstract

The temporomandibular disorders (TMD) are one of the main concerns regarding orofacial pathologies and there are an ascending number of cases. They are characterised as a group of pathological conditions that may affect the temporomandibular joint (TMJ), the masticatory musculature and/or other adjacent anatomical structures, leading to pain and dysfunction [ 1 Cuccia AM , Caradonna C , Bruschetta D , et al. Imaging of temporomandibular joint: approach by direct volume rendering . J Clin Diagn Res. 2014 ;8(11): ZC105 – 9 . [PubMed]   , [Google Scholar] ]. The multifactorial aetiology of TMD affects a relatively large number of the world population and requires a multidisciplinary evaluation and diagnosis by the clinical team [ 2 Okeson JP. Management of temporomandibular disorders and occlusion. 7th ed. Mosby-St Louis (MO) : Elsevier ; 2013 .   [Google Scholar] ]. Among the various elements that constitute the multidisciplinary team we highlight the dentist and the physiotherapist. The dentist as a first-line professional, most of the time is responsible for the identification of patients potentially at risk and for the follow-up of those who already present the disease [ 3 Kogawa E , Kato M , Santos C , et al. Evaluation of the efficacy of low- level laser therapy (LLLT) and the microelectric neurostimulation (MENS) in the treatment of myogenic temporomandibular disorders: a randomized clinical trial . J Appl Oral Sci. 2005 ;13(3): 280 – 285 . [Crossref], [PubMed]   , [Google Scholar] ]. On the other hand, the physiotherapist aims to reduce musculoskeletal pain, promote muscle relaxation, reduce muscle hyperactivity, improve function by restoring the quality and quantity of mandibular movements and maximise joint mobility [ 4 Armijo Olivo S , Magee D , Parfitt M , et al. The association between cervical spine, the stomatognathic system and orofacial pain: a critical review . J Orofacial Pain. 2006 ;20(4): 271 – 287 . [PubMed]   , [Google Scholar] ]. A 24-year-old female patient with a history of temporomandibular disorder and bruxism she presented an non-assisted mouth opening (UMO) of 28 mm and an assisted mouth opening with pain in the masseter and TMJ bilaterally of 29 mm, after the clinical assessment with the DC/TMD protocol we arrived at a diagnosis of disc displacement without reduction (DDwR) with limited opening, degenerative joint disease in the left TMJ, arthralgia (II), myofascial pain (III) in the masseter with pain referred to other anatomical regions. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. The treatment plan consisted of cognitive behavioural therapy (CBT), prescription of muscle relaxants, occlusal splint especially for reduction of overload due to bruxism, infiltration with 1 ml -Abstract Truncated-