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News Bulletin : ADA News Bulletin July 2011
44 July 2011 POLICY STATEMEnT On TEMPOROMAndIbULAR dISORdERS (TMd) fROM THE AMERICAn ASSOCIATIOn Of dEnTAL RESEARCH (AAdR) The AADR recognises that temporomandibular disorders (TMDs) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJs), the masticatory muscles, and all associated tissues. The signs and symptoms associated with these disorders are diverse, and may include difficulties with chewing, speaking, and other orofacial functions. They also are frequently associated with acute or persistent pain, and the patients often suffer from other painful disorders (comorbidities). The chronic forms of TMD pain may lead to absence from or impairment of work or social interactions, resulting in an overall reduction in the quality of life. Based on the evidence from clinical trials as well as experimental and epidemiologic studies: 1. It is recommended that the differential diagnosis of TMDs or related orofacial pain conditions should be based primarily on information obtained from the patient’s history, clinical examination, and when indicated TMJ radiology or other imaging procedures. The choice of adjunctive diagnostic procedures should be based upon published, peer-reviewed data showing diagnostic efficacy and safety. However, the consensus of recent scientific literature about currently available technological diagnostic devices for TMDs is that except for various imaging modalities, none of them shows the sensitivity and specificity required to separate normal subjects from TMD patients or to distinguish among TMD subgroups. Currently, standard medical diagnostic or laboratory tests that are used for evaluating similar orthopedic, rheumatological and neurological disorders may also be utilized when indicated with TMD patients. In addition, various standardized and validated psychometric tests may be used to assess the psychosocial dimensions of each patient’s TMD problem. 2. It is strongly recommended that, unless there are specific and justifiable indications to the contrary, treatment of TMD patients initially should be based on the use of conservative, reversible and evidence-based therapeutic modalities. Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time. While no specific therapies have been proven to be uniformly effective, many of the conservative modalities have proven to be at least as effective in providing symptomatic relief as most forms of invasive treatment. Because those modalities do not produce irreversible changes, they present much less risk of producing harm. Professional treatment should be augmented with a home care program, in which patients are taught about their disorder and how to manage their symptoms Adopted 1996, revised 2010. REfEREnCES References supplied with the AADR Policy Statement are available on request from firstname.lastname@example.org http://www.dentalresearch.org The Australian and New Zealand Academy of Orofacial Pain (ANZAOP) focuses on education, research and clinical management of orofacial pain. One of its primary goals, as laid down in its constitution, is in the education of dental professionals in the best practice of orofacial pain management. The ANZAOP has adopted the policy statement on Temporomandibular Disorders (TMD) from the American Association of Dental Research. This statement endorses the fact that technological devices do not demonstrate an ability to differentiate TMD from healthy individuals. These technological devices include electromyography to assess jaw muscle activity, jaw movement recording and tracking, and jaw muscle electrical stimulation. Whilst such equipment has an important role in research, it has not been shown to improve the diagnosis or management of TMD. The statement also endorses the fact that patient treatment needs to be based on conservative, reversible, best-practice management strategies. This has important implications in dental practice and emphasizes that treatments such as occlusal adjustment, crown and bridge procedures or other irreversible interventions to the dentition are not indicated for the management of TMD. Chris Peck President Greg Murray Secretary and Treasurer Australian and New Zealand Academy of Orofacial Pain Assessment and management of teMPOROMAnDiBULAR DiSORDeRS AnZAOP position statement
ADA News Bulletin June 2011
ADA News Bulletin August 2011