Dr Michael B Lewis

Temporomandibular joint disorders are a collection of conditions united by pain and dysfunction in the temporomandibular joint and the adjacent facial muscles.

Traditionally it was believed that temporomandibular joint disorders werecaused by the way the teeth bite together, however contemporary research indicates the teeth play a smaller role than we initially expected. There are a number of factors which may precipitate onset of facial pain. These include, but are not limited to: • Trauma to the head or neck • Prolonged opening at the extremitiesof opening • Stress • Occlusal trauma caused by issue with inappropriate biting surface of new restorations • Uncontrolled clenching and grinding

Our practice advocates a conservative approach including physiotherapy and occlusal splint therapy to provide our patience with relief and restored function. There is NO contemporary, respected dental science to support the use of occlusal remedies such as occlusal adjustment, full mouth reconstructions or a change in biting portion to cure TMD.

Temporomandibular joint disorders are classified into acute and chronic conditionsdepending on their duration. As a rule of thumb acute onset is more likely to be cured than chronic ones. Chronic pain tends to be “managed” as opposed to “cured”with the understanding that they will most likely reoccur. Dental research suggests that our ability to eradicate temporomoandibular joint clicking is low, however our ability to restore pain-free function and range of motion is high.

Prosthodontics, oral medicine and oral surgeons are the board-registered dental specialties which treat temporomandibular joint disorders. Prosthodontists tend to adopt a management strategy, whilst oral medicine specialists adopt a medical model and oral surgeons offer surgical intervention. Orofacial pain is best managed using an interdisciplinary approach involving one or more specialties where appropriate. Allied health such as physiotherapy and psychological services are also of great help in managing these conditions. Note, dentists offering complex dental treatments, tens therapy, oral reconstruction, bite adjustments and rebuilds are practicing outside the scope of accepted management of these conditions.

A well made splint is highly effective at reducing pain associated with TMD. When poorly made or adjusted they can have the opposite effect. We utilise the latest CADCAM technology to produce our splints, providing patients with a lighter, smaller and more comfortable occlusal splint than traditionally available. The real skill lies in diligent adjustment. The mark of an appropriate occlusal splint is: • They should be flat with no indentions - like an “ice-skating rink” for teeth. • All the opposing teeth should be in even contact with the biting surface of the splint. • All teeth in the jaw that the splint seats against should be engaged to avoid over eruption of unopposed teeth. • They should have small inclines of acrylic called “canine rises”. When the jaw moves from left to right only the lower canines shouldbe engaged. • A splint should be madefrom hard acrylic - there is evidence to suggest rubbery or resilient splints encourage grinding as opposed to preventing parafunction.