Journal of Craniomandibular Function, 01/2017

Changing paradigms are transforming our understanding of functional mechanisms and clinical and technical procedures in clinical practice. Within this context is the emerging importance of maintaining or rehabilitating the occlusion to optimize mastication for multiple benefits. These benefits include improved diet, nutrition, and health; improved esthetics for speech, social interaction, and self-confidence; and, more recently, the recognition of maintaining or enhancing cognition. Keywords: oral rehabilitation, occlusion, esthetics, mastication, cognition

Tooth wear is a multifactorial condition leading to the loss of dental hard tissue, ie, enamel and dentin. Tooth wear can be divided into the subtypes mechanical wear (attrition and abrasion), and chemical wear (erosion). Due to its multifactorial etiology, tooth wear can manifest in many different ways. The condition can therefore be difficult to diagnose and manage. A systematic approach is a sine qua non. In the Tooth Wear Evaluation System (TWES) described in this article (the second in a series of two), all the necessary tools for a clinical guideline are presented in various modules. This allows the clinician to perform a state-of-the-art diagnosis, in both a general practitioner and a referral setting. To avoid the risk of cumbersome usage, the clinician can select only those modules appropriate in a given setting. The modules of the TWES match each other, which is indispensable and essential when different modules are being compared. With the TWES it is possible to recognize the problem (qualification), grade its severity (quantification), diagnose the likely causes, and monitor (the progress of) the condition. In addition, a proposal for the classification of tooth wear is made. Further, it is possible to decide when to start a restorative treatment and which kind of treatment to apply, as well as to estimate the level of difficulty of the treatment. In this second article of the two-part series1, the management modules are described. Keywords: clinical guideline, management planning, tooth wear

Joint effusion associated with structural changes in the temporomandibular joint (TMJ) can result in severe pain and considerable functional impairment. This article describes the diagnostic and therapeutic approach used to treat a patient with severe structural damage to the TMJs in association with a ruptured disc and joint effusion. After describing the diagnostic procedures, the therapeutic procedures used in our purely conservative management approach are outlined. Treatment consisted of a combination of the following measures: 1) Information about the nature of the anatomical and dysfunctional events. 2) Fabrication and insertion of a special three-dimensionally aligned equilibration splint that was modified several times over the course of treatment. 3) Anti-inflammatory medication. Combination therapy resulted in the elimination of joint effusion, restoration of the original bite position, and subjective improvement of masticatory function. Consequently, there was no need for later restorative occlusal adjustment and/or surgical intervention. Keywords: temporomandibular joint dysfunction (TMD), osteoarthrosis, posterior disc displacement, disc rupture, clinical functional analysis, manual structural analysis, condylar position analysis, jaw motion analysis, magnetic resonance imaging (MRI), functional

In routine dental practice, bruxism is generally diagnosed based on patient-reported signs and symptoms as well as clinical examination findings indicative of bruxism. According to the present-day definition of bruxism, current bruxism activity can be identified with high probability based on an evaluation of these findings. The Bruxism Status Examination Protocol (BSEP) is a two-part procedure consisting of a history interview and a clinical examination. It also includes an evaluation for treatment-related risk factors and comorbidities, and a thorough assessment of the masticatory muscles, oral cavity, teeth, and oral soft tissue for signs of bruxism activity. This structured procedure not only serves to identify bruxism activity, but also makes it possible to distinguish between awake bruxism (AB) and sleep bruxism (SB), and to ascertain the predominant type of bruxing action (clenching or grinding). Another indication is for bruxism-specific risk assessments in dental restoration and denture planning. Keywords: sleep bruxism, awake bruxism, clenching, grinding, bruxism screening and diagnosis