Journal of Craniomandibular Function, 03/2011

Occlusal splint therapy is a central element of the treatment of temporomandibular disorders (TMD). However, little has been reported about the effect of transcutaneous electrical nerve stimulation (TENS)-based methods of myocentric jaw position recording on the effect of splint therapy. In this randomized clinical trial, 40 patients with myofascial pain of the jaw muscles were treated with occlusal splints fabricated using bimanual manipulation (Michigan group, n = 20) or myocentric jaw position recording (myocentric group, n = 20) for determination of centric vs. myocentric relation. Therapeutic effects were evaluated based on the change in pain symptoms and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) procedure after 4 and 12 weeks of treatment. The extent of change in mandibular position was determined by condymeter measurements and magnetic kinesiography as well as by comparison with a healthy control group. Twelve weeks of wearing the respective splints at night resulted in the significant relief of symptoms in both groups, as determined based on subjective pain reports and visual analog scale (VAS) scores. Group comparison revealed that the VAS scores were significantly lower in the myocentric group. Myocentric positioning of the mandible led to mandibular position changes of similar extent in TMD patients and healthy controls. The use of TENS to establish myocentric relation for splint therapy is therapeutically effective and achieves a greater reduction in pain. Furthermore, TENS treatment alone also has a significant pain-relieving effect. Keywords: condylar position, jaw relation, Michigan splint, myocentric relation, occlusal splint, positioning, pain reduction, treatment effect

The present review provides a brief overview of sleep bruxism and sleep-disordered breathing in pediatrics, aimed at promoting an integrated multi-specialist approach (including dentists, sleep specialist physicians, and psychologists) in the diagnostics and management of these frequently associated disorders. Keywords: ADHD, headache, oral parafunction, sleep apneas, sleep bruxism, sleep-disordered breathing

Patients with tick-borne Lyme neuroborreliosis (LNB) can present with a variety of symptoms, and frequently the oral and maxillofacial areas are affected. Even though treatment with antibiotics generally results in a remission of symptoms, patients with permanent nerve damage may show residual symptoms. This case report describes a 61-year-old Caucasian woman, who was referred by a neurologist for residual LNB-induced pain in the face and impaired movement of the mandible. Since these signs and symptoms resembled those of temporomandibular disorders (TMD), the patient received physical therapy, ie, intra-oral massage and mobilization exercises. Three months later, the myofascial pain had diminished, and the mouth opening had increased. It was concluded that dentists play an active role in the management and/or referral of patients with residual LNB complaints in the orofacial area. In addition, a concise overview is presented of the clinical manifestations, diagnosis, and treatment outcome of LNB. Keywords: dental profession, Lyme neuroborreliosis, physical therapy, residual orofacial complaints