Journal of Craniomandibular Function, 04/2014

Pain-associated psychological and psychosocial findings are the rule in patients with persistent orofacial pain. In German-speaking countries, the overall impairment of the subjective state of health (unspecific adverse health effects) is often determined using the Beschwerden-Liste, of which there are two versions (B-L and B-L'). The aim of this study, carried out on 98 orofacial pain patients, was to determine the correlations between both of these questionnaires, and the health strain associated with other pain parameters (duration and extent of existing pain, pain-descriptive adjectives, depressive preoccupation; pain-related impairment of daily activities). The B-L and B-L' resulted in almost identical average sum-total values (26 and 27, respectively), representing a severe health strain. Unspecific adverse health effects were shown to rise proportionally with increasing pain distribution. Strong correlations were shown between the extent of the health strain and the degree of agreement with the pain descriptors, the degree of depressive preoccupation, and the severity of pain-related impairment in everyday life. It was concluded that: (1) It is sufficient to use one of the two versions of the Beschwerde- Liste; and (2) due to the pronounced pain-related non-somatic findings, they should be included in pain diagnosis and therapy. Keywords: depressive preoccupation, facial pain, pain descriptors, pain distribution, pain duration, pain measurement, somatization

There appears to be no consensus as to what defines an adequate occlusion. Dentists still resort to the generalized concept of static ideal occlusion. However, the concept is questionable in the light of evolutionary theory. During evolution the dentition was subjected to functional wear that is almost non-existent today. Occlusions changed constantly, and cusps did not persist to old age. The recent change in morphology is a possible source of the problems experienced today in function. The low sensory threshold of periodontal mechanoreceptors protects the teeth from trauma. The effect of direct contacts between minimally worn teeth tends to move them not only axially but also in non-axial directions, in analogy with the effect of small hard particles in food. This may disturb the function of the muscles of mastication because adaptation to such contacts was not needed as long as wear eliminated them. Instead of determining the degree of conformity with a static gross morphological norm, actual load distribution on the teeth over the whole range of contact movements appears a valid variable in the assessment of the quality of occlusion. Keywords: classification, functional tooth wear, temporomandibular disorders, variation in occlusion

For years, many different concepts of etiology and resultant treatment recommendations for temporomandibular disorders (TMDs) have been presented. Unfortunately, a clear consensus has not been achieved. For the time being, much effort has been focused on the understanding and treatment of TMD as a chronic pain problem with subsequent affective, emotional and cognitive distress, including all possible psychosocial factors. This enlarged, comprehensive aspect of TMD has been stressed by several researchers, as well as many clinicians. It has added a new dimension towards a more individualized treatment regimen for the TMD patient, which has been highly appreciated. The use of a variety of simple, conservative and non-invasive therapies has been evaluated and strongly advocated. Unfortunately, this has led to a situation where clinically well-functioning treatment concepts that have been used for many years have been discarded. In particular, all kinds of irreversible modalities, including occlusal adjustment, have been rejected. Recently, even legal, moral and ethical aspects concerning irreversible interventions for treating TMD problems have been more widely discussed. From having been the most important factor for the development of TMDs, occlusion and occlusal factors are nowadays more or less neglected as causal factors, and occlusal treatments are not appreciated by many leading authorities. This has led to a controversy between clinicians still using occlusal treatments when needed, in addition to conservative modalities, and researchers who do not accept occlusal treatments as relevant in the treatment of TMD. On the other hand, most authorities, dental textbooks and other literature sources regard occlusal factors to be of great importance in all other dental treatments to achieve a good treatment outcome. What should the clinician think? Why is there a difference between TMD and other clinical areas in dentistry? Do we have evidence for continuing to use occlusal treatment modalities in clinical dentistry, including TMD?

The method of recording mandibular movements was first introduced in dentistry as a tool for treatment planning decades ago. The objective is to capture condylar movement data for patient-specific programming of articulators with individualized adjustment. Apart from that, current systems now enable the clinician to analyze the acquired mandibular/ condylar movement recordings in order to obtain insight into the morphological situation of the temporomandibular joint region. The latest application for analysis of the recorded jaw-motion data allows a functional monitoring of the patient as a diagnostic and surveillance tool accompanying treatment. Parameters for the analysis of such recordings have already been published. However, so far a standardized and practicable protocol for the documentation and analysis of jaw-movement recordings is still lacking. Such a diagnostic protocol and the respective documentation guidelines are presented in this article by a multicenter group of authors.