The Gazette 1993

GAZETTE

Evaluation of the Patient

This should include patient history and presenting symptoms.

Objective findings

1. Radiology - a. Loss of lordotic curve - b. Cranial extension - c. Posture displacement of mandible MRI scan - Displacement of the disc.

Mandibular repositioning will decrease the hyperstimulation of the trigeminal nerve by restoring normal masticatory muscle function and a normal cranial cervical relationship Figures 6 and 7

biofeedback. Surgery may be required in extreme cases. Experience in dealing with trauma induced TMJ patients where the immediacy of the trauma gives the observer the total picture of the causes and effects of the dysfunction, points to aetiology as the key factor in determining treatment. Interdisciplinary evaluation and treatment is essential and leads to a high success rate in the treatment of this painful condition. A correct diagnosis will thus establish a direct causal relationship or not to the accident which is obviously essential in assessing damages for what in many j cases is a permanent injury. j therefore important if a client presents j with any of the symptoms previously described, that the question of a TMJ involvement should be looked at. ! TMJ problems are often overlooked when medical or legal professionals are evaluating whiplash cases. It is j | *Dr Meurig Devonald, Dental Surgeon, works at the Haddington Clinic, Ballsbridge, Dublin 4. He limits his practice to the treatment of TMJ disorders and craniofacial pain. •

1. The muscles of mastication are allowed to relax which relieves the spasms which cause the headaches and facial pain. One has to remember that 80% of headaches are muscle spasm related and the major muscles in the head are related to the function of the mandible. 2. Forward mandibular repositioning creates anterior forces on the cervical vertebrae and helps in reforming a normal lordotic curve and also increases the distance Í between the cervical vertebrae thus reducing neck pain. Failure to appreciate the significance of this characteristic explains why many chronic neck problems fail to resolve as the cause of the problem ; is distant from the point of pain and thus undiagnosed. I j recapture the disc as shown in figure 6 and 7. Restorative procedures may have to be done on the teeth to j stabilise the jaw in its new position j after treatment is completed. j Other treatments would include - Manipulative medicine, physiotherapy, trigger point injection, transcutaneous, electrical nerve stimulation (TENS), ! ultrasound, head and coolant therapy, spray stretch exercises and 3. Use of the appliance may also

Medical History

Interdisciplinary Evaluation

Neurology - Negative Orthopaedics - Negative ENT - Negative

Observe for:

• tenderness to palpation, • masticatory musculature, • cervical musculature, • TMJ joints - pain with or without clicking, • sub occipital musculature,

• head forward position, • range of motion studies,

Interdisciplinary evaluation must be utilised to rule out any organic causes of pain related to other medical specialities. Then a proper referral should be made to a specialist in head, facial and neck pain and TMJ orthopaedics. Treatment must be based upon a specific diagnosis for a specific problem otherwise it will only result in symptomatic relief which will be temporary in nature. Of the many treatment techniques available one of the most successful is the repositioning of the mandible and utilising an intraoral mandibular orthopaedic repositioning appliance (splint). The purpose of the appliance is to bring the mandible downwards and forwards.

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The effect of this would be as follows:

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