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Difference between revisions of "4° Clinical case: Temporomandibular disorders"

4° Clinical case: Temporomandibular disorders (view source)

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== Abstract ==
{{ArtBy|autore=Gianni Frisardi}}
[[File:Clicker 00.jpg|left|350x350px|alt=]]
The chapter explores the complexities of diagnosing and treating temporomandibular disorders (TMD), challenging traditional views of malocclusion. It emphasizes the need to relate occlusal morphology to trigeminal neuromotor responses. A case study shows that a subject with occlusal abnormalities exhibits perfect trigeminal system symmetry, suggesting that not all occlusal issues lead to masticatory disorders.
 
The narrative highlights a shift towards 'Functional Neuro Gnathology' (NGF method), which prioritizes masticatory system functionality over structural aspects. This approach is represented by a new diagnostic model, '<math>\Psi</math>Index'  is the datum of aiming to align dental practice with neurological insights for comprehensive TMD evaluation.
 
The chapter cites a study by Ahmad and Schiffman, noting that 4.6% of the US population is affected by TMD, with annual management costs around $4 billion. This underscores the economic and healthcare significance of accurate TMD diagnosis and treatment. The discussion covers overlapping symptoms between TMD and other craniofacial conditions, complicating diagnosis. Traditional methods may not distinguish between different causes of similar symptoms. The text advocates for an indeterministic and probabilistic view of medicine to better address the multifaceted nature of TMD. Clinical cases illustrate that TMD symptoms can mask serious conditions like hemimasticatory spasm or meningioma, highlighting the need for comprehensive diagnostic approaches. The NGF method incorporates trigeminal electrophysiological tests to assess neuromuscular interactions and abnormalities related to TMD.
 
A patient named "Clicker" exemplifies the NGF method's practical application. Despite previous treatments focusing on symptom management, the NGF method provided a definitive diagnosis by examining neuromuscular responses. Detailed trigeminal electrophysiological testing revealed a functional disorder due to asymmetry in jaw jerk responses, influenced by unbalanced peripheral input.


Further examination identified a malocclusion contributing to the symptoms, addressed through neurognathological rehabilitation that restored neuromuscular function. The narrative calls for integrating neurophysiological assessments in dental practice, advocating a holistic approach to TMD management that considers both dental and neurological aspects. This aims to improve diagnostic accuracy and treatment outcomes, addressing root causes rather than just managing symptoms.
'''Abstract:''' This article explores the complex relationship between Temporomandibular Joint Disorders (TMD) and Orofacial Pain, as highlighted by Ahmad and Schiffman, who reported that 4.6% of the U.S. population is affected by these conditions. The cost of managing TMDs is considerable, yet their diagnostic complexity often leads to delays in appropriate care. A critical element in the differential diagnosis between orofacial pain and TMD is the high incidence rate of the condition, which can distort the predictive value of diagnostic tools like Bayes' theorem. Moreover, while TMD is the second most common chronic musculoskeletal condition after low back pain, its symptoms often overlap with other pathologies, making diagnosis even more challenging.


This examination promotes understanding the interconnected nature of craniofacial disorders and the benefits of integrating neurognathological insights into dental practice for more effective TMD treatments.
Through clinical case examples, this study underlines the limitations of current gnathological approaches, which focus predominantly on dental occlusion without sufficiently considering the neuromotor network. The Neurognathological Functional (NGF) method is introduced as a paradigm shift in diagnosing and treating TMDs, emphasizing the role of trigeminal neuromotor responses over occlusal parameters alone. This method utilizes advanced trigeminal electrophysiological techniques, such as the bRoot-MEPs (bilateral motor evoked potentials), to assess the organic and functional integrity of the trigeminal system and restore masticatory function through neuro-evoked centric rehabilitation.
 
{{ArtBy|autore=Gianni Frisardi}}


The study also discusses mandibular spatial analysis and its role in determining the optimal occlusal position, moving away from manual and traditional methods. Clinical results from patients treated with the NGF method reveal improvements in both neurophysiological symmetry and masticatory function. Furthermore, the article delves into the broader neuro-occlusal correlation, showing that chewing and occlusal patterns can influence brain activity and potentially affect neurodegenerative diseases.


In conclusion, TMD and orofacial pain require a more integrated diagnostic approach that considers the trigeminal system's role in masticatory and neuromotor function. The NGF method offers a new perspective on TMD management, addressing both the dental and neurological aspects of the condition for a more precise and effective treatment.
===Introduction===
===Introduction===
An article by Ahmad and Schiffman<ref name=":0">Mansur Ahmad, Eric L Schiffman. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/26614951/ Temporomandibular Joint Disorders and Orofacial Pain.] Dent Clin North Am. 2016 Jan;60(1):105-24. doi: 10.1016/j.cden.2015.08.004.Epub 2015 Oct 21.</ref> revealed interesting elements that call for a more in-depth analysis of the TMD phenomenon. The authors reported, in fact, that about 5-12% of the US population is affected by TMD and the annual cost of TMD management, excluding imaging costs, is about $4 billion. Interview Survey (NHIS) that included a total of 189,977 people, 4.6% (n = 8964) had temporomandibular joint and muscle disorders (TMJD).
An article by Ahmad and Schiffman<ref name=":0">Mansur Ahmad, Eric L Schiffman. [https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/26614951/ Temporomandibular Joint Disorders and Orofacial Pain.] Dent Clin North Am. 2016 Jan;60(1):105-24. doi: 10.1016/j.cden.2015.08.004.Epub 2015 Oct 21.</ref> revealed interesting elements that call for a more in-depth analysis of the TMD phenomenon. The authors reported, in fact, that about 5-12% of the US population is affected by TMD and the annual cost of TMD management, excluding imaging costs, is about $4 billion. Interview Survey (NHIS) that included a total of 189,977 people, 4.6% (n = 8964) had temporomandibular joint and muscle disorders (TMJD).
Gianni
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