Temporomandibular Disorders: TEN RULES

Logo GSID definitivo alta risoluzioneGUIDELINES OF THE ITALIAN STUDY GROUP ON CRANIOMANDIBULAR DISORDERS: TEMPOROMANDIBULAR DISORDERS

(Daniele Manfredini, 2017)

1. Temporomandibular disorders (TMDs) are musculo-skeletal conditions…not occlusal pathologies [AADR Statement, 2010]!

2. The onset of TMD signs and symptoms is rarely attributable to a single etiological factor (multifactorial etiopathogenesis) [Klasser et al., 2017].

3. TMD diagnosis is based on clinical assessment and history taking [Schiffman et al., 2014].

4. None of the available “technological” devices (e.g., electromyography, kinesiography, postural platforms, condilography, other electronical recordings) has diagnostic value, because they do not correlate with symptoms [Manfredini et al., 2011]. The best diagnostic instrument is our brain!

5. Imaging techniques (Magnetic Resonance [MRI], Computerized Tomography [CT]) are required in selected cases and/or as a second-step diagnostic assessment in individuals who do not respond to common conservative treatment [Petersson, 2010].

6. TMD treatment is seldom a true causal therapy [Greene, 2001].

7. TMD treatment is often provided in the form of symptoms management, with focus on the psychosocial correlates of pain [List & Axelsson, 2010].

8. Symptoms management can be usually achieved by means of conservative and reversible approaches (e.g., counseling; physiotherapy; cognitive-behavioral treatments; physical therapy; oral appliances without predetermined occlusal designs; pharmacotherapy for pain control; arthrocentesis) [Manfredini et al., 2011].

9. Irreversible occlusal treatments (e.g., orthodontics; prosthodontics; occlusal adjustments; oral appliances to search for an “ideal” interarch relationship) are not recommended and should not be used to prevent and/or treat TMDs [Manfredini et al., 2016].

10. Patients with chronic pain require a multimodal approach managed by an expert in orofacial pain, with focus on phenomena of central sensitization and maladaptive pain experience [Harper et al., 2016].

10bis. Evidence-based dentistry and professional deontology require clinicians to consider the patient (and his/her pain), and not the dentist (and his/her unuseful technicisms and dogmaticms), as the fulcrum of the diagnostic and treatment program [Reid & Greene, 2013]!

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Decalogo TMD 2017

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