What happens when conservative care fails? What if you have prescribed patient education and the 'best' occlusal appliance and none of it is working? That's where surgery MAY be indicated for certain diagnoses. Listen or Watch my podcast with Professor Andrew Sidebottom Maxillofacial surgeon (who is limited to the management of TMJDs) to help us make timely and appropriate referrals to provide the best possible outcome for our patients.
https://youtu.be/7m30jvUPlMA
Need to Read it? Check out the Full Episode Transcript below!
Ready to learn the management of Bruxism and TMD online? Click here to enrol to SplintCourse
Protrusive Dental Pearl: Head over to the Protrusive Dental Community Facebook group where I posted an 8-minute walk-through video on how to screen which patients are at risk for getting a bite change or AOB after an occlusal appliance and how you can minimize that risk.
The highlights of this episode:
12:47 Why you need to provide Conservative Care first15:57 TMD is a Spectrum19:21 Early Surgical Intervention?21:42 Acute disc displacement without reduction26:40 Imaging used when managing TMD patients35:10 Pain Management41:03 Arthroscopic procedure for TMD50:29 How much does TMJ Surgery cost in the UK?53:22 Successful management of temporomandibular disorders
Check out these studies as mentioned on the podcast.
Orofacial Pain Prospective Evaluation and Risk Assessment StudyDownload
A Real-Time screening tool to aid management of Post-Traumatic Stress Disorder in facial traumaDownload
Temporomandibular-joints-in-asymptomatic-and-symptomatic-nonpatient-volunteers-prospective-15-year-follow-up-clinical-and-MR-imaging-studyDownload
Also check out Prof. Andrew Sidebottom’s website for more information and download leaflets.
Check out the Tubules Congress in Heathrow October 2022
If you enjoyed this episode, check out Stay away from TMD! [SPLINTEMBER]
Click below for full episode transcript:
Opening Snippet: So I think understanding TMD is about understanding that it's a spectrum of care from joint related right down to muscular related, and patients are somewhere in the middle of that. Probably about 90% of the patients I see down at that muscular end as you say.
Jaz's Introduction:What happens to our TMD patients when conservative care fails? Like you've done your patient education, you've given him the best occlusal appliance, you've worked alongside your TMJ physiotherapist, you've been through exercises, and you've even counseled them about the importance of recognizing awake bruxism, a huge player, and all this stuff isn't working. What happens next? Well, depending on your diagnosis, the next step for some patients will be see a maxillofacial surgeon, but not any old maxillofacial surgeon, you ideally want to send someone who's got an interest in TMJ and TMD. So I've got today a private physician, private maxillofacial surgeon in the UK, who exclusively treats TMD. So what this guy doesn't know about surgery and TMJ. And what happens in the latter parts once conservative care fails, how the referrals manage, when should we refer these patients, which patients are suitable for referral to Maxfax, once conservative care fails. Let me give you a clue, if your primary diagnosis is muscular, then really, you know, really need to go and exhaust conservative care and the physio and by the way, most TMDS are of a muscular nature that myalgia and myofascial pain and there's no real scope for surgery when it comes to muscles that are upset. That's when we really to give the best conservative care we can and involve a pain specialist sometimes potentially Botox and lots more which we will discuss.
Now if you want to learn more about occlusal appliances, bruxism as a GDP as a restorative dentists who wants to just not be afraid of doing a TMJ exam when the patient comes into an emergency slot and they're complaining of pain from their jaw,
