Library
APS Bulletin • Volume 18, Number 2, 2008
Resource Reviews
John D. Loeser, MD, Department Editor
TMDS: An Evidence-Based Approach to Diagnosis and Treatment
Reviewed by Edmond L. Truelove, DDS MSD
Daniel M. Laskin, Charles S. Greene, William L. Hylander, (Eds.). Hanover Park, IL, Quintessence Publishing Co, Inc., 2006. Hard cover, 548 pages, ISBN 0-86715- 447-0, $158.00
This authoritative 541-page text on temporomandibular disorders (TMDS) is focused on evidencebased discussions of the biology, pathobiology, psychobiology, and clinical management of disorders of the functional components of the temporomandibular joint (TMJ) and the muscles of mastication. An impressive 43 contributing authors have provided a total of 36 chapters divided into two parts: the first part is devoted to discussions of the basic biology of jaw function in health and disease and the second part focuses on the clinical management of TMDS. Chapters 1-4 are devoted to anatomy, function, adaptive remodeling, and neurology of the trigeminal system. The information is current, well-documented, and simply but effectively illustrated using diagrams that represent functional aspects of jaw movement and histological presentations of normal and progressive joint changes over time. Neurological mechanisms related to jaw function, control, and symptoms are particularly well-covered in the chapter on sensory and motor neurophysiology written by Barry Sessle.
The second section contains five chapters that address the pathophysiology of TMDS with attention focused on mechanisms of persistent pain, muscular pain, arthritis, internal derangements of the meniscus, and systemic disorders that affect the joint. The remainder of the text addresses clinical management from diagnosis through all components of management. Section A provides information about diagnostic modalities used in TMDS including imaging, physiological monitoring, and psychological assessment. The chapter on imaging is particularly well-illustrated and begins with a classification of TMJ disc positions seen in internal derangements. The combination of radiographic and matched anatomic dissections helps the reader understand what the imaging modality detects. Serial images of patients followed over time demonstrating progressive changes of the joint are included. The reader is provided with an excellent set of the most common changes seen with imaging when internal derangements occur or arthritic conditions exist.
Subsequent chapters address the biochemistry of osteoarthritis, use of diagnostic technologies, and psychological assessment strategies for the dental practitioner.
Chapters 15-22 present the clinical side of arthritis, internal derangements, muscular disorders, traumatic injuries, movement disorders of the jaws, fibromyalgia, and neoplasms. The chapters are a useful guide to clinicians who treat TMDS and are further strengthened by the inclusion of Chapter 20, which describes the differential diagnosis of orofacial pain with inclusion of non-TMDS that may present with symptoms often seen in TMDS. A number of useful tables and illustrations are included that help characterize the process of differentiating orofacial pains as neuropathic musculoskeletal, or psychogenic, although many experts would argue that psychological issues represent a second axis seen in those with chronic pain rather than a specific category of orofacial pain.
The remaining chapters (Chapters 23-36) deal with treatment modalities including medications, surgical approaches, physical treatments, and behavioral management. The discussions, to the extent possible, address the topics from an evidence-based perspective using data from the literature rather than personal opinion. Treatment of myogenous pain and movement disorders is addressed in two chapters with specific treatment approaches advocated. The discussion of temporomandibular movement disorders is welcome and has been lacking in many previous discussions of TMDS. The last chapter describes idiopathic condylar resorption, an uncommon, destructive process that is most often seen in teenage and young adult females. The topic is approached from a diagnostic as well as therapeutic perspective. Risks of early intervention are effectively described based on the limited literature available.
The book addresses TMDS with a serious effort to use evidence from the scientific literature as a guide to the summaries provided at the conclusion of each chapter. Although entire texts have been written about some subjects and are only given a chapter in this text, the authors have achieved their goal of condensing the universe of TMDS information into a readable and well-illustrated guide. For the clinician who wishes to enhance the scope of his or her diagnostic and treatment skills for TMDS, the text should prove very useful.
Dr. Truelove is Professor and Chair, Department of Oral Medicine at the University of Washington, Seattle.
