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GAZETTE
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
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.
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.
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
3. Use of the appliance may also
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
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.
TMJ problems are often overlooked
j
when medical or legal professionals
|
are evaluating whiplash cases. It is
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.
!
*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.
•
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.
The effect of this would be as follows:
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