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TMJ Disorders and Orofacial Pain: The Role of Dentistry in a Multidisciplinary Diagnostic Approach

360 pages. 1,304 illustrations. $199. 2002.
Thieme New York
333 Seventh Ave.
New York, NY 10001
(800) 782-3488; www.thieme.com

Although dental problems were once considered to be the primary etiologic factor in temporomandibular disorders, there has been a growing awareness that TMD is a multifactorial disorder requiring a multidisciplinary approach to treatment. This theme is beautifully developed by Axel Bumann and Ulrich Lotzmann in their contribution to the "Color Atlas of Dental Medicine" series.

The introduction sets the tone, underlining the importance of a careful evaluation of the functional condition of the masticatory system. Harmful influences such as malocclusion, parafunctional activities, dysfunction, and trauma are covered, as well as the patient's capacity for adaptation or compensation. What is tolerable to one individual may not be to another.

The first major section of the text is a thorough discussion of the anatomy of the masticatory system, from embryological development to the anatomy and physiology of the hard and soft tissues of the TMJ, the musculature and jaw movement, the dentition, and finally the relationship between condylar position and static and dynamic occlusion. The discussion of centric relation is clear and refreshing.

The second section--probably the highlight of the book--reviews the traditional methods of evaluating masticatory movement and function, then develops the concept of "manual functional analysis". This technique allows the practitioner to pinpoint specific areas of dysfunction while eliminating other factors. Developed many years ago, but largely ignored by most diagnosticians, manual analysis will likely become an integral part of TMJ diagnosis in the future.

In the third section, the authors describe state-of-the-art imaging techniques, including panoramic, transcranial, and tomographic radiography, as well as three-dimensional and magnetic resonance imaging. There is a valuable interpretive discussion of disk position and TMJ abnormalities. David Hatcher, an expert in this field, comments in the foreword that "the imaging portions alone would make this a valuable reference text for all practitioners trying to understand or diagnose patients with craniomandibular disorders".

The fourth major section discusses the mounting of casts and occlusal analysis. The authors insist that instrumentation should not be the sole source of information, but a complement to the previously described techniques, and that there are a variety of adequate instruments for this purpose.

These four topics are followed by a diagnostic summary and a classification of TMD. The book concludes with a relatively short section on the principles of treatment, emphasizing that if the clinician makes a proper diagnosis for the individual patient, rather than following preconceived notions of cause and effect, the treatment may be relatively straightforward.

Drs. Bumann and Lotzmann strike a skillful balance between illustrations and text, allowing for easy reading and comprehension. They also provide current and complete references wherever possible. This atlas will certainly assist any clinicians in gaining a more complete understanding of the etiology ,diagnosis, and treatment of craniomandibular disorders.



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