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Reviewed here: Bumann, Lotzmann: TMJ Disorders and Orofacial Pain: The Role of Dentistry in a Multidisciplinary Diagnostic Approach (2002)

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; [url_new=http://www.thieme.com]www.thieme.com[/url_new]

Although dental problemswere once considered to bethe primary etiologic factor intemporomandibular disorders,there has been a growing awarenessthat TMD is a multifactorialdisorder requiring a multidisciplinaryapproach to treatment.This theme is beautifully developedby Axel Bumann and UlrichLotzmann in their contributionto the "Color Atlas of DentalMedicine" series.

The introduction sets thetone, underlining the importanceof a careful evaluation of thefunctional condition of the masticatorysystem. Harmful influencessuch as malocclusion,parafunctional activities, dysfunction,and trauma are covered,as well as the patient's capacityfor adaptation or compensation.What is tolerable to oneindividual may not be to another.

The first major section ofthe text is a thorough discussionof the anatomy of the masticatorysystem, from embryologicaldevelopment to the anatomy andphysiology of the hard and softtissues of the TMJ, the musculatureand jaw movement, the dentition,and finally the relationshipbetween condylar positionand static and dynamic occlusion.The discussion of centricrelation is clear and refreshing.

The second section--probablythe highlight of the book--reviews the traditional methodsof evaluating masticatory movementand function, then developsthe concept of "manual functionalanalysis". This techniqueallows the practitioner to pinpointspecific areas of dysfunctionwhile eliminating other factors.Developed many years ago,but largely ignored by most diagnosticians,manual analysis willlikely become an integral part ofTMJ diagnosis in the future.

In the third section, the authorsdescribe state-of-the-artimaging techniques, includingpanoramic, transcranial, and tomographicradiography, as wellas three-dimensional and magneticresonance imaging. Thereis a valuable interpretive discussionof disk position and TMJabnormalities. David Hatcher, anexpert in this field, comments inthe foreword that "the imagingportions alone would make this avaluable reference text for allpractitioners trying to understandor diagnose patients withcraniomandibular disorders".

The fourth major sectiondiscusses the mounting of castsand occlusal analysis. The authorsinsist that instrumentationshould not be the sole source ofinformation, but a complementto the previously described techniques,and that there are a varietyof adequate instruments forthis purpose.

These four topics are followedby a diagnostic summaryand a classification of TMD. Thebook concludes with a relativelyshort section on the principles oftreatment, emphasizing that ifthe clinician makes a proper diagnosisfor the individual patient,rather than following preconceivednotions of cause andeffect, the treatment may be relativelystraightforward.

Drs. Bumann and Lotzmannstrike a skillful balance betweenillustrations and text, allowingfor easy reading andcomprehension. They also providecurrent and complete referenceswherever possible. Thisatlas will certainly assist any cliniciansin gaining a more completeunderstanding of the etiology,diagnosis, and treatment ofcraniomandibular disorders.


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