SPECIFIC THERAPY 1 Myofascial pain withwithout limitation SPECIFIC

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation : - INFORMATION (parafunctions), CBT

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation : - INFORMATION - physical therapy (home + professional), including heat, massage, ultrasound, horizontal stretching. In case of limitation : active exercises mouthopening

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation : - INFORMATION - physical therapy (home + professional), including heat, massage, ultrasound, horizontal stretching. In case of limitation : active exercises mouthopening - in case needed : biofeedback

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation : - INFORMATION - physical therapy (home + professional), including heat, massage, ultrasound, horizontal stretching. In case of limitation : active exercises mouthopening - in case needed : biofeedback - long standing myofascial pain : stretch and spray – trigger point injection

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation In case of persisting problems in the morning (fatigue, stiffness, pain) – nightly parafunctions : protective splint

AND OCCLUSION …? Ø No arguments to change or optimise occlusion to “influence” parafunctions…. Ø Steeper or increased canine guidance might “protect” the premolar-molar teeth better against abrasion

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) : - without pain : - INFORMATION

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) : - without pain : - INFORMATION - instructions : relaxation, rotation, ipsilateral or protrusion , exercises

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) : - without pain : - INFORMATION - instructions : relaxation, rotation, ipsilateral or protrusion , exercises - in case of locking in the morning : stabilisation or repositioning splint

AND OCCLUSION …? Longitudinal research has proven that long term succes rate of “Phase 2” treatment for clicking is insuffcient (40 -50 percent) Sometimes depending on clinical situation : - clicking during maximal occlusion - complete denture

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) : - without pain - with pain : first treat the pain : - relaxation, physical therapy, medication

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) Anterior disc displacement without reduction with/without limitation

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) Anterior disc displacement without reduction with/without limitation : - INFORMATION - physical therapy + medication - after pain decrease : increasing mouth opening - sometimes a splint for the night (if pain)

SPECIFIC THERAPY Ø 1. Myofascial pain with/without limitation Ø 2. Anterior disc displacement with reduction (clicking joint) Anterior disc displacement without reduction with/without limitation 3. Arthritis, arthrosis, arthralgia : - INFORMATION, rest, medication - physical therapy - dorsal support - part of generalised treatment

AND OCCLUSION …? Ø Decent dorsal support in addition to correct instructions for use

So : “occlusal treatment…” ? Ø Very few patients need occlusion oriented treatment in view of their pain/dysfunction. Ø Also in orthodontic therapy, the end goal should encompass ‘stability in a physiological maximal occlusion’ Ø Stabilisation appliance : OK, Repositioning appliance : seldom or never…

Some final thoughts regarding orthodontics and (dys)function Ø Occlusion is only a part of a complex system, with varying characteristics (laxity, growth, , …) and orthodontics intervenes during an important period Ø Importance of (mini-) trauma, including (orthodontic) treatment Ø “Dynamic overloading” much more dangerous than “static imperfection”

THANK YOU !