Orofacial Pain and Oral Medicine

Appliance-Based and Occlusion-Based Treatments for TMJ

Appliance-Based and Occlusion-Based Treatments for TMJ

Occlusal Appliances Occlusal guards have several purposes.  The guards can protect the teeth from wear such as attrition, interrupt oral habits such as clenching, redistribute forces of sore and sensitized teeth, and establish a comfortable occlusal position in a...

TMJ Manipulation & Mobilization Treatments

TMJ Manipulation & Mobilization Treatments

Open Locking TMJ Manipulation This procedure is done to reduce open locking or open dislocation of the TMJ, and it can be done in one of two ways. One method includes grasping the jaw with both hands and placing the molars on the posterior molar teeth and the fingers...

Home-Based Physical Therapy Treatments for the TM Joint

Home-Based Physical Therapy Treatments for the TM Joint

The Myalgia or Myofascial pain protocol (MFP) is a self-directed home-based (and sometimes office-based) treatment approach, which includes several elements such as identifying and avoiding activities that are potentially harmful to the jaw system, increasing local...

Preventive and Avoidance-Based Temporomandibular Treatments

Preventive and Avoidance-Based Temporomandibular Treatments

Preventive and avoidance-based treatments to combat or resolve temporomandibular disorders are essential to relieving chronic pain. These procedures can be administered based on the circumstances or levels of pain. Self-limiting disease or non-progressive pain is an...

Diagnostic Tests for Temporomandibular Disorders

Diagnostic Tests for Temporomandibular Disorders

In this article we'll explore three primary tests to help diagnose temporomandibular disorders: Imaging testsPhysical medicine testsSerologic tests 1. Imaging Tests A. Panoramic Radiographs A panoramic radiograph is utilized primarily to have a general vision of the...

Arthritic Temporomandibular Joint Disorders

Arthritic Temporomandibular Joint Disorders

Arthralgia or Capsulitis Arthralgia/Capsulitis is defined as a painful joint (even without any osseous changes) with increased tenderness to palpation pressure. The clinical history and examination evidence needed for this diagnosis includes: A unilateral or bilateral...

Internal Derangements of the Temporomandibular Joint

Internal Derangements of the Temporomandibular Joint

Internal Derangement is not a diagnosis but a category of conditions and it simply means abnormal function of the intra-articular structures. It is a non-specific term applied as a descriptive subdivision term for the group of non-arthritic TM joint disorders (e.g.,...

How to Diagnose Masticatory Muscle Disorders

How to Diagnose Masticatory Muscle Disorders

Localized Myalgia Localized myalgia is a term used to describe a dull aching continuous which the patient localizes to muscles in the masticatory system (usually the masseter and temporalis) or cervical muscles (SCM and trapezius).  If the myalgia is in...

How to Insert and Adjust Occlusal Stabilization Appliances

How to Insert and Adjust Occlusal Stabilization Appliances

There are four primary elements that form the theoretical basis for an occlusal stabilization appliance: It protects teeth from wear It stabilizes an unstable bite It makes the patient more aware of any oral habit It allows you to reduce loading on a specific...

Oral Laser Ablation Surgery: Step-by-Step Guide for Dentists

Oral Laser Ablation Surgery: Step-by-Step Guide for Dentists

What is a laser? Lasers are an intense, high energy, coherent (travels in a constant phase in time and space), monochromatic (a single wavelength particular to the medium), and collimated (travels in the same direction) electromagnetic radiation that is produced by a...

Step-by-Step Instructions for Performing Oral Cryotherapy

Step-by-Step Instructions for Performing Oral Cryotherapy

Oral Cryotherapy Oral cryotherapy is a very safe, easy to perform, and relatively inexpensive treatment for various selected oral lesions.  You should never perform cryotherapy unless you know the diagnosis of the lesion you to freeze. HPV is associated with papillary...

How to Perform a Jaw Bone Biopsy

How to Perform a Jaw Bone Biopsy

What is a jaw bone biopsy? When you use the term “bone biopsy,” this could mean you are taking a piece of bone or you are taking tissue that resides inside a bone. There are two approaches for a bone biopsy.  A closed/needle bone biopsy involves inserting a needle...

Minor Salivary Gland Biopsy for Diagnosing Sjogren’s Syndrome

Minor Salivary Gland Biopsy for Diagnosing Sjogren’s Syndrome

Minor Salivary Gland (MSG) Biopsy Minor salivary gland (MSG) biopsy of the lower lip mucosa is used to confirm the diagnosis of Sjogren’s syndrome.  Sjogren’s is a chronic autoimmune disorder involving the destruction of glandular tissue. Sjögren's syndrome can cause...

How to Conduct an Oral Cavity Punch Biopsy

How to Conduct an Oral Cavity Punch Biopsy

What is a punch biopsy? An oral cavity punch biopsy is considered the primary technique to obtain diagnostic, full thickness skin specimens.  It is performed using a circular blade or trephine attached to a pencil-like handle.  The instrument is rotated down through...

How to Perform an Oral Biopsy

How to Perform an Oral Biopsy

A biopsy is defined as the sampling or removal of tissues or liquids from the body for examination, in order to determine the existence or cause of a disease.  A biopsy is strongly recommended for most of the lesions that persist for more than two weeks which...

Trigger Point Mapping: Theory & Step-by-Step Technique

Trigger Point Mapping: Theory & Step-by-Step Technique

What is a trigger point? A trigger point is due to sensitized sensory nerves within a taut band of a muscle that when squeezed generates local and referred pain. The cause of a taut band is a hyperactive motor nerve branch, which generates sustained contraction in the...

How to Administer a Gingival Cold Test

How to Administer a Gingival Cold Test

This test is utilized when you have a focal, intraoral, probable neuropathic pain disorder involving a branch of the trigeminal nerve with palpable gingival allodynia/hyperalgesia and no obvious, local dental pathology exists such as tooth fractures, periapical...

How to Perform a TMJ Injection

How to Perform a TMJ Injection

TMJ injections are performed with corticosteroid and anesthetic to produce a two-fold effect: one reduce inflammation with the corticosteroid (triamcinolone acetonide) and two produce anesthesia or pain relief using lidocaine 2% without epinephrine.  Corticosteriod is...

How to Measure Orofacial Pain With a Muscle Tenderness Exam

How to Measure Orofacial Pain With a Muscle Tenderness Exam

In this article, we review ways to assess muscle tenderness and pain.  Common abnormalities of the masticatory muscle include injection induced myositis, myofascial taut band, trigger point, hypertrophy, spasms, etc. Note: Prior to each procedure, introduce yourself...

How to Conduct a Cranial Nerve Examination

How to Conduct a Cranial Nerve Examination

The following equipment is required for a Cranial Nerve Examination: Cotton ball Safety pin Pen torch (source of light) Tongue blade Tuning fork (512 Hz) 1.)  Olfactory Nerve (I) The olfactory is a sensory nerve, and damage in the nasal epithelium or the basal...

Closed Lock Mobilization: TMJ Exercises & Stretches

Closed Lock Mobilization: TMJ Exercises & Stretches

In this article, we'll provice step-by-step TMJ exercises and treatments for Dentists and self-mobilization stretches for patients. The main reason why a jaw locks closed is due to a derangement of the TM joint (disk displacement without reduction or DDNR).  It is...

How to Perform an Occlusal Analysis

How to Perform an Occlusal Analysis

Occlusion, simply defined, is how teeth meet when the lower and upper jaw come together.  Proper occlusion is necessary for eating, aesthetics, and disease prevention.  However, many factors can cause malocclusion including trauma and genetics. Before we cover the...

TMJ Assessment: Jaw Range of Motion, Noise, and Tenderness

TMJ Assessment: Jaw Range of Motion, Noise, and Tenderness

For TMJ mobilization procedures read: Closed Lock Mobilization: TMJ Exercises & Stretches. Jaw Range of Motion Assessment Prior to the procedure, introduce yourself to the patient, explain the purpose of the examination, obtain consent, and be sure to meet...

How to Perform a Lymph Node Examination

How to Perform a Lymph Node Examination

Lymph Node Examination A lymph node evaluation should be included in all new patients as part of the oral cancer triage.  Below is a video showing the proper technique and a written explanation of what is expected from dentists when performing a lymph node and...

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