Phase II rehabilitation of the temporomandibular joint dysfunction patient.

Treatment of pain and dysfunction of the craniomandibular apparatus commonly follows one of two courses, not necessarily independent of each other. In many patients, treatment involves both appliance and non-appliance modalities. A thorough and careful diagnostic evaluation of the patient will help the dentist to select the proper modality of treatment. Following successful Phase I therapy, the patient is now prepared for Phase II therapy, a more definitive treatment stage. The purpose of this article is to provide the reader with the rationale and principles underlying the stabilization and rehabilitation direction of Phase II therapy, emphasizing the prosthodontic and orthodontic perspectives.

Management of the acute TMJ emergency.

The urgent or after hours phone call to the dentist's office usually indicates a dental, traumatic, infectious, or pain emergency relating to the teeth or adjacent supporting structures. One subject not discussed at length in the professional literature is the emergency patient with acute pain or dysfunction of the orofacial musculoskeletal system, primarily the muscles of mastication and the temporomandibular joint (TMJ). The practitioner should be able to rapidly and efficiently diagnose and manage these emergency patients, or make adequate referral as necessary. Essential features in the diagnosis involve distinguishing muscle problems from intracapsular disorders. Knowledge of general medical-dental differential diagnosis is essential to rule out those problems masquerading as muscle or TMJ disorders. Proper emergency management is directed at controlling the pain or hypomobility disorder and stabilizing the patient. Contrary to most other aspects of dental practice, rapid and complete elimination of symptomatology may not be possible at this visit. Subsequent management should further define the pathologic process and direct the patient to additional phases of care. This report suggests a series of diagnostic and therapeutic guidelines.

Mineralization of dentin, bone and tendon in vitro.

Bovin dentin, bone and tendon slices, and rat bone, readily mineralize to variable degrees after demineralization by (EDTA) at pH 7.4, but they fail to mineralize after dimeralzation with acetic acid (HAc) at pH3.0. The demineralized dentin, but neither bone nor tendon, contained organically bound phosphate. The EDTA-demineralized dentin contained less phosphate than HAc-demineralized dentin. HAc-demineralized rat dentin contained high levels of phosphate. Since the EDTA- and HAc-demineralized rat dentin contained widely different levels of phosphate, yet both mineralized, it was concluded that phosphoprotein had little effect on nucleation. The reason why HAc-demineralized tissue other than rat dentin failed to nucleate and mineralize was not clarified.