Temporomandibular disorders assessment: medicolegal considerations in the evidence‐based era

Abstract

Summary Temporomandibular disorders (TMD) are a frequent finding in cases of facial trauma or dental malpractice, and legal claims for TMD damage have been increased over the years. Temporomandibular disorders assessment in the medical legal setting is complicated by the peculiarities of these disorders, whose symptoms are heterogeneous, fluctuant, and recognise a multifactorial origin. A systematic Medline search in the National Library of Medicine's PubMed database pointed out that, despite the medical legal aspects of the dental profession are gaining a growing attention, there is a paucity of literature dealing with patients with TMD assessment. For these reasons, evidence-based knowledge in the field of TMD diagnosis and treatment was summarised in this article with the aim of providing useful suggestions for a medical legal approach to TMD.

Evolución de la patología oclusal. Una revisión de la literatura.

“…La comprensión de la oclusión debe basarse en el conocimiento de la fisiología y morfología del sistema masticatorio, con el fin de entender las adaptaciones funcionales y el desarrollo de las patologías oclusales. Para tal fin, se realizó una revisión narrativa de la literatura, sobre anatomía de ATM 3-9 , ligamentos 10,11 , músculos [12][13][14][15] , irrigación 10,14 ; sobre conceptos de oclusión normal, así como sobre los cambios generados en: plano oclusal [16][17][18][19][20][21][22][23][24][25][26][27][28][29] , guía anterior [30][31][32][33][34][35] , relación céntrica 36-39 y dimensión vertical [40][41][42][43][44] ; el presente documento se enfoca en el desarrollo progresivo de la patología oclusal.…”

Emergency consultations for malfunctions of the masticatory apparatus

“…Occlusodontic emergencies are similar to traditional medical emergencies and generally require practitioners to act in a tactful and delicate manner because no matter what the particular circumstances may be -spontaneous, accidental, or traumatic causes of the disorder -the symptoms are usually acutely dolorous and anxiety provoking for patients who are subjected not only to pain but also to a handicapping loss of function 26 .…”

“…Orthodontists should never initiate invasive and irreversible treatment for acute TMD problems but instead focus on helping patients ''survive the crisis'' and offering symptomatic relief by reducing pain and improving both function and prognosis 26,31 .…”

“…Orthodontists should attempt to minimize these problems by: -using soothing psychological techniques, reassuring patients about their condition and detailing the treatment solutions that are available for it; -establishing a differential diagnosis that distinguishes functional anomalies of the masticatory system from symptoms of other generalized pathologies (Is this a tempero-mandibular joint disorder, TMD, or is it something else [13][14][15][16][17][18][19][20][21][22][23][24][25][26] ); -establishing a positive diagnosis (type of pathology) 23 ; -establishing a therapeutic regimen, if possible immediately, to reduce pain and restore at least minimal function by eliminating impediments to it 26 ; -establishing a schedule of follow-up appointments during which they can optimize the diagnosis 25 in order to make an accurate diagnosis and institute treatment if indicated.…”

“…It is essential for orthodontists to reassure them, to explain the parameters of the situation, and later, when indicated, to prescribe medication and to begin managing the disorder under optimal conditions [26][27][28] .…”