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Tuesday, January 19, 2010

Ankylosing Spondylitis Associated With (TMJD) Craniomandibular Disorder

THIS IS AN INTERESTING ABSTRACT ON TREATMENT OF ANKYLOSING SPONDYLITIS AND TMD TREATMENT COMBINED

I have a patient who we treated many years ago with neuromuscular dentistry who had ankylosing Spondylitis as did his father. We started with a diagnostic work-up that included EMG and MKG and use of ULF TENS to relax trigeminally innervated muscles and created a dianostic orthotic. The patient finished his case orthodntically and has been stable for close to 20 years. The Ankylosing spondylitis resolved (Was this because of neuromuscular dental treatment or an incidental occurence?)

The patient firmly believes the neuromuscular dentistry "saved him" He later married and we treated his wife for severe headaches and vertigo again using neuromuscular dentistry. Her treatment included implants and overdentures but began with a diagnostic orthotic.

The neuromuscular diagnostic orthotic is an essential element in treating TMJ disorders, migraines and Tension Type headaches. After determination of the patients initial condition thru use of EMG (bipolar skin electrodes) MKG (mandibular kinesiograph) or computerized mandibular scan, ULF TENS a neuromuscular bite registration is taken to build the diagnostic orthotic. The orthotic is not 'perfect" at delivery but must be continually adjusted to account for changes in the patients posture and physiology. When the patient is stabilized it is necessary to reevaluate whether the desired results have been obtained ie; relief of headaches, ear pain , joint pain, sinus pain , clicking , locking , migraines or other symptoms. If the patient feels substantial improvement they can opt for a second phase of treatment for long term relief. This can be a cast removable orthotic, Crown and/or bridge reconstruction, implants, orthodontics or jaw surgery. If substantial improvement is not seen non-reversible treatment should be avoided. Sometimes irreversible treatment can be provided but expectations for relief should be minimal if orthotic treatment is not successful. I suggest "Patient Beware" , ask lots of questions and proceed with caution.

Contrast the Neuromuscular Dental approach to the CR or Centric Relation approach that often begins with equilibration (permanent changes to teeth and occlusion) as the first step or treatment. The position is often based on the concept of Bimanual Manipulation. This means that the dentist uses his hand muscles to determine the proper jaw position by manipulating the jaw. This has also been caused "Romancing the mandible" Barney Jankelson the Father of Neuromuscular Dentistry felt that romancing the mandible was a concept that would fall to the wayside when scientific instruments could be used to measure where and how the muscles and joints functioned with physiologic ideals. His famous quote "If it is measured it is a fact , otherwise it is an opinion " described why he felt the old concept of Centric Relation had outlived it usefullness. There have actually been at least 26 different definitions of CR as proponents tried to define an appropriate position for the joint.

Neuromuscular Dentistry is more concerned with creating a healthy condition where the muscles and neuromuscular bite auto-position the condyle of the TM Joint in the proper position.

Publication: World Journal of Orthodontics Winter 2009 Volume 10 , Issue 4

Ankylosing Spondylitis Associated With Craniomandibular Disorder—A Combined Orthodontic And Prosthodontic Therapeutic Approach
Petros T. Koidis, DDS, MS, PhD/Ioanna Basli, DDS/Nikos Topouzelis, DDS, PhD
Ankylosing spondylitis is a disease that causes inflammatory changes of the involved joints. Although the initial clinical signs are pain and discomfort, synovial changes progressively involve all the axial joints, including the temporomandibular joint (TMJ). Eventually, bony alterations develop (condylar erosions, flattening, sclerosis) that affect the position of the condyle, the superior joint space, and the range of movements. These symptoms correlate with the severity of the disease. Besides physiotherapy and surgery, no dental rehabilitation has been reported for these patients. This report of a female patient with ankylosing spondylitis and a TMJ disorder emphasizes dental rehabilitation. The aim of the splint, orthodontic, and prosthodontic treatment was to relieve the subjective symptoms through establishing a stable optimum occlusion. Anamnestic, laboratory, and clinical findings including pre- and postradiographic examination records are presented. World J Orthod 2009;10:371–377.

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posted by Dr Shapira at 7:45 PM

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