Clinical Management of Temporomandibular Disorders and Orofacial Pain.

Pertes RA, Gross SG, eds. Carol Stream, Ill 601 88, Quintessence Publishing Co, 1995, paperback, 368 pp, illus, $58.

Pertes and Gross, both dental school professors, edited this comprehensive book for clinicians and students. Twenty-four clinicians, including dentists of varying specialities, anesthesiologists, radiologists, physical therapists, psychologists, psychiatrists, and a neurologist contributed to the text. The authors make complex issues more understandable by using many illustrations and examples.

The first section, "Diagnostic Foundations," has an excellent chapter on the cervical spine by John Dunn and Jeffrey Mannheimer, both physical therapists. Posture of the cervical spine in relation to craniofacial pain and temporomandibular disorders is covered adequately. Cervical range of motion is shown by illustrations; however, no mention is made or illustration is shown of how this measurement is obtained, such as by use of inclinometers. Also, surface electromyography as a tool for determining the amount of muscle activity is mentioned only briefly and without a description of how this type of analysis can be useful in understanding muscle imbalance of the cervical and facial area.

The second section, "Temporomandibular Disorders (TMD)," continues with descriptions of examination procedures for such problems as disk displacement, degenerative disease, muscle disorders, and congenital disorders. This section has many excellent illustrations of pathology as seen by magnetic resonance imaging, computed tomography scan, and photography. Travell's trigger-point evaluation of referral patterns and treatment are presented in depth in a chapter on muscle disorders. The role of the disk in TMD is covered, including the manual mobilization procedure used to reduce a displaced disk.

Although management of TMD and orofacial pain (OFP) is a part of all sections, the third section specifically discusses appliance therapy, surgery, physical therapy, pharmacology, and behavioral-psychosocial care. Case studies highlight chapter 17 by providing a comprehensive look at long-term management of patients with TMD.

The role of physical therapy in management of patients with TMD and OFP is reviewed by Mannheimer. According to the author, the heat intensity of choice is 3-MHz ultrasound, applied for 3 to 5 minutes while the joint is being stretched by tongue depressors or a device developed for this joint, the Therabite. The chapter also describes a superficial heating or cooling modality known as the Thermoset, a headphone-like divide that fits over the joint. The Cryostim Probe is also discussed as another recent tool for applying cold to the area during stretch. This probe allows the clinician to depress the soft tissue for stretching while giving a cold treatment and maybe especially good for those who cannot tolerate a vapocoolant spray. Additional treatment procedures and tools are given, followed by therapeutic exercises for specific problems such as abnormal mandibular movement. The author reminds the clinicians to make use of biofeedback equipment to assist the patient in being aware of and then learning to control self-perpetuating pain patterns such as bruxism.

Long-term studies continue to suggest that restorative treatment by dentists is not indicated in many of the patients with occlusional problems. This makes it necessary for the dentist to refer patients with masticatory problems to other health professionals, especially physical therapists who assist with muscle stretching and strengthening, relaxation of muscles, pain relief, and improved posture pat terns. Physical therapy professionals need to be prepared to understand the pathology and to evaluate and treat such disorders. This book, in addition to other recent publications such as Bell's Orofacial Pains, will be helpful for clinicians who want to expand their knowledge concerning diagnosis and management of orofacial pain and TMD.

Mary Lee Bergeron, PT The Therapy Center Knoxville, Tenn

Ms Bergeron is Director of Quality Assurance at The Therapy Center, where she oversees both physical therapists and occupational therapists. She also uses surface electromyography for pain management.