Current Controversies in Temporomandibular Disorders.

McNeill C, ed. Chicago, IL 60188-1881, Quintessence Publishing Co Inc, 1992, hardback, 194 pp, illus, $58.

The intent of this text is not to be an all-inclusive book about temporomandibular disorders (TMD), but, as the title suggests, a book based on various current clinical ideas and options in the management of TMD. Written by 14 people who are experts in the field, it is a summary of the proceedings from the 10th annual meeting of the Craniomandibular Institute, held in Squaw Valley, Calif, in January 1991.

The book is divided into four main sections, each of which represents one of the four days of the symposium. Following each section is a narrative of the panel discussion on that day's topics. These discussions are extremely relevant to current practice and are helpful in tying ideas and clinical concepts together. Also, a panel discussion focusing on defining and differentiating between temporomandibular and craniomandibular disorders precedes the text, and is helpful in clarifying the terminology used during the symposium and in the book.

Section 1 encompasses the prevalence and etiology of TMD, the associations between both headaches and bruxism and TMD, congenital and developmental conditions, signs and symptoms of TMD, and masticatory muscle disorders and muscle pain in TMD.

Section 2 covers etiologic factors contributing to TMD, including metabolic factors, psychological factors, musculoskeletal biomechanics of the mandible, and occlusal factors. This section ends with an excellent chapter on the scientific design constraints that are related to clinical studies of TMD and occlusion, shedding some light on the lack of current evidence that would tie TMD to occlusal factors.

Section 3 covers the evaluation and diagnosis of TMD. This includes history and examination, and various diagnostic techniques such as magnetic resonance imaging, diagnostic injections, electromyography, tomography, cephalometry, and measurement of jaw motion. This section includes a chapter on the validity of psychological testing in patients with TMD. It focuses on the standard written psychological tests such as the Minnesota Multiphasic Personality Inventory, but fails to include other areas of psychological screening such as inconsistent objective findings, and the many short-form questionnaires that are now in use and that may be given by nonpsychologists to determine the need for psychologic intervention.

Section 4 concludes the book by addressing the management of TMD. It covers various topics such as pharmacology, home care and behavioral therapy, dental appliances, and surgeries including arthroscopy. Section 4 also includes a brief summary of the use of physical therapy in the management of TMD. This chapter, although written by an advocate of physical therapy, falls far short of describing the different roles and numerous treatment interventions that physical therapy can provide. Also absent was any information on interaction between the dentist and the physical therapy practitioner and how it can benefit the patient.

This text is most appropriate for dentists involved in the treatment of TMD. Physical therapy practitioners, physicians, and other health care practitioners involved in the care of these patients may also find this book useful. Entry-level students and anyone with a limited background in this field may find this book to be difficult reading because it has no introductory chapters and because it is assumed that the reader has a good knowledge not only of the terminology involved, but also of what is currently going on in the field. Overall, the writing is excellent. Each of the 30 chapters more closely resembles a separate journal article. The illustrations and photographs are helpful and well done. In summary, I found this book much more interesting than a typical text on TMD because it is extremely current and relevant to today's issues.

David Levine, PT The Univ of Tennessee at Chattanooga Chattanooga, Tenn