Journal of Craniomandibular Function, 02/2010

The T-Scan III system introduced in the present paper allows fast and easy digital recording of occlusal contacts, including the exact time at which the contacts occur and the resulting force distribution. The tests achieved 80.5% conformity in the values measured with the T-Scan III system with the control results of the Greifswald Digital Analyzing System over the entire study population. An analysis of the test results determined that there is a very high degree of conformity between the values measured in the posterior region for all study subjects, and in the anterior region for the part of the study population with craniomandibular dysfunctions. Only in subjects who were healthy with respect to function, did the values for the anterior region show a lower conformity (61.8%). Keywords: electronic occlusal diagnosis, GEDAS, T-Scan III

Das Ziel des vorliegenden Beitrags besteht darin, ein praxistaugliches Konzept vorzustellen, mit dem in der niedergelassenen Zahnarztpraxis Patienten mit orofazialen Schmerzen zeitgemäß betreut werden können. Als besonders hilfreich erweist sich in der Diagnostik von Patienten mit kraniomandibulären Dysfunktionen (CMD) die Anwendung der RDC/TMD-Kriterien, einem international anerkannten und validierten Verfahren, unter differenzialdiagnostischer Einbeziehung anderer orofazialer Schmerzdiagnosen mittels Checklisten. Durch eine Priorisierung von Therapieoptionen bei der Behandlung von CMDPatienten hat sich die evidenzbasierte Zahnmedizin einen festen Platz in der Praxis erobert. Die richtige Gewichtung von Ergebnissen aus wissenschaftlichen Studien mit der klinischen Expertise des Behandlers ermöglicht dem Zahnarzt - in Abstimmung mit dem Patienten - eine zielführende und effiziente Therapiestrategie innerhalb seines Therapeutennetzwerks. Keywords: Praxiskonzept, orofazialer Schmerz, kraniomandibuläre Dysfunktion

The mechanosensors that are located within the periodontal ligament (PDL) are most sensitive to the minimal forces that act upon them when touched without any force1. Accordingly, the moment of occlusal contact is perceived more easily if the patient only touches the occlusal surfaces without putting any load on them. In order to achieve this behavior, patients can be effectively instructed during treatment. They are familiarized with imagining the dental substance as being fragile and not able to take any load, and they are asked to act accordingly. This line of thought only permits a cautious touching of the occlusal surfaces and forbids any masticatory pressure. If the activity of the stomatognathic organ consists in the occlusal surfaces only touching each other, this is not a modification of masticatory activity, but the opposite of masticatory work. Like in other sensorimotor organs, in the stomatognathic organ one has to differentiate between a working strategy, which is supposed to produce an output, and a cognitive strategy, which is supposed to impart a perception. The task of touching the "fragile" tooth surfaces leads to a change of strategy that turns the masticatory organ that does the chewing work into a tactile organ. In restorative dentistry, new occlusal defects can be clearly detected and eliminated by employing a corresponding cognitive strategy. In functional diagnostics, the change of strategy is the basis for a fast and complete reduction of increased muscle tone. As a result, premature contacts can be diagnosed reliably. Keywords: sensorimotor function, cognitive strategy, working strategy, focused attention, muscle tone reduction, diagnosis of premature contacts

While the first part of this paper outlined the general aspects of communicating with CMD patients, the present article will describe the specific communication processes for the examination and consultation of patients with chronic pain. It will detail how to communicate with patients about their history and findings and will describe a procedure for the psychological consultation of CMD patients. Each individual element of this procedure serves a common purpose: to enable the patient to experience that they are capable of influencing their disorder and to thus motivate them to actively participate in their treatment. Keywords: communication, CMD, psychology, consultation, behavior therapy, hypnosis, functional findings, functional therapy