Policy on the Screening, Diagnosis, and Treatment of TMJ Pathology and Facial Pain in the UDM Undergraduate Clinic
The intent of this policy document is to outline the limits of care, consistent with NIH guidelines, which can be predictably and consistently provided in the UDM undergraduate dental clinic.
1. Screening : Due to longer appointment times required by our students, patients with the following signs or symptoms of TMJ disk displacement or muscle dysfunction should not be accepted for treatment in the undergraduate dental clinic: limited jaw motion; painful and/or harsh TMJ clicking; pain in the preauricular, temporal or ramus area accompanying jaw movement; sudden-onset malocclusion.
2. Diagnosis: The occasional patient may develop some of the above signs and symptoms while under our care, or present with asymptomatic occlusal wear. NIH policy outlines the use of palliative and reversible management only. Patient education, self-care programs of moist heat, rest, and over-the-counter NSAIDs are appropriate. A soft diet and heightened awareness to avoid oral habits may also be recommended.
When a patient is identified with any of the above signs and symptoms, or
an occlusal guard is indicated due to excessive occlusal wear, please request
a consultation from one of the two faculty experts based on availability: Coverage is not always available at UHC. Your patient must be willing to come to the Outer Drive Campus for the consultation only.
- Dr. John Brand
Contact Deverly at - 46670 to set up an appointment time for you and your patient.
- Dr. Adry El Geneidy
Leave a phone message (-46679) or e-mail at elgeneak@udmercy.edu. Dr. El Geneidy will arrange to meet with you and your patient.
If clinical management is required after the diagnosis is made, the consultant will recommend what procedures and follow-up will be needed, and whether or not he/she will need to see the patient again.
3. Occlusal Guard:
If an occlusal guard is indicated, the consultant may delegate fabrication and follow-up to a supervising faculty member comfortable with the procedures. The occlusal guard should be done after Phase II so that changes in the size and shapes of teeth do not interfere with the fit of the guard unless the patient is in pain.
Casts should be poured in dental stone (buff) and mounted on a semi-adjustable articulator with a facebow transfer in ICP by hand articulation.
Please ask the lab to design your occlusal guard with the following characteristics:
Please fabricate an occlusal guard of clear methylmethacrylate resin with full coverage of all teeth (specify maxillary or mandibular guard) with 1-2 mm thickness over the molars. Create occlusal contacts of the buccal cusps and incisal edges of the opposing dentition in a comfortable, relaxed jaw position (ICP or habitual centric). Create anterior guidance in protrusive and canine guidance in lateral excursions. Posterior teeth move out of contact with the splint with any movement from the habitual closure position. The peripheral margins of the splint must provide retention and stability from the extensions over the height of contour on the facial surfaces of all teeth, or when undercuts are not available, ball clasps may be used. Lingual peripheral margins extend 5mm beyond the CEJ of the teeth to give strength to the appliance.
Procedure code is 9940-occlusal guard acrylic, and 6 cpus are given by Dr. Hoelscher in Operative Dentistry.
Splints are sent to Edward J Laboratory.
Phone number is: 586-774-3600.
Contact person is Mr. Doug Kusmierz.
