ISBN: 1-901865-44-4

204 pp; 700 color illus

Contents

Part 1 Diagnostic Scheme
1. Normal TMJ Function
2. Pain from the TMJ Region
3. TMJ Sounds
4. TMJ Dysfunction

Part II TMJ Disorders
5. TMJ Anatomy Related to Disorders
6. Trauma
7. Internal Derangement–Disc Replacement
8. Osteoarthritis
9. Hypermobility and Dislocation
10. Infectious Arthritis
11. Inflammatory Diseases
12. Miscellaneous Conditions
13. Nerve Entrapment Processes
14. Growth Changes
15. Tumors
16. Radiographic Imaging

Preface

Over the past 25 years I have been honoured by invitations to present my research results and their clinical implications within odontology and medicine at universities and international congresses throughout the world. Discussions with colleagues from different countries and all the questions they have posed have consistently inspired me to carry out investigations with the aim of providing scientifically based answers. The impact of an orthopaedic temporomandibular joint disorder on facial growth is such an example. A question put to me by a group of specialists in jaw orthopaedics in 1982 resulted in an ongoing series of experimental and clinical studies in collaboration with different universities in the USA, South America, and Europe. I am grateful for the challenging questions I have been asked, for the endless support that I have received as a visiting professor at other universities, and not least for the encouragement to author a book on the subject.

In 1975 I asked an older and more experienced colleague why temporomandibular joint clicking could be associated with pain and what caused the clicking. The literature did not provide an answer. He replied that the clicking was known to be a variation of normal joint function. Since his and others’ experience was that these patients mostly were women, it was considered to prove that women more readily sought treatment without any major reason. His answer did not satisfy me, but initiated my first scientific work which in 1980 resulted in my PhD thesis, Temporomandibular Joint Clicking. Since then we have learnt a lot more about temporomandibular joint diseases, and the aim of this book is to present current knowledge to the clinician in a readable format.

Thus I am grateful for the incorrect answer given to me in 1975. It taught me that only science can prove if personal experience is reflecting the truth and is universally applicable.

Some people make the same mistake
Over, and over, and over again
And call it experience. (Oscar Wilde)

Knowledge is to know how little we know.

The state-of-the-art is scientifically based knowledge.

Annika Isberg
Sweden, March 2000

Foreword

The dawn of the new millennium heralds great promise in the arts and sciences. Observers are highly optimistic about continuing progress in our battle with disease. We are on the threshold of conquering cancer, and even inherited abnormalities with genetic engineering.

In dentistry, however, one of the gnawing problems, which has engendered much controversy, multiple diagnostic errors and misapplied therapy in the past is temporomandibular joint (TMJ) dysfunction. The literature is replete with articles that purport to be authoritative, but are, in truth, anecdotal experiences, so often based on poor diagnostic assessment and mechanical thinking. Gnathology, which analyses condylar position, is based on an arbitrary articular emulation of a biological phenomenon. Lysle Johnston facetiously comments that, ‘Gnathology is the science of how articulators chew.’ There is much truth to this observation, as the dental profession is mesmerized by the lectures and writings of mechanically oriented gurus, whose mechanical reconstructions of the TMJ fail to take into consideration the multiple anatomical and physiological variations of the human TMJ. Controversy rules the roost.

What a breath of fresh air to read the manuscript of this landmark volume by Annika Isberg! The timing is perfect! I have known the author for almost 20 years and have avidly read every article she has written, after seeing her doctoral dissertation on cinefluorography of the TMJ at Karolinska Institutet. As one of the world’s authorities on radiology of the TMJ, Professor Isberg has significantly broadened the diagnostic horizons, substituting reason for rote, exhaustive studies for selected case reports. This monumental work is the culmination of all those years of research in this contentious field and is a ‘must’ for all dentists and a ready reference for medical confreres, physical therapists and psychologists who deal with craniofacial pain. This is not an esoteric discourse on the problems, but rather a practitioner’s guide – a patient-oriented work that is dominantly clinical and immediately applicable to daily practice.

The volume is divided into two parts. Part I deals with the diagnostic scheme. Tragically, this has been the quicksand of the past, the ‘Archilles heel’ (or joint!) of dental manipulations and ill-considered therapies. Inadequate diagnostic study leads to jumping to improper therapeutic conclusions. The woefully inadequate, two-dimensional transcranial radiographs that have been used as a diagnostic source by thousands of dentists are totally inadequate and misleading in many patients. Having been in the TMJ field since 1946, when I joined Jack Thompson, one of the pioneers in the TMJ area at Northwestern University, I have seen the passing parade of occlusal reconstructionists, as well as the leaders in the field, like Harry Sicher, the great anatomist, with whom I worked on my PhD in 1950. I dissected 198 cadaver condyles and learned much under his tutelage. I learned methodology from Arne Bjork, when he visited us for three months in 1953. Nevertheless, I made my share of mistakes and diagnostic errors. It became clear to me that not only is a thorough knowledge of the anatomy and physiology essential, but also an appreciation of the broad range of normal structure and function and a comprehensive background of the potential departures from normal, i.e., the pathological manifestations. Clearly, the overly simplistic and mechanistic conclusions that dental occlusion was the basis for most TMJ abnormalities was and is patently wrong.

Part I of the present volume is the answer to the practitioner’s prayer. It deals with normal TMJ function, pain from the TMJ region, TMJ sounds and TMJ dysfunction. Based on seminal research and extensive clinical experience, the evidence-based four chapters could be a stand-alone volume. Surely, it is essential reading for all dentists, whether they treat TMJ disorders or not. The multiple illustrations are a great help for the average reader. The text is documented with numerous studies by world-class authorities. Dental students around the world, as well as dental practitioners, would greatly benefit from this text.

Part II deals specifically with TMJ disorders. The 12 chapters provide an exhaustive analysis and illustrations of multiple departures from the normal, based on the anatomical and physiological sections in Part I. Unlike so many texts by multiple authors, where correlation is difficult and repetition is common, this essentially single-author volume is built ‘block by block’, with constant referral and inter-relationship of the various sections. Magnificently organized and presented, straight-forward text and unequalled illustrative material! Chapter 5 deals with TMJ anatomy as related to TM disorders. Chapter 6 covers trauma. Chapter 7 is a magnificent discussion and illustration of internal derangement and disc replacement. So much has been written by so many authors on this subject, but none equals the authoritative, well-illustrated chapter here. Another stand-alone section for students and practitioners alike.

Subsequent chapters on osteoarthrosis and osteoarthritis, hypermobility, infectious arthritis, inflammatory diseases, miscellaneous conditions, nerve entrapment, growth changes and tumors cover the broad panoply of potential abnormalities. Chapter 16 is a dual-author chapter on radiographic imaging by Jan Ahlqvist and Annika Isberg. Again, this is a fantastic, profusely illustrated section that is a ‘must read’ for students and practitioners alike. It discusses the various radiographic approaches, showing advantages of each technique, i.e., the information best displayed by each radiographic approach.

I congratulate all who had a part in this new millennium masterpiece on the TMJ. The challenges of reproducing histological and radiological images are very real, but the production details rise to the level of the actual text. The book sets a standard that others will find difficult to emulate. The book shows that even after 55 years in the field, TMG can be truly excited by a new ‘bible’ in the field of TMJ/TMD.

T.M. Graber