Mini-Course on Orofacial Pain, TMD, and Bruxism: 3 Days in Madeira for Dentists and Physiotherapists

Temporomandibular disorders (TMD) as a clinical diagnosis have more than 80 years of history. From the first moment this set of dysfunctions began to be studied, the intervention of different health professionals was assumed to be imperative for their treatment. According to the guidelines of recognized international bodies such as the American Academy of Orofacial Pain (AAOP) and the International Association for the Study of Pain (IASP), it is obvious that the first line of action is based on conservative treatments, including physiotherapy, occlusal devices and physical self-regulation. Thus, teams made up of physiotherapists and dentists are responsible for a large part of the treatment of patients with Temporomandibular Dysfunction.

Temporomandibular disorders (TMD) are the most frequent cause of non-dental pain in the orofacial region, and their management requires an understanding of their etiology and the establishment of a systematic process for differential diagnosis. The diagnosis and treatment of orofacial pain and temporomandibular disorders (TMD) are complex due to the high density of anatomical structures in the area, the mechanisms of referred pain, and the significant psychological and emotional meaning attributed to the face and oral cavity. The complexity of head and neck anatomy and the psychogenic mechanisms involved in pain often require a multidisciplinary team approach.

In this course, the teaching staff will include both a Dentist and a Physiotherapist, providing students with the opportunity to learn how to master the assessment and treatment of these pathologies, as well as to understand the collaborative work between the Dentist and the Physiotherapist and the most appropriate methodology for interdisciplinary teamwork.

The course will last three days. The first day (with dentists and physiotherapists together) will focus on fundamental theoretical concepts. Days two and three will be specifically directed toward Dentists and Physiotherapists individually, and will include both theoretical and practical content.

PROGRAM

DAY 1 – DENTISTS AND PHYSIOTHERAPISTS

Introduction to the Study of Orofacial Pain, Temporomandibular Disorders, and Bruxism
TMD: History, Etiology, Epidemiology
Anatomy of the temporomandibular joint.
Biomechanics of the temporomandibular joint.
Classification of Temporomandibular Dysfunctions: types and different classifications.
Signs and symptoms of stomatognathic system dysfunctions.
Diagnosis and Physical Examination (Overview)
Auxiliary diagnostic tests: types, characteristics, utilities.
Bruxism: Definition, Epidemiology, Etiology, Types of Bruxism, Signs and Symptoms, Diagnosis
Sleep and Pain, OSA and TMD, Bruxism and TMD
Treatment of Temporomandibular Dysfunctions and Orofacial Pain: from conservative to surgical treatment.
The Occlusal Stabilization Gutter and the Anterior Repositioning Gutter.
New Technologies, Gadgets and "Alternative Therapies" in Occlusion: a critical approach.

DAY 2 – DENTISTS

History of Occlusion Studies; Interactions in Prosthetic and Occlusal Rehabilitation
Orofacial Pain Mechanisms, Pain Neuroanatomy; Referred Pain
Clinical History of the Dysfunctional Patient: Anamnesis, Physical Examination (Muscular and Articular), and Complementary Diagnostic Tests
Main Subtypes of Non-Odontogenic Orofacial Pain
Distúrbios articulares e musculares: protocolos de abordagem.
Bruxismo: definição, epidemiologia, etiologia e abordagem.
Multidisciplinary treatment: dentist, orthodontist, physiotherapist, CMF, neurology, etc.
Diferentes tipos de tratamento / abordagens.
Occlusal drips: types, indications and preparation techniques.
Fundamentals of Diagnosis and Planning in Occlusal, Orthodontic, and Prosthetic Rehabilitation
What Are the Main Risk Factors and Variables to Consider in Rehabilitative/Orthodontic Planning by the Dentist
Protocol for Managing Patients with Signs and Symptoms of TMD Before or During Occlusal Therapy or Prosthetic Rehabilitation
O conceito de oclusão ideal vs DTM vs objetivos do TO/Reabilitação Protética.
Concepts of Snoring and Obstructive Sleep Apnea (OSA)
Clinical Cases
Conclusions

DIA 2 – FISIOTERAPEUTAS

Exame subjectivo e objetivo.
Questionários e métodos de avaliação.
Especificidade do exame subjetivo em contexto de DTM e DOF.
Relevância da intervenção interdisciplinar também no contexto da avaliação.
Relação postura e DTM/DOF.
Relação crânio-cervico-mandibular e DTM.
Medição de amplitudes articulares.
Exame específico da ATM.
Radiological examinations relevant to the physiotherapist's functional diagnosis.

DIA 3 – MÉDICOS DENTISTAS

Demonstrative and practical component:

História Clínica do paciente com Dor Orofacial e DTM.
Exame Físico e Palpação do Paciente.
Palpação articular e muscular para diagnóstico diferencial.
Observação e ilustração dos diversos tipos de goteiras oclusais e Dispositivos de Avanço Mandibular (para SAOS).
Agulhamento/punção seca e Viscossuplementação.
Observação de exames complementares de diagnóstico.
Raciocínio Clínico para orientar o plano de tratamento.

DIA 3 – FISIOTERAPEUTAS

Métodos e técnicas de intervenção – estado da arte e evidência.
Tratamento dos distúrbios articulares – terapia manual e exercício terapêutico.
Tratamento dos distúrbios musculares – terapia manual e exercício terapêutico.
Programação de exercício domiciliário.
Educação e ensino ao paciente.
Fisioterapia em contexto de distúrbios do Sono.

Bibliografia:

Serão disponibilizados aos alunos:

Ficheiros Pdf das aulas teóricas.
Bibliografia/livros de referência.
Acesso a uma biblioteca on-line com artigos selecionados das revistas de maior impacto das temáticas abordadas.