Guidelines for clinical management of temporomandibular disorders: Part 1.
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Biomedical subjects
Publications and source records attributed to R A Pertes.
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Successful diagnosis of chronic orofacial pain is a difficult task. This article attempted to simplify diagnosis by first classifying the orofacial pain on the basis of clinical characteristics into three basic pain categories: somatic, neurogenous, and psychogenic, and then according to the tissue system affected. An accurate and thorough history is essential, along with a detailed physical examination. In addition, an awareness of the local, systemic, and psychological causes of orofacial pain is necessary. The adage "what you don't know, you don't diagnose" is especially apt in regard to orofacial pain.
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Although occlusal splints are useful in the treatment of MPD and internal derangements, they must be used in a rational manner. Two basic appliances are employed in Phase I palliative therapy: a maxillary full coverage (MAR) and a mandibular orthopedic repositioning appliance (MORA). The MAR is used in MPD patients primarily to disengage the occlusion and reduce parafunctional activity. In many cases of internal derangement, protrusive mandibular repositioning is indicated. By using the MORA during the day and the MAR at night, the disadvantages of each appliance are minimized.
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