SciELO - Scientific Electronic Library Online

vol.70 issue7Forensic dentistry case book 4: Non-maleficence in dental practice, "primum non nocere"What's new for the clinician? Summaries of and excerpts from recently published papers author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand



Related links

  • On index processCited by Google
  • On index processSimilars in Google


South African Dental Journal

On-line version ISSN 0375-1562
Print version ISSN 0011-8516

S. Afr. dent. j. vol.70 n.7 Johannesburg  2015




Management of Temporomandibular Disorders and Occlusion



WG Evans




Copyright Mosby, by imprint of Elsevier Inc. Seventh Edition 2013 468 pages of text and illustrations.

This is a well respected and widely read textbook which first appeared in 1985. Why then a book review of the Seventh Edition? The answer lies in the extensive revision and enhancement in the new presentation.

The book is arranged in four Parts: Functional Anatomy, Etiology and Identification of Functional Disturbances in the Masticatory System; Treatment of Functional Disturbances of the Masticatory System; Occlusal Therapy.

This logical progression through the intricacies of one of the most, if not the most, complex joints in the human body has proven .eminently readable through all previous editions but the text is now enhanced by superb full colour illustrations and explicit flow charts. The text and illustrations are carefully balanced to ensure ready comprehension of the principles.

Part One deals firstly with the essential factual description of the components and their inter-relationships. It is most apposite that the detail of the anatomy is couched in terms of how it will contribute to function.... and in the long run, to therapy. Indeed, Okeson quotes Okeson with the entirely apt maxim leading into the chapter: "Nothing is more fundamental to treating patients than knowing the anatomy" Hence it is no surprise to find in the ensuing five chapters a deeply investigative analysis of just how the masticatory system works. the discussion and descriptions link muscle, bone, nerves, blood supply in drawing an intellectual image of contemporary concepts of function activity of the normal joint system. Okeson does not stint in his dealings with the contradictions between different philosophies and schools of thought. Contrasting opinions are unveiled and debated and where there is no consensus a balanced explanation is provided to the reader.

Part Two commences with a telling resume of previous work on Temporomandibular Disorders, a vivid illustration of the complexity of the problems. The text explores the contributory factors in the several formats in which the disorders may present and once again the illustrations are precise in emphasising or elucidating a concept. This section comprises four chapters which consider Etiology, Signs and Symptoms, History and Examination and Diagnosis. There are some 150 pages filled with these descriptions and discussions.

Part Three moves into Treatment and there is evident an overt intention to link therapeutic approaches with the underlying etiology. In the approximate 150 pages devoted to Treatment there is a depth of consideration given to all the varied approaches to management of this vexacious problem. Considerable space is afforded to concepts of myofunctional therapy and guiding the patient in conservative programmes of self directed treatment. Chapter 16 includes several highly valuable flow charts detailing the treatment sequences and options applicable to the different classes and subclasses of the affliction. Once again it is apt to have Okeson quote Okeson: The complexity of TMD makes developing a cookbook impossible, even though that is precisely what everyone would like. Here is an attempt."

Part Four takes a separate view by considering only the options offered by Occlusal Therapy. This is a shorter contribution but most relevant to the dentist seeking guidance on whether occlusal adjustments are appropriate and in which category of patient. Here appears analyses of functional movements, here are descriptions of managing the interferences and here are some presentations of the techniques of jaw tracking by electronic systems. Of course recognition is emphasised that Occlusal Therapy will not solve all TMD difficulties.

The extensive referencing will be invaluable to serious students of the joint. It may be relevant that most of the more recent references are reflected in the later sections of the book, giving an indication of how the emphasis has been in contemporary times focussed on diagnosis and therapy.

This is a book for the shelves of every practitioner who has grappled with the problem......which is a very real difficulty for those who suffer TMD in all its varied manifestations. It is a book which will quite frequently be consulted. If the precise answer is not there, excellent guidance will be, pointing in the most apposite direction.