Faculty Bibliography

Treatment of pain and dysfunction of the craniomandibular apparatus commonly follows one of two courses, not necessarily independent of each other. In many patients, treatment involves both appliance and non-appliance modalities. A thorough and careful diagnostic evaluation of the patient will help the dentist to select the proper modality of treatment. Following successful Phase I therapy, the patient is now prepared for Phase II therapy, a more definitive treatment stage. The purpose of this article is to provide the reader with the rationale and principles underlying the stabilization and rehabilitation direction of Phase II therapy, emphasizing the prosthodontic and orthodontic perspectives.

The urgent or after hours phone call to the dentist's office usually indicates a dental, traumatic, infectious, or pain emergency relating to the teeth or adjacent supporting structures. One subject not discussed at length in the professional literature is the emergency patient with acute pain or dysfunction of the orofacial musculoskeletal system, primarily the muscles of mastication and the temporomandibular joint (TMJ). The practitioner should be able to rapidly and efficiently diagnose and manage these emergency patients, or make adequate referral as necessary. Essential features in the diagnosis involve distinguishing muscle problems from intracapsular disorders. Knowledge of general medical-dental differential diagnosis is essential to rule out those problems masquerading as muscle or TMJ disorders. Proper emergency management is directed at controlling the pain or hypomobility disorder and stabilizing the patient. Contrary to most other aspects of dental practice, rapid and complete elimination of symptomatology may not be possible at this visit. Subsequent management should further define the pathologic process and direct the patient to additional phases of care. This report suggests a series of diagnostic and therapeutic guidelines.

Completely demineralized bovine dentin mineralized to a high degree, but only after extraction of about half of its organic phosphate. Initiation of mineral formation depended on the concentrations of Ca2 plus, Pi, HCO3 minus and H plus ions in the incubation solution. After nucleation, mineral accretion by the dentin continued in solutions that did not, themselves, initiate mineralization. The nucleation phase, but not the subsequent accretion of mineral, was sensitive to small changes in temperature. Inclusion of 0.05 mM NaF in the solution markedly reduced the amount of mineral deposited during the nucleation phase but apparently enhanced subsequent mineralization