Temporomandibular Disorders
(Standards of Care)
1. Medical-Dental History and Treatment Plan
A thorough and complete medical and dental history is obtained from the patient and the patient's dental record to include required medical and/or dental consultation. Any medical or dental conditions are considered in the treatment plan. The prosthodontic resident should be technically capable of diagnosing and completing the conservative treatment plan with staff supervision. The patient is in agreement with the plan and understands the time required to complete it.
2. Diagnostic Casts
Are accurate, clean, bubble-free reproductions of the existing dental anatomy. Casts should be properly articulated on an appropriate articulator when indicated.
3. Jaw Relation Records
The resident is capable of performing proper patient jaw manipulations in order to capture appropriate centric relation/occlusion positions. Records should accurately reproduce centric relation/occlusion when working casts are articulated. Records should be of an appropriate material to allow handling by laboratory personnel without severe distortion or fracture.
4. Laboratory Procedures
Working casts should be trimmed, smoothed, and free of all bubbles and voids. Land areas of working casts should be trimmed and rounded. The resident should be capable of fabricating stabilizing (flat plane) occlusal splints, soft splints, and anterior jigs.
5. Prescription Forms
All laboratory prescription forms should be completed. All prescription forms going to the lab must be countersigned by a Prosthodontic mentor. Prescriptions for medications will be monitored by the staff.
6. Occlusion
All devices should restore the proper occlusal plane of the patient to restore VDO, protect the TMJ, or reduce myofacial pain. This may include recontouring of opposing dentition or splints. All devices should contact in centric relation occlusion or maximum intercuspation to hold shim stock (8mm) firmly. Devices should be free of lateral interferences in accordance with the patient's occlusal scheme, i.e., canine disclusion, group function, etc.
7. Delivery
All devices should be smoothed and polished to be irritation free. Devices should be retentive with no movement during functional and para-functional excursions. Residents should provide the patient with instructions as to nature, usage, and care of all devices.
8. Follow-up
Residents should provide timely post-insertion visits for patients under splint therapy. All devices should be thoroughly inspected and evaluated as to their effectiveness and any needed adjustments made at this time.
9. Patient Management
All patients should be treated in accordance with the highest professional standards. Derogatory comments or negative comments will not be made. Any questions concerning patient treatment should be discussed in private with the appropriate mentor.
10. Time Management
Residents should preplan all conservative TMD treatment. Residents should arrive on time, begin treatment promptly, and complete treatment in an expeditious manner. All laboratory procedures should be accomplished to allow the laboratory technicians ample time to meet the delivery date.
11. Standards of Care
All patients will be evaluated utilizing the appropriate standard of care form.
Temporomandibular Disorders Standards of Care Evaluation Form