Tempromandibular dysfunction TMD

Much attention in the literature has been focused on the relationship between TMD and orthodontic treatment. Whilst TMD is common in the orthodontic aged population whether orthodontic treatment is carried out or not, there is no evidence to support the theory that orthodontic treatment causes TMD or cures it.29 Pre-existence of TMD should be recorded, and the patient advised that treatment will not predictably improve their condition. Some patients may suffer with increased symptoms during treatment which must also be discussed at the beginning of treatment. Where patients experience symptoms during treatment, treatment should be directed at eliminating occlusal disharmony and joint noises whilst reassuring the patient. Standard

Fig. 11 Ulcer in a patient's lower lip from a long stretch of unsupported wire. Bumper sleeve has been placed along the wire to prevent further trauma
Interlandi HeadgearInterlandi Headgear
Fig. 14 Safety Kloehn bow with Nitom locking mechanism to prevent disengagement from the molar tube
Kloehn Type Head Gear
Fig. 15 Interlandi headgear with a rigid Masel safety strap to hold the Kloehn bow and prevent disengagement for the buccal tubes
Interlandi Headgear
Fig. 16 Quick release headgear attachment. The breakaway design allows the bow to come out of the headgear tube, but is no longer under tension and therefore unable to act as a projectile

treatment regimes may also be indicated eg soft diet, jaw exercises. We have not reviewed this area in detail in this section as it is dealt with under facts and fantasy in the next, but an excellent overview of the relation between orthodontics and occlusal relation has recently been published.30

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