Evaluation and Treatment of the TMD Patient
Utilizing a Physical Therapy/Dental Coordinated Approach:
A Clinical and Evidence-Based Program
Saturday and Sunday April 1 and 2, 2017
Presenter: Bill Esser, PT, MS, CCTT
Contact Hours: 15
Course Location / Hours: Seattle-Area (Kirkland), WA / 7:30-7:55 am registration / 8 am (prompt start)-5:00 pm
Registration: $475 prior to March 10, 2017 and $550 on or after March 11, 2017.
Who should attend?: This 2 day course is appropriate for Dentists, Dental Hygienists, Chiropractors, Physical Therapists, and Physical Therapy Assistants. All levels of experience are welcome. We are an approved CE provider by the WA State Licensing Board for Dentists/Dental Hygienists and PT/PTA's.
Evaluation and Treatment of the TMD Patient Utilizing a Physical Therapy/Dental Coordinated Approach" is a 2-day lecture and lab-based course developed by Mr. Esser. This course presents the fundamental principles underlying the most common temporomandibular joint dysfunctions and the relationships between occlusion, the TMJ, the cranium, and the upper cervical spine. The course provides an algorithmic approach (LPTMJ format) for evaluation of the TMJ and upper cervical area. Accurate evaluation is key to appropriate treatment planning for this complex patient population, incorporating both physical therapy and dentistry. Treatment techniques presented will include manual therapy for the TMJ and upper cervical area, TMJ splinting, and therapeutic exercise for the TMJ and upper cervical area.
- Understand the basic anatomy and function of the temporomandibular joint and upper cervical area and their role in temporomandibular symptomology.
- Properly evaluate the head and neck for primary TMD causative factors and determinants for using a team approach to care.
- Be able to classify TMJ dysfunction into the appropriate classification system to assist in treatment planning.
- Appreciate the role dentistry and physical therapy play in the care of patients with TMD.
- Implement a coordinated treatment plan incorporating dental and physical therapy concepts to achieve optimal outcome for the TMD patient.
Lectures, demonstration and labs, and case studies.
7:30 - 8:00 Registration
8:00 - 8:45 Lecture - Historical perspective of physical therapy and dental roles in TMD care / introduction to the LPTMJ evaluation format / TMD categories
8:45 - 10:00 Lecture - Anatomy and arthrokinematics of the temporomandibular joint / clinical relevance of anatomy as it affects function of the TMJs
10:00 - 10:15 Break
10:15 - noon Lecture - LOOK - 3D association of the head, neck, posture and occlusion / evaluation of the lips, tongue, and dentition as indicators of TMD dysfunction
noon - 1:00 Lunch
1:00 - 1:30 LAB 1 - LOOK - Posture and oral assessment of the lips, tongue, and dentition
1:30 - 2:15 Lecture - Staging categories of temporomandibular joint dysfunction
2:15 - 3:00 Lecture - Assessment of range of motion (ROM) of the TMJ and upper cervical spine
3:00 – 3:15 Break
3:15 – 3:45 LAB 2 - Graphing ROM of the TMJ / assessing ROM of the suboccipital area and atlas
3:45 - 4:30 Lecture - Muscle testing / joint compression tests / temporomandibular ligament testing
4:30 – 5:15 LAB - Muscle testing / joint compression tests / temporomandibular ligament testing
8:00 – 8:15 Questions from Day 1
8:15 – 8:45 Lecture - Palpation of the face, neck, and suboccipital triangle
8:45 – 9:30 LAB 4 - Palpation of the face, neck, and suboccipital triangle
9:30 – 10:15 Lecture - treatment of TMD parafunction
10:15 – 10:30 Break
10:30 – 11:00 Lecture - Treatment of muscle pain / teaching TMJ arthrokinematics
11:00 – 11:30 Lecture - Manual mobilization of the TMJs
11:30 – 12:15 LAB 5 - Mobilization of the TMJs
12:15 – 1:00 Lunch
1:00 – 1:30 Lecture/Mini LAB - Patient self-mobilization of the TMJs for home care
1:30 – 2:00 Lecture - Disc stabilization with helicoidal program
2:00 – 2:45 Lecture/LAB - Managing disc displacement without reduction / demonstration of splinting for acute disc displacement / managing the post-arthrocentesis patient
2:45 - 3:15 Lecture - Addressing the head and neck for postural correction including the atlas
3:15 - 3:45 LAB - Atlas correction
3:45 – 4:45 Lecture - Dental concepts for TMD management
4:45 - 5:00 Questions/Answers/Adjourn
Presenter: Bill Esser, PT, MS, CCTT
Bill graduated in 1979 with a master's degree from Purdue University and in 1981 from the University of Iowa Graduate Program in Physical Therapy. Since 1981, Bill has worked in outpatient orthopedic physical therapy settings, including being an owner/partner in private practices in Southern Oregon from 1986 until 2013. In 2013 he retired from partnership/ownership to concentrate on clinical treatment of complex facial pain, temporomandibular dysfunction, and teaching.
Bill's clinical specialization for over 35 years has been in the management of TMD, cranial, and cervical spine dysfunction, evaluating thousands of patients with TMD over his career. Bill is a diplomate of the Physical Therapy Board of Craniofacial Therapeutics, established by an international group of physical therapists and holds the title Certified Cervical and Temporomandibular Therapist (CCTT). There are fewer than 100 diplomates worldwide.
Bill has presented as an instructor for Empiridence and Myopain Seminars and as an adjunct instructor on TMD for the Schools of Physical Therapy at Pacific University and George Fox University. Bill has also taught for the Oregon Physical Therapy Association and Oregon Dental Association on TMD. In 2011 and 2015 Bill was asked to speak at the OBI Foundation for Bioesthetics Dentistry National Conferences on "The Interrelationship of the Cranium, Cervical Spine and Occlusion – A Team Approach for an Optimal Outcome."
In 2016, Bill joined the staff of Therapy Plus in Roseburg, Oregon.
"Bill has helped many of my patients experience significant relief and enjoy long-term improvement to their debilitating TMD conditions. He possesses an uncommon enthusiasm and drive to educate people of all ages in managing their jaw difficulties."
Jake Layer, DMD, Past President,
Jackson County Dental Society
"Bill has given numerous courses to our local dental society. He is not only thorough, but an entertaining and excellent speaker."
Tamara Abbett, DDS
"Taking classes from Bill has allowed me to effectively treat patients that I was previously unable to help."
Justin Carson, DPT, CSCS
"This is one of the most information-rich courses I have taken in years."
Mike Doden, PT
"We ask dentists and physicians to first refer their TMJ patients to Mr. Esser for consultation prior to referral to our office."
Jim Savage, DDS, and Rajiv Rajagopal, DMD – Oral Surgeons
"Mr. Esser is a tremendously valuable resource for my patients with TMJ dysfunction. His educational background, passion for his work, and years of clinical expertise make him uniquely qualified to diagnose and treat these patients."
Ted Bennion, DMD, Orthodontist
"As a practicing dentist for 30 years, and a massage therapist for the last 2 years, I found Bill Esser's TMJD course to be, by far, the most informative information I have ever heard or read regarding TMJ function, dysfunction, and treatment."
Bruce Austin, DMD, LMT
The Need for Multidisciplinary Treatment for TMD
An understanding of the interrelationship of the masticatory system, the temporomandibular joints, and the head and neck is imperative when evaluating and planning treatment for patients with temporomandibular dysfunction. Dentists, physicians, physical therapists, and medical professionals often have only a selective understanding of one area of the head and neck, limiting evaluation and treatment planning for patients with TMD. Consequently, a vast majority of patients with TMD may not be adequately evaluated for the cause of their dysfunction, appropriate treatment planning using a multidisciplinary approach fails to be implemented, and patients suffer unnecessary ongoing pain and further joint damage. Current research supports intervention for TMD dysfunction versus the often-held belief that little can be done for the patient with TMD:
The majority of patients do not improve without intervention and progress to further dysfunction. (1)
Acute close-locked patients should be unlocked immediately and stabilized with a splint by a dentist or physical therapist. (2)
Youth who suffer direct trauma to the jaw resulting in disc displacement often experience changes in growth of the mandible, facial asymmetry, clicking in the joint and early degenerative changes. (3), (4)
Adults who ignore years of clicking and popping can progress to acute close-lock conditions, degenerative joint disease and chronic pain. (5)
Faced with the complexity of this population, dental and medical care providers find that a coordinated team approach is the key to successful outcomes. This course provides evidence-based and clinically applicable skills to help you understand the role you can play on that multidisciplinary team.
1. Donald T. Brown, DDS, M.S.: Elmer L. Gaudet Jr. DDS Temporomandibular Disorder Treatment Outcomes: Second Report of a Large-Scale Prospective Clinical Study, MSD Journal of Craniomandibular Practice, October 2002, Vol.20, No. 4
2. Sembrano et al. Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint?, Udine, Italy Department of Maxillofacial Surgery, Faculty of Medicine, University of Udine. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. Vol. 105 No. 3 March 2008
3. H. David Hall, DMD, MD. Intra-articular Disc Displacement Part II: Its Significant Role in Temporomandibular Joint Pathology. J Oral Maxillofac. Surg 53: 1073 – 1079, l995
4. Gidarakou et al. Comparison of Skeletal and Dental Morphology in Asymptomatic Volunteers and Symptomatic Patients with Bilateral Disc Displacement with Reduction.
Angle Orthodontist, Vol 72, No 6, 2002
5. Brook IR, Leeds LDS, Grander RM. Long-term prognosis for the clicking jaw. American Journal of Pain Management. 1988; 00065:668-678.
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