Abstract
The treatment of temporomandibular disorders (TMD) may often include complicated problems such as chronic pain, occlusal parasthesia, unidentified complaints and psychosomatic disorders. Although most dentists have a consultation and treat TMD patient by themselves, the author works with a psychiatrist in these complicate conditions. The cooperative consultation and treatment with a psychiatrist is called “liaison” and is its importance is gradually being realized. This paper explains the liaison management in cases of TMD with chronic pain, occlusal parasthesia and other unidentified complaints.
The patients are classified into the following four categories: A. There is no objective finding which explains the subjective symptoms, B. The relationship between the objective findings and subjective symptoms is weak, C. Both psychic symptoms and somatic diseases are present, and D. Psychosomatic disorder is obvious. The management was done following this classification.
Managements : In cases of A and B since the possibility of the cause being dental or medical somatic diseases is low, the patients' clinical conditions are explained, followed by conservative treatment, rather than actively providing surgical treatment. If subjective symptoms such as insomnia and depression are found, then the patients are suggested to consult a psychiatrist for collaboration treatment. In the comorbid case C, both dental diseases and mental disorders are treated in parallel. It is important to maintain good communication with psychiatrist with these cases. In the case D, psychosomatic disorders in a narrow sense, the patients must be aware of their stresses, and understand the relationship between mind and body and be encouraged to ease their mental burdens. In addition, they should be introduced to relaxation methods, such as autogenic training and progressive muscle relaxation method and, if necessary, combined drug therapy (antianxiety drug, antidepressants, etc). Multiple evaluation and management is important for TMD patients with complicated conditions.
