23123 - NEW PERSPECTIVES IN APPROACHING THE PHYSIOTHERAPY OF CRANIO-MANDIBULAR DYSFUNCTIONS

Subject type: Optional

Coordinator: Esther Wall Gimeno

Trimester: Third term

Credits: 4

In order to be able to take this subject, there are no prerequisites related to passing other subjects in the study plan.

Craniomandibular disorders have a very high prevalence in the general population with a maximum incidence in adolescence and in adults, especially related to the female sex (the ratio of affect is approximately four women for every man). These disorders can include disorders related to the temporomandibular joints, the muscles of the masticatory system or nearby areas such as the cervical region and the skull itself. The symptoms are very diverse and may refer to joint pain, joint noises during jaw function, alterations of jaw dynamics or limitations of oral mobility; tensional pain in the muscle areas of the masticatory system, mobility disturbances and cervical myofascial pain and other disturbances referring to the ears (otalgia, tinnitus, etc.) and the skull in the form of headaches and orofacial pain.

A multidisciplinary approach is essential to properly treat these disorders and, therefore, collaboration between dentists, physiotherapists, psychologists and maxillofacial doctors is essential. The role of physiotherapy is basic and requires anatomical and joint biomechanical knowledge in order to apply a correct functional assessment. The treatment techniques are very varied: specific joint mobilizations, anti-pain electrotherapy techniques, application of myofascial procedures, indication of therapeutic exercise and even the application of invasive techniques such as dry needling.

The aim of this subject will be to introduce students to this area of ​​knowledge in a broad way so that they can acquire the necessary knowledge and procedural skills to be able to evaluate this type of disorder and to be able to come up with an appropriate approach in the design of the therapeutic intervention from the point of view of physiotherapy. Teaching will take into account the perspective of gender and sex, differentiating those clinical entities or clinical manifestations in which an incidence related to sex is observed.

LO 22. Establishes the intervention protocol based on the joint negotiation between the therapist and the patient.

RA 23. Carry out the physiotherapeutic diagnosis to determine the dysfunctions and handicaps that will require a specific physiotherapy intervention.

LO 28. Identify the main treatments used in physiotherapy interventions for each of the clinical specialties. Classifying them according to their importance and establishing an order of priority in their therapeutic application.

 LO 29. Analyze the effects produced by the interventions. It assesses benefits and risks and establishes an intervention criterion based on the priorities and effects pursued.

 RA 33. Performs the specific physiotherapy diagnosis for each of the clinical specialties in order to determine the dysfunctions and disabilities that will require a specific physiotherapy intervention.

Topic 1. Temporomandibular anatomy and biomechanics:

- Articular bone surfaces

- Articular disc

- Capsular and ligamentous containment elements.

- Vascularization and joint innervation

- Masticatory muscles

- Physiology of joint movement
 

Topic 2. Craniomandibular dysfunction:

- Concept and epidemiology

- Classification of clinical articular entities

- Classification of myofascial clinical entities masticatory system
 

Topic 3. Clinical examination:

- Assessment of joint pain

- Evaluation and registration of mandibular movements

- Joint examination

- Myofascial exploration masticatory system
 

Topic 4. Physiotherapy in craniomandibular disorders

- Manual joint mobilization techniques

- Physical agents in the treatment of pain

- Myofascial treatment techniques
 

Topic 5. Complementary diagnostic tests:

- NMR

- Computerized axial tomography

- Radiological tests
 

Topic 6. Craniomandibular dysfunction and cervical region

- Functional relationships between the cervical area and the masticatory system

- Craniomandibular dysfunction and posture

Teaching methodologies:

MD1. Expository method or master class: to transmit knowledge and to activate the cognitive processes of the student by means of a unidirectional learning.

MD2: Case study: acquire learning through the analysis of real or simulated cases.

MD3: Solving exercises and problems: exercise, rehearse and put into practice the previous knowledge.

MD4: Problem-based learning (PBL): developing active knowledge through problem-solving.

MD5: Project-oriented learning: carrying out a project to solve a problem, applying acquired skills and knowledge.

MD6: Cooperative learning: Fostering active and meaningful knowledge in a cooperative manner.

This subject will be evaluated following the indicators detailed in the following table:

In this subject the following evaluation activities are proposed:

Examen: final practical test demonstrating procedural skills (30%) and final written test (30%)

Portfolios: it will include a set of activities, some of which can be carried out in the classroom and which will be related to the resolution of exercises, clinical cases and questionnaires (the set of these activities will weigh 40% of the total mark of the subject).

The proposal for assessment activities will not have any conditions that involve their passing in order to pass the subject. In other words, the calculation of the average of the grades obtained between the different assessment activities will be applied and the grade of pass will be determined when this final average is equal to or higher than 5 points.

Recovery conditions

Students who have not passed the subject in the first ordinary call will have the option of the make-up call. In these cases, it must be taken into account that the activities linked to the portfolio cannot be recovered. Therefore, only the final written test and the final practical test can be evaluated at the retake.

Assistance and Rules of Conduct

Attending class without respecting the basic rules of hygiene and uniform dress may be sanctioned. During the practices in class and especially during the assessment tests, students may not wear objects that could interfere with the execution of the techniques, such as rings, watches, bracelets, long earrings, etc. Likewise, hand hygiene will be essential, with short, clean, unpainted nails. Given the practical nature of the classes and in order to facilitate and correctly perform the manual palpation procedures and the execution of the evaluation tests, it will be necessary to wear appropriate clothing such as shorts and a top, considering that in many situations the anatomical region evaluated must be stripped of clothing to be able to observe and palpate the anatomical reliefs. It will be essential to comply with an attendance of no less than 80% of the hours in order to pass the subject. In case of non-compliance with this rule, the subject will be suspended and will have to be re-enrolled in the following academic year.

Specific criteria of the grade Not Presented

This situation will be considered when the student has not taken the final written exam or the final practical test.

Okeson JP. Treatment of occlusion and temporomandibular disorders. 7th edition. Barcelona: Elsevier Spain; 2013

Fernández de las Peñas C, Mesa Jiménez J. Disorders of the temporomandibular joint. Manual therapy, exercise and invasive techniques. Pan American: Madrid; 2020

Pérez Fernández T, Parra González A. Physiotherapy in temporomandibular disorder. Barcelona: Elsevier Spain; 2019.

César de las Peñas C, Arendt-Nielsen L, Grewin R. Tension headache and of cervical origin. Pathophysiology, diagnosis and treatment. Barcelona: Elsevier Spain; 2010

Okeson JP. Orofacial pain according to Bell. Barcelona: Quintessence; 1999

Palla S. Myoarthropathies of the masticatory system and orofacial pains. Milano: RC Libri; 2013

Isberg A. Dysfunction of the temporomandibular joint. A practical guide. Sao Paulo: Medical Arts; 2003

Platzer W. Atlas of anatomy with cynical correlation. Tomo I. Locomotive apparatus. 9th edition. Madrid: Pan American; 2008