Friday, Augustus 30th 2019

Peter Svensson | Orofacial Pain Classification Update 

Gerelateerde afbeelding


Pain classification could seem to be a purely academic exercise but is indeed essential for our diagnosis and decision on treatment and management strategy. Recently the International Association for the Study of Pain (IASP) has launched a new, pragmatic classification of all types of chronic pains including headaches and orofacial pains. It is a big step forward that this IASP classification is aligned to the International Classification of Diseases (ICD-11). While the IASP classification covers most overall types of orofacial pains, then in clinical practice there is a need for an even more comprehensive and detailed classification. The International Classification of Orofacial Pain (ICOP) represents a new initiative to classify both acute and chronic orofacial pains in seven main categories. The lecture will summarize the recent developments in classification and the implications for management in the dental clinic. The ICOP is assumed to set the standards for the field and to be the new reference guide for orofacial pains.

Download here the CV of Mr. Svensson


Thomas List | DC/TMD: a model for all Orofacial Pain conditions?

Afbeeldingsresultaat voor thomas list chairman Orofacial Pain and Jaw Function


The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) is based on extensive data from multicenter clinical studies - including studies funded by the National Institutes of Health in the US - and on international consensus conferences. The DC/TMD comprises two domains, a physical Axis I (diagnosis) and a psychosocial Axis II (psychosocial assessment). The Axis I protocol provides standardized evaluation of subjective symptoms, contains clearly defined examination methods, and utilizes specific diagnostic criteria to interpret the clinical findings. The strengths of the DC/TMD Axis I include reliable and valid diagnostic criteria for common pain-related disorders and intra-articular disorders. The Axis II protocol, a psychosocial assessment, has two options: a brief assessment and a comprehensive set of instruments for expanded assessment. The DC/TMD is being translated into more than 30 languages, of which nine are finished. The DC/TMD is also part of the new International Classification of Orofacial Pain and ICD-11. The presentation will focus on describing the development and process of the DC/TMD, on strengths and weaknesses of the diagnostic system as well as future perspectives.

Download here the CV of Mr. List


Corine Visscher | Headache and TMD

Afbeeldingsresultaat voor Corine Visscher Headache and TMD


This presentation will provide an overview of the current knowledge on headache in TMD patients, with special focus on migraine, tension-type headache and secondary headache attributed to a TMD. Not only its prevalence, but also possible explanations for the comorbidity, and consequences for treatment will be discussed. The lecture will summarize current evidence from published literature, supplemented by recent results from a clinical trial on TMD patients with headache complaints. Together, the evidence provided will indicated a multidisciplinary approach in both the diagnostic process as in treatment is warranted.  

Download here the CV of Mrs. Visscher


Per Alstergren Neuropathic Orofacial Pain: Diagnosis and management


Temporomandibular joint (TMJ) arthritis is a disorder due to either local or systemic factors. Clinically, TMJ arthritis may present with articular pain and pain in adjacent structures and reduced jaw mobility. Cartilage and bone tissue destruction may result in occlusal changes with impaired chewing (function) and, if present in children and adolescents, mandibular growth arrest that may lead to micrognathia.

Inflammation is a complex, rapid, first-line and highly unspecific immune system response with a clear and important biologic purpose in the acute phase but may transfer into a chronic state with very unclear, if any, biologic purpose. Since ancient times, inflammation has clinically been described and diagnosed by the presence of the five cardinal signs swelling, redness, warmth, pain and impaired function. However, for chronic inflammation as well as for many other acute inflammatory states, these cardinal signs are neither sufficient nor correct to describe, diagnose or monitor the inflammatory activity. At a given time point, the clinical presentation may be anywhere on a continuum from no sign or symptom whatsoever to any combination of pain, swelling/exudate, tissue degradation or growth disturbance.

For diagnosis of TMJ arthritis, clear and ideally specific clinical criteria should be defined but until recently there are no such criteria established. In rheumatology, a swollen or painful joint leads to a diagnosis of definite synovitis in that particular joint. The TMJ differs to some extent from other synovial joints since the TMJ is seldom swollen, seldom shows redness and the mechanical pain sensitivity over the TMJ is only weakly, if at all, related to an inflammatory intraarticular milieu but rather to systemic inflammatory factors (8). Earlier diagnostic studies on TMJ arthritis have been hampered by the lack of an established, valid and reliable reference standard. Today, the true synovial fluid concentrations of inflammatory mediators can be determined from TMJ synovial fluid samples obtained with a joint washing technique, and cut-off values for healthy and inflamed joints are available.

This lecture will present and discuss the presentation and consequences of TMJ arthritis, inflammatory activity as well as the recently proposed diagnostic criteria.  


Lene Baad - Hanssen | Neuropathic Orofacial Pain: Diagnosis and management


Neuropathic orofacial pain conditions are important differential diagnoses when dealing with pain in the orofacial region. This presentation will begin with touching upon the pathophysiological mechanisms behind neuropathic pain conditions and present the current knowledge on diagnosis and management strategies.  

Download here the CV of Mrs. Baad - Hansen


Daniele ManfrediniImaging of the TMJ

Afbeeldingsresultaat voor daniele manfredini


Within the field of Temporomandibular Disorders (TMDs) practice, there is consensus about the need to perform a clinically-based diagnostic evaluation supported by Temporomandibular Joint (TMJ) imaging in selected cases. Technological progress has been impressive to get a better insight into the anatomy of the TMJ. Based on that, the current classification of TMJ disorders resembles the deep knowledge gathered over the years on the disc position with respect to the condyle and on the different conditions that may be associated with an internal derangement of the TMJ.

Download here the CV of Mr. Manfredini

Download here the full abstract of the lecture. 


Saturday, 31st of August 2019

Frank Lobbezoo Bruxism


The question that will be answered during this lecture is, whether bruxism is the patient’s and dentist’s  friend or foe. Bruxism is a phenomenon that is well-known to dentists and about which knowledge has accumulated for many decades. Over the past years, however, new insights have emerged that represent a true paradigm shift. Where in the (recent) past bruxism was considered the patient’s and dentist’s enemy, being responsible for a host of dental problems like extreme tooth wear and intense pain in the masticatory muscles and temporomandibular joints, nowadays evidence is piling up on possible positive health outcomes for bruxers, thus making bruxism not only a foe but also a friend!

Download here the CV of Mr. Lobbezoo


Peter Wetselaar Tooth wear


Tooth wear is a multifactorial condition, leading to the loss of dental hard tissues, viz., enamel, dentine and cementum. Tooth wear can be divided in the subtypes mechanical wear (attrition and abrasion) and chemical wear (erosion). There is evidence that the prevalence of tooth wear is growing.

Because of its multifactorial etiology, tooth wear can manifest itself in many different representations, and therefore it can be difficult to diagnose and manage the condition. Therefore the Tooth Wear Evaluation System (TWES) was revealed in 2016 with all necessary tools for a clinical guideline. Since then, by using the system, adaptations and improvements were suggested. In 2017 an European consensus statement on management guidelines was published. These two facts resulted in the further development of the TWES, the so called TWES 2.0. The proposed changes in the diagnostic decision tree and a resulting classification will be discussed.

There is evidence that dental sleep disorders (e.g. orofacial pain, oral dryness, gastro-esophageal reflux disorder (GERD), obstructive sleep apnea (OSAS), and sleep bruxism) do have an association with tooth wear, while at the same time it is clear that tooth wear is not the only sign or symptom of these disorders. We will update the existing knowledge, which can support dental clinicians to have a better comprehension of the possible etiological factors of tooth wear in their patients, and thus improve the provided dental care.

Download here the CV of Mr. Wetselaar


Ambra Michelotti Orofacial pain and occlusion

Afbeeldingsresultaat voor Ambrosina Michelotti


Across dentistry, numerous aetiological and therapeutic theories continue to be based on a presumed causal association between orofacial pain and occlusion, and have justified the use of many occlusion-focused therapeutic approaches. The positive responsiveness of orofacial pain to a wide range of treatments, including placebo, means that mechanical interventions by the dentist could likely be successful, at least in the short term. This short-term success thereby reinforces a belief that the correction of the so-called “malocclusion” is associated with orofacial pain improvement. However, the research literature strongly supports the hypothesis that orofacial pain is a complex functional pain disorder, with multifactorial etiopathogenesis. Trauma, individual anatomic and neuromuscular abnormalities, biopsychosocial and neurobiological factors, adverse oral behaviors, and bruxism may contribute to their establishment. Muscle overload could be one possibility among factors that may be involved in the pathophysiology of pain sensitivity. The general treatment principles including behavioural therapy and home exercises are currently regarded as appropriate for the majority of patients with these complaints. Dental practitioners should be aware of the combination of oral parafunction, orofacial pain and psychological characteristics of their patients, and possibly should recognize those individuals who may be at risk for complications during irreversible prolonged dental treatments.

Download here the CV of Mrs. Michelotti.


Justin Durham Axis II Assessment


The biopsychosocial model has was first published in 1977, but it took until the late 1980s early 1990s before the orofacial pain field began to truly embrace it. The seminal moment was the publication of the dual axes RDC/TMD in 1992 which devoted a whole axis – the so called “Axis 2” – to assessing the psychosocial state in people experiencing TemporomandibUlar disorders (TMD). This lecture will discuss: the evolution of psychosocial assessment from the RDC/TMD to the DC/TMD (2014); the importance of the assessment in terms of multidisciplinary care; and the interpretation of the Axis 2 screening instruments.

Download here the CV of Mr. Durham


Jan de Lange TMJ Surgery


This lecture will give an overview on the variety of surgical techniques that have been used in the past to treat different TMJ problems. The results of these interventions were often disappointing and not to the benefit of the patients. The lecture will than focus on techniques that have scientifically proven to give more positive results and their indications.  Reconstruction of the joint by costo-chondral grafts and total joint replacements will also be presented. Moreover, fractures of the joints and their treatment will be discussed. The aim of the lecture is to balance the risks and benefits of different types of surgical interventions in order to enable the therapist to appraise the possible value of surgery for the individual patient.

Download here the CV of Mr. de Lange