Cultura

Comprehensive Specialized Care In Temporomandibular Joint Disorders (TMD): The Role Of Dentists, Assistants, Physiotherapists, And Laboratory Tests In Enhancing Diagnosis And Treatment Quality

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Areej Mosem Alsolame
Samaher Fahad Mahfouz
Yosef Salem Abdullah Al Juhani
Fawaz Eabdalrahman Salim Alharbii

Abstract

Temporomandibular Disorders (TMD) encompass a heterogeneous cluster of musculoskeletal and neuromuscular conditions affecting the temporomandibular joint (TMJ), masticatory musculature, and associated anatomical structures. Historically managed through a mechanistic, occlusion-centric paradigm, the understanding of TMD has undergone a profound transformation toward a biopsychosocial model. This shift acknowledges the intricate interplay between peripheral pathophysiology, central sensitization, systemic inflammation, and psychosocial comorbidities. This research report provides an exhaustive, evidence-based analysis of the specialized care required for TMD, delineating the distinct yet synergistic roles of the multidisciplinary team—comprising dentists, dental assistants, and physiotherapists. It further evaluates the critical role of advanced diagnostic frameworks, including the Diagnostic Criteria for TMD (DC/TMD), emerging biomarkers, and artificial intelligence in medical imaging.

The analysis synthesizes data from peer-reviewed literature to demonstrate that while dentists remain the primary point of entry for diagnosis and orthotic intervention, the integration of physiotherapy is essential for addressing the high prevalence of cervical spine comorbidities and functional limitations. Furthermore, the report highlights the often-underutilized role of dental assistants in administering psychosocial screening instruments and facilitating patient education, which is pivotal for adherence to self-care protocols. Through a detailed examination of clinical pathways, such as the Alberta Model and university-based specialized clinics, this report substantiates the clinical and economic efficacy of interdisciplinary care over fragmented treatment approaches. Ultimately, the findings advocate for a standardized, integrated care model to effectively mitigate the global burden of this "silent epidemic."

Keywords : Temporomandibular Joint Disorders, TMD, Multidisciplinary Care, Dental Team, Physiotherapy, Diagnostic Testing.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty