Dentistry Book


Temporomandibular Joint Disease

Aka: Temporomandibular Joint Disease, Temporomandibular Joint Syndrome, Temporomandibular Joint Disorder, Temporomandibular Joint Dysfunction, TMJ Dysfunction, Arthralgia of Temporomandibular Joint
  1. See Also
    1. Temporomandibular Joint
  2. Definition
    1. Temporomandibular Joint inflammation
  3. Epidemiology
    1. Affects 10-15% of adults (but only 5% pursue evaluation and treatment)
    2. Peak Incidence: 20-40 years old
    3. Twice as common in women
  4. Risk Factors
    1. Comorbid pain syndromes (e.g. Fibromyalgia, chronic Headaches)
    2. Autoimmune disorders
    3. Sleep Apnea
    4. Major Depression
    5. Anxiety Disorder
  5. Causes
    1. Malocclusion
    2. Displacement of condylar head
    3. Bruxism
    4. Trauma
    5. Acute synovitis
    6. Arthritis (Osteoarthritis or Rheumatoid Arthritis)
  6. Symptoms
    1. Pain on opening and closing mouth or chewing
      1. Consider alternative diagnosis if pain is not affected by jaw opening and closing
      2. Pain is classically anterior to tragus
      3. Worse in the morning
    2. Pain Radiation
      1. Facial pain (96%)
      2. Ear Pain (82%)
      3. Headache (79%)
      4. Jaw pain (75%)
      5. Cheek pain
      6. Temple pain
      7. Eye Pain
      8. Neck Pain
      9. Shoulder Pain
      10. Cooper (2007) Cranio 25(2): 114-26 [PubMed]
    3. Restricted Jaw function
      1. Jaw movement feels 'Tight'
      2. Sudden 'catching' suggests mechanical dysfunction
    4. Noise or crepitation at TMJ
      1. Clicking or grating sound (common and not a marker of worsening or improvement)
      2. Exacerbated by chewing
  7. Signs
    1. Temporomandibular Joint exam technique
      1. Apply index finger on either side of face
        1. Position finger preauricular over pretragal area or inside external meatus
      2. Patient opens mouth widely and closes several times
    2. Observe for
      1. Clicking or popping noises or Sensation
        1. Click on opening and again on closing suggests disc displacement with reduction
        2. Crepitation suggests TMJ Osteoarthritis
      2. Limited range of opening (Normally 4-5cm)
        1. Disc displacement may interfere with condyle translation (Closed lock)
      3. Subluxation (locking on opening)
      4. Deviation of jaw during movement (>7 mm lateral movement)
      5. TMJ Joint Pain on palpation
        1. Suggests intra-articular disorder
      6. Temporalis Muscle, masseter Muscle or neck Muscle tenderness on palpation
        1. Suggests masticatory Muscle disorder or myofacial pain
  8. Diagnosis
    1. Consider Temporomandibular Joint injection (Auriculotemporal Nerve Block)
      1. Consider alternative diagnosis if it does not relieve pain
  9. Classification
    1. TMJ due to articular disorder (intra-articular causes)
      1. Congenital disorder or tumor of the Mandible or cranial bones
      2. Articular disc displacement (most common intra-articular condition)
      3. Condylar process Fracture
      4. Anklyosis, synovitis, capsulitis or Osteoarthritis of the Temporomandibular Joint
      5. Temporomandibular Joint disclocation
    2. TMJ due to masticatory Muscle disorders (extra-articular causes, 50% of cases)
      1. Myofascial Pain
      2. Myofibrotic contracture
      3. Myositis or Muscle spasm
  10. Imaging (consider)
    1. Jaw XRay (Transcranial and transmaxillary or panorex views)
    2. Jaw CT
    3. Arthroscopy
    4. Jaw MRI
      1. Preferred imaging for a comprehensive imaging evaluation of the jaw
      2. Indicated in cases refractory to conservative management or with suspected intraarticular cause
      3. Test Sensitivity: 78-95%
      4. Test Specificity: 66-80% (up to a 34% False Positive Rate)
      5. Lamot (2013) Oral Surg Oral Med Oral Pathol Oral Radiol 116(2): 258-63 [PubMed]
    5. Jaw Ultrasound
      1. Consider as an alternative to Jaw MRI
      2. Bas (2011) J Oral Maxillofac Surg 69(5): 1304-10 [PubMed]
  11. Differential Diagnosis
    1. See Orofacial Pain
    2. TMJ Arthritis
  12. Management: General Measures
    1. General measures are effective in 80% of cases
    2. No chewing gum or ice, pencils
    3. Avoid tooth grinding and tooth clenching
    4. Avoid excessive jaw opening (e.g. Yawning or on tooth hygiene such as Tooth Brushing)
    5. Very soft diet
    6. Analgesics
      1. NSAIDs are effective for local synovitis or Myositis
      2. Avoid Opioids
      3. Avoid Tramadol (ineffective)
      4. Avoid Topical Analgesics (ineffective)
    7. Local massage
    8. Heating pad or local moist heat as needed
    9. Elevate head of bed to 30 degrees or more
    10. Consider Temporomandibular Joint Diagnostic Injection
  13. Management: Bruxism and Chronic Pain Management (masticatory Muscle or myofacial pain)
    1. Muscle relaxants (e.g. Flexeril)
    2. Neuropathic Pain Medications
      1. Tricyclic Antidepressants at bedtime (e.g. Amitriptyline, Nortriptyline)
      2. Gabapentin
    3. Cognitive Behavioral Therapy or biofeedback
      1. Aggarwal (2011) Cochrane Database Syst Rev (11):CD008456 [PubMed]
    4. Physical therapy (weak support)
      1. McNeely (2006) Phys Ther 86(5): 710-25 [PubMed]
    5. Acupuncture
      1. Protocols of 6-8 sessions of 15-30 min each
      2. Rosted (2001) Oral Dis 7(2): 109-115 [PubMed]
      3. Cho (2010) J Orofac Pain 24(2): 152-62 [PubMed]
    6. Transcutaneous electrical nerve stimulation (TENS unit)
    7. Anxiolytics or Antidepressants
      1. Risk of Bruxism with SSRIs (rare)
      2. SSRIs and SNRIs appear ineffective for Chronic Pain of TMJ Dysfunction
      3. Benzodiazepines have been used for short 2-4 week courses (but risk of dependence)
    8. Onabotulinumtoxin A (Botox)
      1. Variable evidence
      2. Soares (2014) Cochrane Database Syst Rev (7): CD007533 [PubMed]
  14. Management: Dental Occlusion and intra-articular disorders
    1. Referral to oral and maxillofacial surgery for refractory cases
    2. Orthodontic appliances
      1. Nonoccluding splint (simple splints)
        1. Prevent teeth clenching and Bruxism by opening the jaw
        2. Inexpensive, pre-fabricated splints are available at pharmacies
      2. Occlusal dental device or night guard (Occluding splints, stabilization splints)
        1. Custom made to assist teeth alignment
        2. Price runs several hundred dollars due to custom fit and adjustment by dentist
        3. Alleviates symptoms in over 70% of TMJ patients
    3. Surgery
      1. Indicated in less than 5% of TMJ patients
      2. Consider in cases of refractory intra-articular disorders (see above)
      3. Procedures include Arthrocentesis, Diskectomy, condyotomy, total joint replacement
  15. Course: Prognosis
    1. Spontaneous resolution of symptoms (without any intervention) in 40% of patients
    2. Improvement in one year: 50%
    3. Improvement completely in 3 years: 85%
  16. References
    1. Buescher (2007) Am Fam Physician 76(10): 1477-84 [PubMed]
    2. Dimitroulis (1998) BMJ 317: 190-4 [PubMed]
    3. Gauer (2015) Am Fam Physician 91(6): 378-86 [PubMed]
    4. Shankland (2004) Gen Dent 52: 349-55 [PubMed]
    5. Truelove (2006) J Am Dent Assoc 137:1099-107 [PubMed]

Temporomandibular Joint Disorders (C0039494)

Definition (NCI) Any condition affecting the anatomic and functional characteristics of the temporomandibular joint.
Definition (MSH) A variety of conditions affecting the anatomic and functional characteristics of the temporomandibular joint. Factors contributing to the complexity of temporomandibular diseases are its relation to dentition and mastication and the symptomatic effects in other areas which account for referred pain to the joint and the difficulties in applying traditional diagnostic procedures to temporomandibular joint pathology where tissue is rarely obtained and x-rays are often inadequate or nonspecific. Common diseases are developmental abnormalities, trauma, subluxation, luxation, arthritis, and neoplasia. (From Thoma's Oral Pathology, 6th ed, pp577-600)
Concepts Disease or Syndrome (T047)
MSH D013705
ICD9 524.60, 524.6
ICD10 K07.6, M26.60, M26.6
SnomedCT 196434003, 41888000
English TEMPOROMANDIBULAR JOINT DISORDER, Disease, Temporomandibular Joint, Disease, TMJ, Diseases, Temporomandibular Joint, Diseases, TMJ, Joint Disease, Temporomandibular, Joint Diseases, Temporomandibular, Temporomandibular Joint Disease, Temporomandibular Joint Diseases, TMJ Disease, TMJ Diseases, Temporomandibular joint disorders, Disorder, TMJ, Disorder, Temporomandibular, Disorder, Temporomandibular Joint, Disorders, TMJ, Disorders, Temporomandibular, Disorders, Temporomandibular Joint, Joint Disorder, Temporomandibular, Joint Disorders, Temporomandibular, TMJ - Temporomandib jnt dis, TMJ Disorder, TMJ Disorders, Temporomandib.joint disord.NOS, Temporomandibular Disorder, Temporomandibular Disorders, Temporomandibular jt disorder, TEMPOROMANDIBULAR JOINT DIS, TMJ DIS, Temporomandibular Joint Disorder, TMD, Temporomandibular Joint Disorders, TMJ disorders NOS, Temporomandibular joint disorder, unspecified, Temporomandibular Joint Disorders [Disease/Finding], disorder temporomandibular, disorders joint temporomandibular, temporomandibular disorders, tmj disorder, disorder joint temporomandibular, temporomandibular joint diseases, temporomandibular joint disease, temporomandibular joint disorder, disease tmj, disorders tmj, temporomandibular disorder, tmj disorders, disorders temporomandibular, tmj disease, temporomandibular joint disorder (diagnosis), Temporomandibular disorders, Temporomandibular joint disorder NOS (disorder), Temporomandibular joint--Diseases, TMJ - Temporomandibular joint disorder, Temporomandibular joint disorder, Temporomandibular joint disorder (disorder), disease (or disorder); temporomandibular joint, jaw; disorder, temporomandibular, temporomandibular; disorder, joint, Temporomandibular joint disorder, NOS, Temporomandibular joint disorders, unspecified, Temporomandibular joint disorder NOS
Dutch temporomandibulaire gewrichtsaandoening, niet-gespecificeerde temporomandibulaire gewrichtsaandoeningen, temporomandibulaire gewrichtsaandoeningen, temporomandibulaire gewrichtsaandoening NAO, aandoening; temporomandibulair gewricht, kaak; aandoening, temporomandibulair, temporomandibulair; aandoening gewricht, Stoornis van het temporomandibulaire gewricht, Stoornissen van het temporomandibulaire gewricht, Temporomandibulaire gewrichtsaandoening, Temporomandibulaire gewrichtsaandoeningen
French Atteinte de l'articulation temporo-mandibulaire SAI, Troubles de l'articulation temporomandibulaire non précisés, Dysfonctions de l'ATM, Affection de l'articulation temporo-mandibulaire, Anomalies de l'articulé dentaire, Troubles de l'ATM, Troubles de l'articulation temporo-mandibulaire, Troubles de l'articulation temporomandibulaire
German Affektion des Temporomandibulargelenks NNB, Erkrankungen des Temporomandibulargelenks, Erkrankungen des Temporomandibulargelenks, unspezifisch, Erkrankung des Temporomandibulargelenks, Krankheiten des Kiefergelenkes, Temporomandibuläres Gelenkstörungen, TMJ-Störungen
Italian Patologia dell'articolazione temporo-mandibolare NAS, Patologia dell'articolazione temporo-mandibolare, Disturbi dell'articolazione temporomandibolare, non specificati, Malattie dell'articolazione temporomandibolare, Disordini dell'TMJ, Disturbi temporomandibolari, Disturbi dell'TMJ, Disturbi dell'articolazione temporomandibolare
Portuguese Afecções das articulações temporomaxilares, Afecção NE da articulação temporomaxilar, Afecções das articulações temporomaxilares NE, Afecção da articulação temporomaxilar, Transtornos da Articulação Temporomandibular, Transtornos da ATM
Spanish Trastornos de la articulación temporomandibular no especificados, Trastornos de la articulación temporomandibular, Trastorno de la articulación temporomandibular NEOM, Trastorno de la articulación temporomandibular, trastorno de la articulación temporomandibular, SAI (trastorno), trastorno de la articulación temporomandibular, SAI, trastorno de la ATM, SAI, trastorno de la articulación temporomandibular (trastorno), trastorno de la articulación temporomandibular, Trastorno ATM, Trastornos de la Articulación Temporomandibular
Japanese 顎関節障害NOS, ガクカンセツショウガイ, ガクカンセツショウガイNOS, TMJ障害, 顎関節疾患, 顎関節障害
Swedish Käkledssjukdomar
Finnish Leukanivelen toimintahäiriöt
Czech Blíže Neurčené poruchy temporomandibulárního kloubu, Porucha temporomandibulárního kloubu, Poruchy temporomandibulárního kloubu, Porucha kloubu temporomandibulárního NOS, temporomandibulární kloub - nemoci, nemoci temporomandibulárního kloubu
Korean 턱관절 장애
Polish Choroby stawu skroniowo-żuchwowego
Hungarian Temporomandibularis ízületi betegség k.m.n., Temporomandibularis ízületi betegség, nem meghatározott, Temporomandibularis ízületi betegség, Temporomandibularis ízületi betegségek
Norwegian Temporomandibulære funksjonsforstyrrelser, Kjeveleddssykdommer, Kjeveleddstilstander
Derived from the NIH UMLS (Unified Medical Language System)

Temporomandibular Joint Dysfunction Syndrome (C0039496)

Definition (MEDLINEPLUS)

The temporomandibular joint (TMJ) connects your jaw to the side of your head. When it works well, it enables you to talk, chew, and yawn. For people with TMJ dysfunction, problems with the joint and muscles around it may cause

  • Pain that travels through the face, jaw, or neck
  • Stiff jaw muscles
  • Limited movement or locking of the jaw
  • Painful clicking or popping in the jaw
  • A change in the way the upper and lower teeth fit together

Jaw pain may go away with little or no treatment. Treatment may include simple things you can do yourself, such as eating soft foods or applying ice packs. It may also include pain medicines or devices to insert in your mouth. In rare cases, you might need surgery.

NIH: National Institute of Dental and Craniofacial Research

Definition (NCI) A common disorder noted with jaw movement. It may be caused by malocclusion, repetitive use injury, trauma or arthritis. It is more prevalent among females between their second and fourth decades. Clinical signs include preauricular pain, temporomandibular joint clicking (as the mandibular condyle slips from the articulation made with the capsular disc and temporal bone) and restriction of jaw motion. Clinical course is typically benign but may progress to associated headaches, ear and neck pain, tinnitus and dislocation of temporomandibular joint. Prognosis is favorable as a majority of cases will respond to conservative management.
Definition (MSH) A symptom complex consisting of pain, muscle tenderness, clicking in the joint, and limitation or alteration of mandibular movement. The symptoms are subjective and manifested primarily in the masticatory muscles rather than the temporomandibular joint itself. Etiologic factors are uncertain but include occlusal dysharmony and psychophysiologic factors.
Definition (CSP) symptom complex consisting of partial deafness, stuffy sensation in the ears, tinnitus, pain, muscle tenderness, clicking in the joint, and limitation or alteration of mandibular movement; symptoms are subjective and manifested primarily in the masticatory muscles rather than the temporomandibular joint itself; etiologic factors are uncertain but include occlusal dysharmony and psychophysiologic factors.
Concepts Disease or Syndrome (T047)
MSH D013706
SnomedCT 266492006, 13612005, 155650000, 196430007, 386207004, 41888000
English TEMPOROMANDIBULAR JOINT-PAIN-DYSFUNCTION SYNDROME, Costen Syndrome, Costen's Syndrome, Costens Syndrome, Joint Syndrome, Temporomandibular, Myofascial Pain Dysfunction Syndrome, Temporomandibular Joint, Syndrome, Temporomandibular Joint, Syndrome, TMJ, Temporomandibular Joint Syndrome, TMJ Syndrome, Syndrome, Costen's, TEMPO MANDIBULAR JOINT DYSFUNC, TMJ SYNDROME, temporomandibular joint syndrome, Temporomandibular Joint Dysfunction Syndrome, TMJPDS-Temprmand jt pn dys syn, Temporomand jt pain dysfun syn, temporomandibular dysfunction syndrome, temporomandibular joint-pain dysfunction syndrome, temporomandibular joint-pain dysfunction syndrome (diagnosis), TMJ pain dysfunction syndrome, Temporomandibular Joint Dysfunction Syndrome [Disease/Finding], tmj syndrome, costen's syndrome, costens syndrome, dysfunction tmj, jaw snaps, tmj dysfunction, jaw snapping, syndrome tmj, costen syndrome, mandibular dysfunction, jaw snap, pain-dysfunction syndrome, TMJ, Temporomandibular Joint Dysfunction, TMD, Temporomandibular joint dysf., Temporomandibular syndrome, Jaw snapping, Temporomandibular synd., Temporomandibular joint dis., Costen's syndrome (disorder), Costen's syndrome, Temporomandibular joint syndrome, Temporomandibular joint-pain-dysfunction syndrome, Costen's complex, Snapping jaw, TMJ syndrome, Mandibular dysfunction, TMJPDS - Temporomandibular joint pain dysfunction syndrome, Temporomandibular joint pain dysfunction syndrome, Myofascial pain - dysfunction syndrome of TMJ, Temporomandibular joint-pain-dysfunction syndrome (disorder), complex; Costen, pain-dysfunction; syndrome, temporomandibular joint, syndrome; pain-dysfunction, temporomandibular joint, Costen; complex, Costen, Temporomandibular joint syndrome, NOS, TMJ-pain-dysfunction syndrome, Tempo mandibular joint dysfunc, Temporomandibular joint dysfunction
Italian Sindrome dell'articolazione temporo-mandibolare, Disfunzione dell'articolazione temporo-mandibolare, Sindrome dell'articolazione temporomandibolare, Sindrome algico-disfunzionale-miofasciale dell'articolazione temporomandibolare, Sindrome di Costen, Sindrome di TMJ, Sindrome disfunzionale dell'articolazione temporomandibolare
Dutch TMJ-syndroom (temporomandibulair gewrichtssyndroom), temperomandibulaire gewrichtsdisfunctie, temporomandibulaire gewrichtsdisfunctie, Costen; complex, complex; Costen, pijn-disfunctie; syndroom, temporomandibulair gewricht, syndroom; pijn-disfunctie, temporomandibulair gewricht, temporomandibulair gewrichtssyndroom, Disfunctie van het temporomandibulaire gewricht, Myofasciaal pijn-disfunctiesyndroom, Temporomandibulairgewrichtssyndroom
French Dysf articul de la mandib temp, Syndrome algodysfonctionnel de l'appareil manducateur, Syndrome algo-dysfonctionnel de l'articulation temporo-mandibulaire, Syndrome algodysfonctionnel de l'articulation temporomandibulaire, DYSFONCT ART TEMPORO-MANDIBULAIRE, Algies dysfonctionelles de l'appareil manducateur, Syndrome de l'articulation temporo-mandibulaire, ADAM, Dysfonctionnement de l'articulation temporo-mandibulaire, Dysfonctionnement de l'articulation temporomandibulaire, SADAM, Syndrome de Costen-Hennebert-Dechaume, Syndrome de Costen, Syndrome de l'ATM, Syndrome de l'articulation temporomandibulaire
German Funktionsstoerung des Temporomandibulargelenks, GELENKFEHLFUNKTION TEMPOROMANDUBU, Kraniomandibulaeres Syndrom, Temporomandibulaere Gelenkdysfunktion, TMJ-Syndrom, Myofaszial bedingtes Schmerzsyndrom, Temporomandibuläres Gelenk, Temporomandibuläres Gelenkdysfunktions-Syndrom, Temporomandibuläres Gelenksyndrom
Portuguese Disfunção articular temporomandibular, Disfunção da articulação temporomaxilar, DISFUNC ARTICUL TEMPO MAND, Síndrome Miofascial de Disfunção Dolorosa Temporomandibular, Síndrome da articulação temporomaxilar, Síndrome da Articulação Temporomandibular, Síndrome da ATM, Síndrome da Disfunção da Articulação Temporomandibular
Spanish Disfunción de la articulación temporomandibular, Disfunción de articulación temporomandibular, ARTICULACION TEMPO-MANDIBU, DISFU, Síndrome de Disfunción de la Articulación Temporomandibular con Dolor Miofascial, síndrome de Costen, mandíbula chasqueante, complejo de Costen, Disfunción de la ATM, Síndrome TMJ, Síndrome de ATM, síndrome de disfunción dolorosa de la articulación temporomandibular (trastorno), síndrome de disfunción dolorosa de la articulación temporomandibular, síndrome de la articulación temporomandibular, Síndrome de la articulación temporomandibular, Síndrome de la Articulación Temporomandibular, Síndrome de la ATM, Síndrome de la Disfunción de Articulación Temporomandibular
Japanese 顎関節機能不全, 顎関節機能障害, ガクカンセツショウコウグン, ガクカンセツキノウショウガイ, ガクカンセツキノウフゼン, アゴカンセツキノウショウガイ, TMJ症候群, 顎関節機能不全症候群, 側頭下顎関節疼痛機能不全症候群, 顎関節症, 顎関節症候群, 疼痛機能不全症候群-側頭下顎関節
Swedish Käkledssyndrom
Czech syndrom temporomandibulárního kloubu, syndrom dysfunkce temporomandibulárního kloubu, Syndrom temporomandibulárního kloubu, Dysfunkce temporomandibulárního kloubu, myofasciální bolestivý dysfunkční syndrom temporomandibulárního kloubu, temporomandibulární bolestivý syndrom, TMJ syndrom
Finnish Leukanivelen toimintahäiriöoireyhtymä
Polish Zespół stawu skroniowo-żuchwowego, Mioartropatie skroniowo-żuchwowe, Zespół Costena, Bólowy zespół skroniowo-żuchwowy, Dysfunkcje skroniowo-żuchwowe, Zespół dysfunkcji stawu skroniowo-żuchwowego, Dysfunkcja bólowa stawu skroniowo-żuchwowego
Hungarian Temporomandibularis ízület syndroma (TMJ syndroma), Temporomandibularis ízület funkciózavara, Temporomandibularis ízület syndroma, Temporomandibularis ízület működési zavara
Norwegian Temporomandibulært syndrom, TMJ-syndrom, Costens syndrom, Kjevespenninger, TMJ syndrom, Kjeveleddsfunksjonssyndrom, Costen-syndrom, Knaking i kjeveledd, Kjeveleddssyndrom
Derived from the NIH UMLS (Unified Medical Language System)

Arthralgia of temporomandibular joint (C0155943)

Concepts Disease or Syndrome (T047)
ICD9 524.62
ICD10 M26.62
SnomedCT 311671000009105, 91943004
English arthralgia of temporomandibular joint, arthralgia of temporomandibular joint (diagnosis), TMJ pain, pain in temporomandibular joint (symptom), pain in temporomandibular joint, arthralgia of TMJ, Arthralgia TMJ, temporomandibular joint pain, joint pain temporomandibular, Temporomandibular joint arthralgia, Temporomandibular joint disorders, arthralgia of temporomandibular joint, Temporomandibular joint pain, Temporomandibular joint pain (finding), Arthralgia of temporomandibular joint, Arthralgia of temporomandibular joint (disorder)
Czech Artralgie temporomandibulárního kloubu
Dutch artralgie van kaakgewricht, temporomandibulaire gewrichtsartralgie
French Douleur temporo-mandibulaire, Arthralgie de l'articulation temporomandibulaire
German Arthralgie des Temporomandibulargelenks, Arthralgie des Mandibulargelenks
Hungarian Temporomandibularis ízület arthralgia, Temporomandibularis ízületi arthralgia
Italian Artralgia dell'articolazione temporo-mandibolare
Spanish Artralgia temporomandibular, artralgia de la articulación temporomandibular (trastorno), artralgia de la articulación temporomandibular, artralgia temporomandibular (trastorno), artralgia temporomandibular, dolor de la articulación temporomandibular
Japanese ガクカンセツツウ, 顎関節痛
Portuguese Artralgia da articulação temporomaxilar
Derived from the NIH UMLS (Unified Medical Language System)

You are currently viewing the original '\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree