We would like to thank Dr. Hargitai for his interest in our research. The work by deLeeuw and colleagues1 that Dr. Hargitai cited provides support for his contention that "joint changes stabilize." According to deLeeuw and colleagues,1 "in 79 percent of the TMJs with moderate to severe radiographically visible degenerative changes at T1 (before non-surgical treatment), no or only slight progression in the extent of these changes was seen between T2 (two to four years after non-surgical treatment) and T3 (30 years after non-surgical treatment)." However, the study by deLeeuw and colleagues1 further showed that clinical subtypes of ID were associated with progressive development of radiographically detectable degenerative changes as "the number and severity of radiographically visible degenerative changes increased significantly from T1 through T2 to T3 in group 1 (reducing disk displacement) and in group 2 (permanent disk displacement)."
The suggestions Dr. Hargitai raises are relevant, timely and important. They highlight the need for a taxonomy of TMD to be placed conceptually within the larger context of all cranio-cervical and craniofacial pain disorders.
A critical obstacle is the development of standardized diagnostic criteria for defining clinical subtypes. The problem with most of the tests used clinically is that they may not be suitable for research questions, and appear to be based on the impressions gained from clinical experience. Specificity is unknown, and the interrater reliability of diagnostic assignment is likely low, given the overlap of signs and symptoms among entities.
The Clinical Diagnostic Criteria for Temporomandibular Disorders system2 covers the major disorders found most often in the clinic. The diagnostic criteria are suitable for research questions and are limited to include only the most powerful criteria for clinical decision making. The system encourages multiple concurrent diagnoses, a common practice in many areas of health care.
TOP
REFERENCES
