Dr. Daniel Laskin’s February JADA guest editorial, "Temporomandibular Disorders: A Term Past Its Time?" (
JADA 2008;139[2];124–128[Free Full Text]
), focused on the history of the term, the current situation, resolving the diagnostic dilemma and conclusions about temporomandibular disorders (TMD). He raised the issue of eliminating "temporomandibular disorder" from our vocabulary.
In our textbook, The Temporomandibular Joint and Related Orofacial Disorders,1 Dr. M. Franklin Dolwick and I addressed many of these same subjects in considerable detail. Although our textbook received favorable reviews by several colleagues in the field, the title was missing among the 29 references listed in Dr. Laskin’s guest editorial.
Because much confusion existed about what was meant by TMD, we attempted to clarify the status of the disorder. Four cardinal signs and symptoms of TMD were described: pain in the TM joints, muscles of mastication and adjacent soft tissue; TM joint sounds that occur during mouth opening and closing and moving the lower jaw to either side or forward; tenderness of the TM joints, muscles of mastication and adjacent soft tissues on digital palpation; and limitation on opening the mouth and moving the lower jaw to either side or forward. We considered that these characteristics set this disorder apart from a host of other signs and symptoms that sometimes were considered to be associated.
We reviewed the literature for and against an association between etiology and disorder. This discussion considered single versus multifactorial etiologies, as well as predisposing, precipitating and perpetuating factors. Among these were anatomical conditions, malocclusions, occlusal disharmonies, improper position of the head and spinal column, osteopathological conditions, muscle disorders, neuralgias, respiratory disorders, trauma, whiplash, orthodontics, root canal therapy, bruxism and emotional factors. None of the information described in the literature at that time provided satisfactory explanations for cause and effect.
Dr. Laskin argues that the "simplest way to avoid the diagnostic confusion in the literature is to eliminate use of the term ‘temporomandibular disorders.’" He suggests that disorders of the temporomandibular complex could be better categorized into muscle problems and joint problems. Under the muscle category he lists seven examples of subcategories, including myositis, myofascial pain, myospasm, hyperkinesia, hypokinesia, contracture and fibromyalgia. Under joint problems he lists congenital and developmental disorders, traumatic injuries, ankylosis, arthritis, neoplasia and internal derangement.
In our textbook written 13 years ago, we identified these same two categories and distinguished them from other conditions that mimicked TMD. These were TMJ problems, muscle problems, dental problems, headache, neural problems, Axis I psychological disorders, Axis II personality disorders and less common disorders mimicking TMD. We proposed algorithms for each of these categories, and listed subcategories within each for the purpose of aiding the practitioner in arriving at a diagnosis.
While designating a specific subcategory tends to improve interpretation of a condition in the narrowest sense, several arguments can be made for keeping "TMD" in our vocabulary. "TMD" identifies a condition localized to a certain area of the body that can be distinguished from other areas such as the chest, knee or foot. "TMD" has widespread use in the general public. Employees of the health insurance industry who are called on to consider TMD in reimbursement for care have come to recognize the term. Furthermore, "TMD" is commonly accepted by many health care providers who render treatment.
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