Contrary to the suggestion in my guest editorial to eliminate use of the term "temporomandibular disorders" (TMDs), Dr. Bush presents four reasons why he believes it should remain in our vocabulary. I would like to address why I believe these reasons are wrong.
First, there is no need to use a special term to distinguish this area from other parts of the body. I am sure that dentists can locate the temporomandibular joint and the muscles of mastication without having a special term to encompass these areas. Moreover, "TMD" refers to diseases and disorders in these two sites, whereas "chest," "knee" or "foot" refers to only an anatomic area. Fortunately, medicine has not fallen into the trap of using an anatomic term to describe a disease, so that we do not have "knee" or "chest" having the same connotation as "TMJ."
Familiarity with the term "TMD" on the part of the health insurance industry is a poor reason for its continued use. Insurance benefits are based on specific diagnoses, and use of an umbrella term can easily result in under or overpayment for the treatment performed. Therefore, continued use of TMD by the insurance industry does a service to neither the carrier, the doctor nor the patient.
Use of the term "TMD" by the general public or health care providers also is not a sufficient reason for maintaining it. Having patients refer to their condition as "TMD" merely makes it more difficult to then explain to them the specific condition that they actually have. In addition, it complicates the doctor’s attempt to explain why their problem may require a different treatment from what they were told by a friend who had similar symptoms or what they have read in the lay literature. Common acceptance by the health care provider is an even worse reason to continue the use of "TMD" for the reasons stated in my editorial.
I regret that Dr. Bush is offended that his textbook was not cited. He might note that I have also co-edited a recent textbook on TMD,1 and this also was not cited. Moreover, the fact that he also identified muscle and joint disorders in his book 13 years ago does not give him claim to priority. As mentioned in my editorial, this concept was first proposed by Laszlo Schwartz2,3 in the 1950s, and was expanded by me and my colleagues in 1969.4
Finally, Dr. Bush’s attempt to clarify what is meant by "TMD" in his textbook, as noted in his letter, seems to add more confusion than clarification, and confirms what I have said in my editorial. His four cardinal symptoms of temporomandibular joint (TMJ) and muscle pain, joint sounds, tenderness in the TMJ and masticatory muscles, and limitation of mouth opening and jaw movements are actually characteristic of most of the conditions ordinarily included under the heading of "TMD." Therefore, rather than separating the various conditions into meaningful subgroups, his approach merely continues the problems associated with using "TMD" as a single entity.
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