The members of the American Society of Temporomandibular Joint Surgeons read with great interest Dr. Daniel Laskin’s February guest editorial, "Temporomandibular Disorders: A Term Past Its Time?" (
JADA 2008;139[2]:124–128[Free Full Text]
). As an organization of surgeons and others committed to the scientifically grounded, compassionate surgical care of patients with temporomandibular joint disease, we are well aware that this group of ailments is viewed as almost mystical, in no small part because of vague terminology. We applaud Dr. Laskin’s effort to improve the clarity of our thinking by improving the words through which we think and communicate.
All too often our patients tell us that their other providers, whether physicians or dentists (who should know better), have diagnosed them with "TMJ." When we communicate directly with our peers, we tend to upgrade our terminology to diagnosing "a TMD." As Dr. Laskin points out, this is hardly an improvement: we have only delayed a true diagnosis by using a broad term mixing distinct anatomic areas and etiologies.
In an attempt to clarify this situation, we would propose the following taxonomy for disorders of the temporomandibular complex:
- – Extra-articular masticatory and cervical muscle fatigue/spasm/pain and dysfunction. This is a specific term that should be used to describe painful and debilitating extra-articular maladies of the head, neck and jaws. These problems result from the abuse of the masticatory and cervical musculature secondary to abnormal parafunctional habits such as bruxism and clenching of the teeth in response to stress and/or myofascial pain. However, if not controlled or eliminated, these problems could, in some cases, cause intra-articular biomechanical pathology owing to overloading of susceptible joints.
- – Intra-articular biomechanical dysfunction. This is a specific term used to describe the consequences of the pathological entities that develop in the intra-articular structures of the TMJ. These are the same intra-articular pathological entities encountered in all body joints: developmental abnormalities, neoplasia, traumatic injury, impairing internal derangements, high and low inflammatory arthritic disease and ankylosis.
The important distinction between these is that the first group of diseases is not primarily centered in the joint itself, whereas the latter group is directly related to the anatomy and associated pathology of the joint. In those patients whose underlying etiology is intra-articular biomechanical pathology, treatment may not be successful without surgical intervention. Nobody can deny that it is critically important to clearly distinguish such patients from those in the first group, for whom surgery is inappropriate.
The health consequences of disorders of the temporomandibular complex can be devastating. Dependence on pain medications, decreased productivity and disability are common. Better, clearer communication between doctors and patients can only improve efficient diagnosis and delivery of care. Dr. Laskin’s recommendations would help distinguish disease amenable to surgical therapy, guide research priorities and improve interpretation of new knowledge, as well as enhance teaching and understanding of this broad topic.
