I must confess that I read Dr. Daniel Laskin’s February JADA guest editorial, "Temporomandibular Disorders: A Term Past Its Time?" (
JADA 2008;139[2]:124–128[Free Full Text]
), with great consternation. Dr. Laskin’s premise concerning TMD terminologies is that, as he puts it, "clearly, the simplest way to avoid the diagnostic confusion in the literature is to eliminate the term ‘temporomandibular disorders.’ " Furthermore, he states, "continued use of the term ‘temporomandibular disorders’ can no longer be defended."
How absurd! If one wants to avoid "diagnostic confusion" about TMJ disorders, why not just learn to accept the modern understanding of what they actually are? Yes, there have been confusion and sloppy terminological usages in the past. That is easily remedied by more careful (and proper) employment of existing definitions. If you think you can suddenly make all dentists stop using terms like "TMJ" or "TMD," you’re wasting your time. What is far more serious here is the revelation that the "old guard scientific spin" somehow seems to still survive with regard to this issue. Dr. Laskin derides the relationship between TMD and occlusion, as well as the critical role of condyle (disk) displacement, as if they were all imaginary.
Dr. Laskin goes on to quote Landa1: "‘One of the gravest mistakes in the diagnosis of temporomandibular joint disturbances is the misinterpretation of certain positions of the condylar head in the glenoid fossa as evidence of pathology.’"
What such a statement actually represents is a misinterpretation of the true "TMD message." Condylar position at full occlusion, in and of itself, means nothing. Condylar position at full occlusion, evaluated in conjunction with certain attending signs and symptoms, means everything. It also serves to direct the need, at times, for certain corresponding treatment strategies (as in condylar decompression procedures), which are in fact now supported by the modern literature.2–4
It seems that Dr. Laskin hasn’t wholeheartedly accepted this yet. He and others of similar view still try to protect the same old "psychosocial turf" in TMD. When physical symptoms are the problem, physical medicine provides the solutions.
As for the development of a practical paradigm regarding the diagnosis and treatment of conventional TMDs, academic leadership has failed to step up and get the job done. As a result, millions of patients with TMD continue to suffer, and thousands of recent dental school graduates are ill-prepared to treat them. It is up to the everyday clinician to fend for himself or herself in this regard, and some have done a pretty good job of it.
To add to the very confusion Dr. Laskin is trying to ameliorate, he compiles two sets—seven "muscle problems" and seven "joint problems"—that he contends could serve as a more precise terminological list from which "diagnoses can be selected from each area when patients have both a TMJ problem and a masticatory muscle problem" (as if the two are pristinely separate entities). Under the heading of muscle problems, he lists myositis, myofascial pain, myospasm, hyperkinesia, hypokinesia and contracture, which are symptoms, not true diagnoses as in the sense of defining an etiological agent or condition. Symptoms do not constitute diagnoses. Since when is "fever" a diagnosis? His list of seven "joint problems" is equally as vague as the term "TMD." Is this helping anything?
When it comes to a subject as complex and controversial as TMDs, space in JADA should be reserved for articles of objective science that discuss proper diagnosis and treatment, not subjective editorials that argue the mere quiddities of TMD semantics.
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