TMJ Disorder

tmj-chartAffecting the temporomandibular joint (TMJ) and/or the muscles of mastication, as well as contigous tissue components. Although specific etiologies such as degenerative arthritis and trauma underlie some TMD, as a group these conditions have no common etiology or biological explanation and compromise a heterogeneous group of health problems whose signs and symptoms are overlapping, but not necessarily identical. Depending on the practitioner and the diagnostic methology, the term TMD has been used to characterize a wide range of conditions diversely presented as pain in the face or jaw joint area, headaches, earaches, dizziness, masticatory musculature hypertrophy, limited mouth opening, closed or open lock of the TMJ, abnormal occlusal wear, clicking or popping sounds in the jaw joint, and other complaints. The severity of these presenting conditions may range from noticeable but clinically insignificant signs to seriously debilitating pain or dysfunction.

Given this variation among the problems labeled TMD, it is not surprising that controversy has emerged. Even the name TMD is not universally endorsed. Generally accepted, scientifically based guidelines for diagnosis and management of TMD are still unavailable. Even so, practitioners representing a variety of disciplines and specialties have responded to their patient’s needs by developing and employing a broad range of treatment approaches that include educational or behavioral counseling, pharmacological or mechanical approaches, occlusal therapies, and a variety of surgical procedures, or combinations thereof. In many cases, patients have improved, and in others-for example, in cases involving the use of certain alloplastic implants – the results have been disastrous. For the majority of TMD patients, the absence of universally accepted guidelines for evaluation and diagnosis compromises the goals of consistent and conservative therapy. The lack of standard treatment protocols accepted across professional specialties means that many patients and practitioners may attempt therapy with inadequately tested approaches.

Although epidemiological data are inadequate, the total number of TMD sufferers in this country ccan be roughly estimated at more than 10 million, and concern about the safely and efficacy of their care requires that we achieve a better understanding of these health problems. Not only must valid and reliable criteria for diagnosis and measurement be developed, but the rationales for and effectiveness of a variety of treatments currently in use must be examined as well.

To address this issues, the National Institute of Dental Research and the NIH office of Medical Applications of Research covened a Technology Assessment Conference on Management of Temporomandibular Disorders, with the encouragement of patient-based support groups. The conference was cosponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health.

This conference brought together specialists in clinical dentistry, medicine, surgery, cellular and molecular biology, biostatistics, epidemiology, immunology, behavioral and social sciences, pain management, tissue engineering, and representatives of the public, including TMD patients and advocacy groups. After 1 ½ days of presentations and audience discussion, this independent, non-Federal technology assessment panel weighed the scientific evidence and the experience of patients and practitioners and developed a draft statement that addressed the following questions:

  • What clinical conditions are classified as temporomandibular disorders, and what occurs if these conditions are left untreated?
  • What types of symptoms, signs, and other assessments provide a basis for initiating therapeutic interventions?
  • What are effective approaches to the initial management and treatment of patients with various TMD subtypes?
  • What are effective approaches to the management and treatment of patients with persistent TMD pain and dysfunction?
  • What are the most productive directions for future research, and what types of new collaborations and partnerships should be developed for pursuing these directions?