Most practicing dentists perceive the subject of temporomandibular
joint (TMJ) diseases and disorders (TMJDs) as one of
controversy, fueled by intense arguments about the relationship
between the dental occlusion and the state of health of the
masticatory system. Will dentistry ever again be able to think
freely about this matter? How will we unravel the etiopathogenesis
of the TMJDs when faced with strong convictions and
consumed by an emotionally charged debate? When are
negative results about the link between the occlusion and
TMJDs sufficient to examine alternative lines of inquiry of the
pathogenesis of TMJDs? How will we ever be in a position to
isolate and reevaluate the uncomfortable factual irregularities
that do not fit the prevailing explanatory models of TMJDs?
How can one practice according to the evidence if the
evidence is not predicted by the popular models of disease
causation? It appears that we have reached a stage in
understanding where the original literature needs to be reassessed
based on BMethods and Materials[ and BResults[
rather than the motivations and constructs expressed in the
BIntroduction[ and BDiscussion[ sections. Influenced by
powerful trends in science at-large, the field of TMJD is at a
point where it is expected that traditional concepts will rapidly
loose appeal and that the field of TMJD will gain significant
new momentum.
Seventy-five percent to 95% of primary care TMJD patients
benefit from interventions administered by a range of health
care professionals offering occlusal appliances, occlusal equilibration,
thermal pads, a host of pharmacological interventions,
orthodontics, crown and bridge treatment, surgery,
physical therapy, relaxation training, acupuncture, biofeedback,
and psychological and diet counseling. None of these
remedies appears to promise a substantially better outcome
over other types of therapy, although each treatment
approach is believed to have its own underlying rationale
and presumably unique mechanism of action.
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