“As to methods, there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principle, is sure to have trouble”
Ralph Waldo Emerson
It should be obvious to anyone involved in health care that to undertake treatment of any condition requires that we first understand what we are treating. In other words, treatment recommendations should always be based upon a specific diagnosis. In the case of Temporomandibular Disorders, “TMJ” is not a diagnosis. The need for a biologically-specific understanding of the condition that is to be treated is crucial; that is the nature of true diagnosis.
After arriving at a biologically-specific diagnosis, the second requirement, prior to undertaking treatment, is to identify the treatment objectives; what do you hope to accomplish with treatment? In the past, all too often the prevailing treatment objective for Temporomandibular Disorders, whether consciously recognized or not, has been primarily the relief of symptoms and little else. Because pain is what often brings a patient to our offices, the patient’s primary objective will nearly always be pain relief and that is quite understandable. The following table, Appliance Type by Dx Category, serves as a guide for the clinician to tailor the treatment to manage both the symptoms and the underlying problem.
Certainly, if pain is a symptom, then pain relief should be one of the primary objectives of treatment. But pain is often not the actual problem, but rather an expression of the problem. Because treatment has often addressed only the symptoms, and has not addressed the problem that was producing those symptoms, this may largely explain why Temporomandibular Disorders have a reputation for recurring chronically, as this approach often has left the patient predisposed to having the problem return.
Dentists have primary professional responsibility for all disorders of the masticatory system. The treatment of other joint systems of the body is usually provided by several other areas of clinical focus that are oriented toward orthopedic problems. But because of the presence of teeth in this unique joint system, which profoundly affects the function of the muscles and that can also affect both structure and function of the temporomandibular joints, non-dental professional groups are not able to provide the definitive care that this system often requires. If the role of the teeth were not such a significant factor in the function of this system, there would be no unique role for the dental profession in managing temporomandibular disorders.
However, like other joint systems of the body, the masticatory system functions according to certain basic orthopedic physiologic principles. In any treatment that is intended to restore physiologic functional homeostasis to the masticatory system, not simply the treatment of symptoms, this reality regarding orthopedic principles must be appreciated and applied as a part of any comprehensive treatment protocol. Dentists who understand these principles and who are able to meet this standard are engaging in true rehabilitation, not simply symptomatic treatment.
• Patient Self-Management
• Behavioral Therapies
• Physical Medicine
• Occlusal Appliance Therapy
• Occlusal Therapies
• Surgical Management