Two-Phase Treatment for Temporomandibular Disorders


With temporomandibular disorders, pain is often what causes the patient to seek treatment and their first desire is usually to eliminate the symptoms. However, the symptoms are not the disorder, they are an expression of the disorder. In nearly all cases, other than acute trauma, dysfunction of the masticatory system precedes the pain. The word “dysfunction” simply means abnormal function and can occur in the muscles of mastication and/or in the temporomandibular joints.


Reducing or eliminating the patient’s subjective awareness of pain does not assure that the associated dysfunction is also resolved. There are a variety of methods for relieving symptoms on a short-term basis, but if the dysfunction that is the source of, and that accompanies, the pain is not addressed in a definitive manner, the patient will be left in a vulnerable condition, predisposed to having the symptoms return. Temporomandibular disorders have a reputation for recurring chronically and if the objective of treatment is only to treat the pain and does not include definitive treatment of the dysfunction, a chronic recurrence of the symptoms should not be surprising.


In our office, treatment of TMDs for most patients is based on a true “rehabilitation” model; i.e., to address not just the presenting symptoms, but to restore normal physiologic function (eliminate dysfunction), or as near to that as is feasible in the individual case. Our objective is to ultimately achieve a definitive level of stability within the masticatory system through the identification and elimination of probable predisposing and perpetuating factors. This approach has proven to be the most effective method of minimizing the likelihood of a return of the patient’s original symptom complex. To accomplish physiologic homeostasis and true rehabilitation within the masticatory system, a two-phase approach is usually employed.