HISTORY AND EVOLUTION OF TMD CONCEPTS

Historically the field of temporomandibular disorders (TMD) has been b ased on testimonials, clinical opinion, and blind faith rather than on science. Reparative procedures to the joints, jaws, or occlusal surfa ces of the teeth to develop idealized structural relationships that ma y be required for dental health and function are less likely to be req uired for the management of chronic musculoskeletal disorders. Because of the concerns of many people today regarding professional credibili ty and intellectual honesty, the need for a scientific foundation to s upport the various belief systems is of paramount importance. In fact, therapeutic approaches for TMD are undergoing a major evolution away from the traditional mechanistic dental concepts of the past to the mo re current biopsychosocial medical concepts that emphasize multidiscip linary approaches. Recent advances in the understanding of pain mechan isms and management of chronic pain have improved long-term treatment outcome. The emphasis is on treatment that involves the patient in the physical and behavioral management of their own problem. The majority of patients with TMD achieve good relief of their symptoms with nonin vasive, conservative therapy.