MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS - CONCEPTS AND CONTROVERSIES

Statement of problem. Controversy continues in the area of epidemiolog y, etiology, diagnosis, and management of temporomandibular disorders (TMD). The field is replete with testimonials and clinical opinion, bu t it has been lacking in scientific foundation. Purpose. This article reviews the recent temporomandibular disorder and orofacial pain liter ature and summarizes the concepts published in the 1993 and 1996 Ameri can Academy of Orofacial Pain guidelines. Temporomandibular disorders rarely occur as single entities but rather as multiple problems with o verlapping symptoms. Clinical significance. The multicausal nature of these problems and the number of conditions with similar signs and sym ptoms demand an effective differential diagnostic process. Diagnostic criteria are used from an operational standpoint to establish specific diagnoses based on a multiaxial diagnostic model. Conclusion. Because little is known about the natural course of the various classificatio ns of temporomandibular disorders, and because most treatment approach es are reported to be equally effective, a conservative, noninvasive m anagement program is endorsed. The emphasis is on a medical multidisci plinary model similar to ones used for other musculoskeletal disorders that involve the patient in the physical and behavioral management of his or her own problem. This article concludes that a majority of tem poromandibular disorder patients achieve good relief of symptoms with noninvasive reversible therapy.