Report of the President's conference on the examination, diagnosis, and management of temporomandibular disorders

Abstract

rConvening a conference on the etiology, diagnosis, and management of temporo­ mandibular disorders was one of my major goals as president of the American Dental As­ sociation. Although temporomandibular (TM) disorders may not be new, they do consti­ tute a relatively new area of research and study. As a result, few, if any, organized or stan­ dardized approaches to the examination, diag­ nosis, or treatment of TM disorders exist. It has been my belief that all of dentistry would bene­ fit from the establishment of a rational, un­ biased approach to these disorders. It was my hope that this conference would review some of the areas of confusion surrounding TM dis­ orders and arrive at an initial set of guidelines. Obviously, it was unrealistic to believe that we would be able to resolve all of our questions with one conference. Many areas and disci­ plines outside dentistry are currently involved in the field of TM disorder management. I have felt very strongly that the time has come for organized dentistry to take the initia­ tive to provide the leadership for the necessary study and discussions required to clarify this area. I have believed it imperative that we es­ tablish, from the outset, that the dentist is the primary therapist in managing TM disorder patients. It is up to us to take the lead in devel­ oping guidelines, based on sound scientific and clinical knowledge, that will allow us to help our patients. I asked that the conference participants focus their attention on those areas that would be both useful to the practitioner and therapeu­ tic to the patient. I identified three areas most in need of attention. First, there was the need to make some specific recommendations regard­ ing the protocol for examination of patients with symptoms indicative of TM disorders. This was the first step, and a very critical one, in the management of the disease. Secondly, there was the need to begin to develop the dif­ ferential diagnoses that could be used to iden­ tify the various kinds of these disorders. This information needed to be organized, pub­ lished, and distributed to the profession for the benefit of dentists and patients alike. Finally, I believed it crucial to identify and recommend the most effective modes of therapy for the management of TM disorders. The conference examined a comprehensive and exhaustive set of issues. Although agree­ ment was frequently difficult to achieve, the conference participants did establish the guidelines presented here. It also recognized the need for the development of dental history questionnaires to assist in screening for TM disorders and for an improved classification for TM disorders. Although the task is far from being completed, I think that this conference achieved the goal that I had in mind for devel­ oping initial guidelines. It will remain for fu­ ture conferences to refine these guidelines. I would like to thank the people who assisted me in putting this program together. An advi­ sory committee of leading practitioners, edu­ cators, and researchers in the field of TM helped recommend and select the speakers who addressed the conference. In addition, a select group of practitioners, currently work­ ing in the field of occlusion and TM disorders, provided additional input during the work­ shop sessions of this conference. I would again add that the following guidelines represent an initial step and, as a re­ sult, suffer from imperfections inherent in such an effort. I would also invite your com­ ments and views about them.