The impact of the American Dental Association's guidelines for the examination, diagnosis, and management of temporomandibular disorders on orthodontic practice

Abstract

There appears to be no simple diagnosis and treatment plan for the management of TM disorder patients. A differential diagnosis of TM disorders should be based upon a logical classification that incorporates a number of variables, such as masticatory disorders, problems involving derangement of the TMJ, problems that result from extrinsic trauma, degenerative joint diseases, inflammatory joint disorders, chronic mandibular hypomobility, and growth disorders of the joint. In the absence of definitive scientific research pertaining to TM disorders, the ADA has established guidelines for the examination, diagnosis, and management of TM disorders. Most often, treatment of TM disorders has been anecdotal and directed at allaying the symptoms and not particularly directed at the cause. The general recommendation of the ADA guidelines regarding TM disorder treatment is that it be conservative, reversible, and based upon scientific data whenever possible. These general recommendations, although nebulous, point to the fact that we simply have not progressed far enough to develop a consensus plan concerning the most appropriate treatment for each and every patient with TM disorders. The problems in the patient population are too complex and varied for an outline or “cookbook” type of treatment plan. Since orthodontists have become more involved in the treatment of TM disorders, some may re-evaluate their thinking in light of the ADA TM disorder guidelines. The orthodontist may also have to resolve conflicts that arise over differing opinions regarding the major issues involved in TM disorder examination, diagnosis, and treatment. Too often simplistic models of natural phenomena may be misleading and inaccurate, as is true of some existing models which explain TM disorders. It is time that we, as members of the great profession of dentistry, critically evaluate current literature in order that we may responsibly justify our diagnoses and treatment modalities. In light of the fact that the more knowledge we accumulate, the more we should realize how much we do not know, it might be wise for us to reflect upon the following quotation from Shakespeare: The fool doth think he is wise, but the wise man knows himself to be a fool.