A new journal article makes the bold claim that most dental websites are misleading potential patients about the causes and treatment of TMJ. However, the article represents a prejudiced attack on neuromuscular dentists and is itself misleading.
The article makes a very strong — and probably wrong — stance on the causes and treatment of TMJ, and in the process makes a mistake it criticizes websites for making.
TMJ and Malocclusion
When TMJ was first described in 1934 and called Costen’s syndrome, the disorder was attributed to malocclusion, teeth that didn’t fit together properly. This explanation was used, successfully, to diagnose and treat the condition for decades.
However, more recent research began to cast doubts on the dominance of malocclusion in TMJ or TMD (as it was coming to be called). In addition to malocclusion and trauma to the jaw as causes of the disorder (or disorders–we’ll talk about that later), researchers began to point to psychological factors, hormonal factors, parafunctions, and joint hypermobility among other causes.
The science supports downgrading malocclusion from the single cause of TMJ to just one of many potential causes of the disorder. It does not support, as this article suggests, eliminating it altogether as a potential cause. The fact that many studies have found an association between TMJ and certain occlusal factors cannot be ignored. It may even be true that for most people it’s more important to consider other factors first and respond to them with other treatments, including counseling, cognitive-behavioral therapy (CBT), physical therapy, medications, and more.
It’s also best to avoid invasive and irreversible treatments when those treatments could do as much harm as good. Noninvasive and reversible treatments are to be preferred in all cases. But that doesn’t preclude occlusal interventions, as some of these can be performed without causing permanent changes to the bite system.
Is TMJ One or Many Disorders?
Another major accusation leveled at the websites of TMJ dentists is that they sometimes describe TMJ as a single disorder rather than as a group of disorders. On the one hand, it’s true that the label we currently use for temporomandibular joint disorders (TMJ) or temporomandibular disorders (TMD) seems to cover a lot of ground and include many people with disparate symptoms and causes, so it makes sense to describe TMJ as being many disorders.
But on the other hand, no one seems to have clearly defined the separate disorders that make up TMJ. In this paper, they give a few examples of potential divisions (myofascial pain, bone pathology, and disc pathology are the examples they use), but there is by no means a consensus that this is the best way to compartmentalize TMJ. The Wikipedia page for the disorder gives a hint at the level of disagreement among doctors and dentists about the disorder(s).
Is it really any better to say that TMJ is made up of many different disorders (but nobody agrees what these disorders are or how to diagnose and treat them) than to say that TMJ is a single disorder with many different causes, physical manifestations, and symptoms? Until we can really define the disorders within TMJ, it doesn’t seem that there’s any benefit to using the multiple disorder description.
Besides, if they truly believe that TMJ is not one condition, but many, doesn’t it make sense that these many conditions might have different causes and treatments, including some that may benefit from occlusal approaches?
We Know We Help Patients
In the end, although some researchers may take issue with our information, we do know that the methods we use can and do work for many of our patients. We have talked about some on our website, and we’ll be happy to introduce you to some of them if you want.
And if the “orthodox” approaches to TMJ treatment aren’t helping, maybe our “unorthodox” approach will.