"The Most Important Thing You Can Do For Your Patient is to
Make the Correct Diagnosis. It is the Foundation For Success"
– Jeffery P. Okeson, DMD
The key to understanding Temporomandibular Disorders is to realize that they present along a broad continuum, from relatively minor muscular conditions to very complex disorders involving intracapsular mechanical dysfunction, usually combined with significant muscular involvement.
Whatever a given patients' presenting condition may be, to provide a proper diagnosis, it must be described in specific biologic terms. In other words, the term “TMJ” is too generic of a term, is not biologically-specific and tells us nothing about the nature of the patient's condition that may need treatment.
For decades the dental profession has used the phrase “TMJ Pain/Dysfunction”, having historically thought of these conditions primarily in terms the pain component. The dysfunction has seemed to be of secondary importance. However, although pain may be what will cause the patient to seek treatment, the underlying cause of the pain is often the dysfunction. It is crucial to recognize that the pain is usually not the actual problem but simply an expression of the underlying problem. Identifying the problem causing the pain is essential to determining a biologically-specific diagnosis which enables definitive treatment for the actual condition, the dysfunction of the musculoskeletal structures, that may be causing the pain.
Our understanding of these conditions, in their broadest sense, is reflected in the definition of TMJ disorders provided by Dr. Weldon Bell — "Pain and/or dysfunction of the masticatory musculoskeletal structures". If we appreciate which painful conditions involve musculoskeletal structures, we can better understand how significantly they vary from other types of orofacial pain, such as vascular or neuropathic pain. Often the source of vascular and neuropathic pain cannot be treated directly, and symptomatic relief may be the best that can be achieved. However, with musculoskeletal pain the underlying condition producing the pain can be directly and successfully addressed. When this can be accomplished, the likelihood of chronic recurrences of the pain can be significantly reduced.
Treatment based on an accurate and biologically-specific diagnosis can be more definitive and is much more likely to achieve true rehabilitation of the underlying condition. For this reason, being able to identify the nature of the underlying problems in specific biologic terms in each individual patient is a critical first step toward achieving successful treatment. See Diagnostic Categories.
Diagnosis begins with a thorough history of the condition, combined with a comprehensive clinical examination. The PDF forms below provide two possible paths:
• A Screening History and Screening Exam form for those who chooses not to provide definitive treatment for TMDs, but who want to identify TMD patients in their practice at an early stage so that their patients receive treatment before their condition worsens.
• Comprehensive TMD History and Comprehensive TMD Examination forms for the provider who chooses to provide comprehensive care for TMD patients.
