"As to methods, there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principle, is sure to have trouble"

                                                                                         Ralph Waldo Emerson

It should be obvious to anyone involved in health care that to undertake treatment of any condition requires that we first understand what we are treating. In other words, treatment recommendations should always be based upon a specific diagnosis. In the case of Temporomandibular Disorders, “TMJ” is not a diagnosis. The need for a biologically-specific understanding of the condition that is to be treated is crucial; that is the nature of true diagnosis. (see “Diagnosis”)

After arriving at an accurate diagnosis, the second requirement prior to undertaking treatment is to identify the treatment objectives; what do you hope to accomplish with treatment? All too often the prevailing treatment objective for Temporomandibular Disorders, whether consciously recognized or not, has been primarily the relief of symptoms. Because pain is what often brings a patient to our offices, the patient’s primary objective will nearly always be pain relief and that is quite understandable. The following table, Treatment by Dx Category, serves as a guide for the clinicain to tailor the treatment to manage both the symptoms and the underlying problem.

Certainly, pain relief should be one of the primary objectives of any treatment that we might undertake for these disorders. But, as described in “Diagnosis”, pain may not be the actual problem, but rather an expression of the problem. Treatment that addresses only the symptoms and does not address the problem that is producing the symptoms may largely explain why Temporomandibular Disorders have a reputation for recurring chronically, as often we may leave the patient predisposed to having the problem return.

Dentists have primary professional responsibility for the masticatory system. The treatment of other joint systems of the body is provided by several other clinicians who focus on orthopedic problems. But because of the presence of teeth in this unique joint system, which profoundly affect the function of the muscles and that can also affect both structure and function of the temporomandibular joints, other professional groups cannot provide the definitive care that this system often requires. If the role of the teeth was not such a significant factor in the function of this system, there would not be such a unique role for the dental profession in managing temporomandibular disorders.

However, like other joint systems of the body, the masticatory system functions according to certain basic physiologic principles of orthopedics. In any treatment that is intended to restore physiologic functional homeostasis to the masticatory system, not simply the treatment of symptoms, this reality regarding orthopedic principles must be appreciated and applied as a part of any comprehensive treatment protocol. Dentists who these principles and who are able to meet this standard are engaging in true rehabilitation, not simply symptomatic treatment.

Patient Self-Management

Behavioral Therapies

Pharmacotherapy

Physical Medicine

Occlusal Appliance Therapy

Occlusal Therapies

Surgical Management