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Another reason is that some dentists who are in the TMD/orofacial arena believe TMD is a medical issue (medical model toward diagnosis and treatment), while other dentists believe it is a dental issue toward diagnosis and treatment. The profession is rout with debate from a smaller group of bio-psychosocials vs wider accepted bio-physiologic occlusal view points (as the Alliance of TMD Organizations and others TMD treating clinician). The attempts by the few who want to control how TMD and or orofacial is diagnosed and treated have been declined for “TMD specialty” status numerous times at the ADA level when a majority of dentists who treat TMD. They are not willing to be dictated by the few dentists who have an agenda to perpetuate the pscyhosocial/orofacial pain perspectives (anti instrumentation) and hold similar biases with the NIH and orofacial pain groups who want to control the TMD arena from a medical perspective. What makes them qualified to diagnose and treat TMD in such a manner? That is what the TMD community is asking and wondering?
It is recommended that the differential diagnosis of TMDs or related orofacial pain conditions should be based on information obtained from the patient’s history, clinical examination, and when indicated TMJ radiology or other imaging procedures including the choice of adjunctive diagnostic procedures should be based upon published, peer-reviewed data showing diagnostic efficacy and safety. However, the consensus of these few anti-instrumentation advocates and their anti occlusion agenda continue to disregard the validity and scientific findings the ADA and FDA have concluded regarding CMS, EMG, ESG and low frequency myomonitor TENS as scientific, valid and acceptable aids in the diagnosis and treatment of temporomandibular joint dysfunction, masticatory dysfunctions and pain.
A long history of scientific literature about currently available technological diagnostic devices for TMDs has been available to the profession, but they refuse to acknowledge such evidence and findings perpetuating their dogmas opinions when in fact, they lack the evidence and credibility regarding the sensitivity and specificity in their own methodology and protocols required to separate odontogentic issues from masticatory muscles (somatic and neuromuscular pains (Axis I) vs psychologic, mood, anxiety, emotional stressors (Axis II). Diagnosing normal subjects from TMD pain groups or distinguishing among TMD subgroups seems to create a challenge many when they chose to diagnose without objective measured recordings that involve the use of electro- diagnostic instrumentation.
Currently, standard medical diagnostic, laboratory testings along with objective measured testings are ADA and FDA recognized to be used among trained dentists as in the medical profession for evaluating similar orthopedic, rheumatological and neuromuscular disorders utilized when indicated with TMD patients.
In addition, various standardized and validated psychometric tests may be used to assess the psychosocial dimensions of each patient’s TMD problem, but testings and diagnostics evaluation should not be limited to these classical assessments, but should include objectively measured evidence-based therapeutic modalities that involve tests of how the patients functional and resting status is, the quality of resting modes of the masticatory system, the quality of functioning modes of the system, the quality of positional modes of the masticatory system and joint sound quality (quiet or noisy) as well as quality of terminal contact balance to and from a terminal position (whether healthy or unhealthy). The later type of testings are not even included in most TMD/orofacial pain assessments.
What is missing in the diagnostic work?
It is strongly recommended that, unless there are specific and justifiable indications to the contrary, treatment of TMD patients initially should be based on the use of conservative, reversible and therapeutic modalities. Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time. While a smaller more complex and chronic group of TMDs have not shown to improve on their own because of this fact, it is very acceptable to use specific therapies that have been proven to be effective when addressing both the neuro-musculo-occlusal components to the masticatory system of this TMD patient subgroup . Many of the conservative modalities have proven to be effective in providing symptomatic relief compared to various forms of invasive surgical treatment.
Because of the increased diagnostic awareness by those clincian’s who implement these advanced instrumentation protocols their conclusions lead them toward a significantly lower chance of recommending joint surgery than those modalities and understanding toward surgery (“when all else fails” type of thinking. This kind of thinking and understanding present much higher risk of producing further harm to those who just don’t know. Professional treatment should be augmented with not only subjective doctors physical assessment, imaging assessment, patient’s history, psychosocial cursory evaluation, and a pharmacological assessment, but additionally an evaluation of the patient’s physiologic resting and functional body responses that go beyond subjective complaints – objective measured K7 data testing as an example.
Our patients who have presented with complex TMD problems, who have seen numerous clinicians within the medical and dental community who have tried to use the “Standard modalities” (“not uniformly effective” allows the judicious use of our modalities and teachings that are obviously “specific and justifiable” as well as conservative.
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Leader in Gneuromuscular and Neuromuscular Dentistry