On the Management of Temporomandibular Disorders: A Plea for a Low-Tech, High-Prudence Therapeutic Approach

Therapeutic efficacy for temporomandibular disorders (TMD) has been defined almost exclusively in terms of symptom relief. This is because symptom management has dominated treatment focus and has precluded necessary emphasis on disease-specific parameters and generic outcome measures. Consequently the scientifically based options for assessing and determining treatment outcomes beyond the relief of pain remain in an early state of development. This fact limits the scientific validity of the conclusions drawn from published reports dealing with disease-specific measures other than pain. As clinical educators and practitioners we have had to recognize our profession's limitations when dealing with patients with TMD. For example, a huge gap exists between those scenarios studied in randomized clinical trials (RCTs) and actual clinical problems. Furthermore, there are no formal rules to test the validity of the extrapolation of findings from one condition to another. Our literature searches and analyses yielded many uncertainties and inadequate data, as well as an overall paucity of rigorously documented scientific information. Given this predicament, we sought to propose a conceptual framework that articulated a concern for patient safety as the overriding objective in the management of patients with TMD.

benefit; risk; cost; clinical decision-making; pain; remporomandibular disorder management