Common Management of TMD – Lets Call The Patient Crazy

Please see blog 1- 5 in this series I read a lot of articles, studies, and opinions on a daily basis. Many have opinions that I don’t agree with but I sit quietly and read them in order to gain a different perspective. One after another, each study disagrees, disputes, and disclaims one another and most of the time, I get something out of each one as I read the different perspectives of the dentist, scientist, or researcher involved. But this one study truly pissed me off. Titled: “Management of Temporo-Mandibular Joint Disorders (TMD) - a Surgeon’s Perspective”, it starts off by saying most of the TMD patients are “psychogenic” meaning made up in your head. It goes on to say that “headache, fibromyalgia, chronic back pain and irritable bowel syndrome with stress, anxiety and depression being the key features” are essentially a sign that you are crazy!!!. It doesn’t even end there; it goes on to say that “The aetiology of the most common types of temporo-mandibular disorders is complex and largely unresolved”!!! What??? That is ridiculous and so not true! It makes TMD sound like anyone suffering with TMD is crazy, made it up in their head, and can’t be treated. As I continue to read this ridiculous article, it states “suggests perhaps an underlying genetic predisposition to TMD which remains an enigma”. WTW???!!!!

But it actually gets even better. It goes on to say that “the presence of joint noises, however, is quite a common finding in asymptomatic people in the general population, and in the absence of pain, its clinical significance is of little importance”. What What What??? Ok let me get this straight… Forget the TMJ. Let’s just try any other joint. Let’s say your shoulder joint. There are noises in your shoulder joint. Loud noises every time you use it. And then as the noises continue, there are changes in your arm position (that’s what happens in the mandible - there are changes in its position as the TMJ degrades). So as your arm shortens and ends up in a different 3-dimensional position as it used to be, and your shoulder is making massive sounds every time you use it, are we going to send you off as “crazy” on your way to “therapy” as long as there is “the absence of pain”? And call it of “little importance”??? Why is it that every other joint in our body, if it behaved as degenerative joint disease, every doctor, specialist, surgeon, etc would take it seriously and move to assess, treat, and resolve in order to prevent further degenerative changes? But if it’s the jaw joint, well… you “must be crazy”!

But my favourite paragraph in the entire “scientific study” of this ridiculous article goes like this: “Headaches, earaches, tinnitus, neck and shoulder pains are just a few of a number of non-specific symptoms that are often reported by patients with temporo-mandibular disorders, other possible causes should be sought and ruled out”!!! OMFG! “Non-specific”??? “Reported”??? “Other Possible Causes”??? Can I just stop here before I say something that I may later regret?