Understanding Diagnostic Failure in Temporomandibular Disorders: A Narrative Synthesis of Evidence and Five-Domain Framework for Iatrogenic Mismanagement

IF 3.8 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of oral rehabilitation Pub Date : 2026-10-10 Epub Date: 2026-08-26 DOI:10.1111/joor.70294

Bernardo Correia Lima, Rayan Eboli Fortunato, Leonardo Brígido Metello Neves, Ricardo Grillo, Mariana Aparedida Brozoski, Fernando Melhem-Elias, Janey Prodoehl, Louis G. Mercuri

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引用次数: 0

Abstract

Background

Diagnostic errors in temporomandibular disorders (TMDs) contribute to unnecessary procedures and avoidable patient mismanagement despite advances in pain science, diagnostic classification systems, and evidence-based care.

Objective

To conduct a narrative review and present a dynamic, five-domain framework explaining how diagnostic uncertainty interacts with educational, cognitive, systemic, and ethical factors to produce iatrogenic overtreatment.

Methods

Searches of PubMed, Scopus, Web of Science, and Google Scholar (inception to April 2026) identified literature on TMD diagnosis, clinical reasoning, dental education, health system organization, and bioethics. Concepts were synthesized into interacting thematic domains.

Results

Five dynamic, interacting domains were identified: (1) Educational Deficits, (2) Structural Reductionism, (3) Occlusal Overinterpretation, (4) System Fragmentation, and (5) Ethical Dissonance. The model demonstrates how educational gaps foster reductionist diagnostic paradigms, which are amplified by health-system silos and defensive clinical practices, increasing the likelihood of non-indicated, irreversible interventions.

Conclusions

The Five-Domain Framework offers a systemic model for understanding diagnostic breakdown in TMD management, providing a structured foundation for educational reform, integrated care pathways, and future empirical research.

查看原文本刊更多论文

了解颞下颌疾病的诊断失败：医源性管理不当的证据和五域框架的叙事综合。

背景：尽管疼痛科学、诊断分类系统和循证护理取得了进步，但颞下颌疾病（TMDs）的诊断错误导致了不必要的手术和可避免的患者管理不当。目的：进行叙述性回顾，并提出一个动态的五域框架，解释诊断不确定性如何与教育、认知、系统和伦理因素相互作用，从而产生医源性过度治疗。方法：检索PubMed， Scopus， Web of Science和谷歌Scholar（成立至2026年4月），确定TMD诊断，临床推理，牙科教育，卫生系统组织和生物伦理学方面的文献。概念被合成到相互作用的主题领域。结果：确定了五个动态的，相互作用的领域：(1)教育缺陷，(2)结构还原论，(3)咬合过度解释，(4)系统碎片化，(5)伦理失调。该模型表明，教育差距如何助长了简化主义的诊断范式，这种范式被卫生系统的孤岛和防御性临床实践放大，增加了非指诊性、不可逆转干预措施的可能性。结论：五域框架为理解TMD管理中的诊断分解提供了一个系统的模型，为教育改革、综合护理途径和未来的实证研究提供了结构化的基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.