The importance of using a specific diagnosis in evaluating and treating TMD

Several years ago, I was asked to be the “Gatekeeper” for the largest medical insurance company in Arizona. They asked me to see patients before they went to surgery to make sure the surgery was appropriate. These patients had been diagnosed with Temporomandibular Disorder “TMD” [1] and treated by an experienced “TMD” dentist who was director of the “TMJ” clinic that was part of the insurance company’s HMO. After standard treatment with intraoral appliances [2] and physical therapy, these patients were sent to an oral surgeon for surgery to treat their “TMD.” Most of these patients were treated with “stabilization” appliances, which are well-referenced in the literature as being effective for treatment of “TMD” [2–4]. They also received physical therapy and medications. I saw about 100 of these patients to evaluate the need for surgery, and after thorough evaluation and specific diagnosis, a more specific treatment plan was formulated. After treatment for the specific diagnosis that included the use of appliances designed to orthopedically reduce loading in specific areas of the TMJ, very few needed surgical intervention and had excellent results. TMD is meant to be a general term for all disorders relating to the temporomandibular joint and related structures [1,5]. Unfortunately, much of the literature is focused on the diagnosis and treatment of “TMD” instead of evaluating the treatment of specific conditions that make up this catch-all diagnosis. Some of the major diagnostic categories that are included in the term “TMD” include, but are not limited to, the following: