The Evolution of TMD Diagnosis

Abstract

This review explores the principles and process associated with the diagnosis of temporomandibular disorders (TMDs). TMD diagnosis has evolved substantially over the past 25 y. Previously, diagnosis focused solely on aberrations in oral structures, largely without empirical evidence. The Research Diagnostic Criteria for TMD (RDC/TMD) were developed on core principles of 1) a dual-axis system reflecting the biopsychosocial model, 2) a clear operationalization for reliability, and 3) the allowance of multiple diagnoses. These principles were retained in the subsequent validation research of the RDC/TMD, and the current diagnostic system-the Diagnostic Criteria for TMD (DC/TMD)-has improved on those principles as well as on diagnostic validity and protocols for assessing the psychosocial domain. Further investigations into etiology and its potential contribution to taxonomy revision are described, particularly within the context of complex disease. The review concludes with an outline of major research areas already underway that will support future revisions of the DC/TMD.

Orofacial myofunctional disorder, a possible complicating factor in the management of painful temporomandibular disorder. Case report

“…Experts in the field of orofacial motricity claim that OMD may not be the cause of TMD, but the more severe the OMD, more difficult its resolution without approaches that specifically target myofunctional orofacial re-education or rebalancing 8 . The presence of comorbidities can be one complication or nonresolution factors of TMD after treatment, that is, another problem that may occur in parallel with what is being treated, that has some relation and influence on its severity 2,3,20,21 . In this case, it seems that the OMD was a TMD comorbidity since we cannot claim that it was the triggering factor, but its presence contributed to the aggravation and maintenance of TMD.…”

“…As the sessions evolved with improvement in the patient's conditions, strategies were included and trained to balance chewing and swallowing and to promote a more intelligible phonoarticulation, in addition to the mandibular rest with free mandibular functional space preserved (step 3 orofacial myofunctional therapy) ( Table 1). After 13 weekly sessions, other 10 sessions were carried for 6 fortnightly sessions and 4 monthly ones, in which were included in the therapeutic process complementary mindfulness practices that constitute an important group of meditation practices used as a tool to reduce stress and anxiety, also being recognized to contribute in the reduction of painful pictures 2,13 . Since the phonological approach was directed to the stomatognathic system, the exercises, guided by the therapist, focused on the rhythm of breathing and attention to the orofacial structures (anchor of the mindfulness practice: aspect or object to which the targeting -or focus -is exercised).…”

“…Currently, temporomandibular dysfunctions (TMD) are defined as a set of signs and symptoms that indicate a painful musculoskeletal syndrome associated to multisystemic changes, as well as changes in behavior, in the emotional state and social interactions, recognized as manifestations of deregulation of the central nervous system [1][2][3] . Among the key predictors for the development of TMD is the presence of comorbidities, non-painful orofacial symptoms (such as self-report of parafunctions), the frequency of somatic symptoms, poor sleep quality, and genetic and epigenetic factors 1,2 .…”

“…Among the key predictors for the development of TMD is the presence of comorbidities, non-painful orofacial symptoms (such as self-report of parafunctions), the frequency of somatic symptoms, poor sleep quality, and genetic and epigenetic factors 1,2 . The most common signs and symptoms are the orofacial pain, joint noises and changes in jaw mobility 4 .…”

Impact of temporomandibular disorders on oral health-related quality of life of institutionalized elderly people

“…The TMD affects psychological conditions and masticatory ability, influencing the oral health-related quality of life (OHRQoL) of individuals 3 . Subjective indicators used for general and oral health showed that TMD plays an important role on the quality of life and, despite the numerous methods used to assess OHRQoL and TMD [4][5][6] , the assessment of elderly subjects is rare.…”