Special Report by H. Clifton Simmons III, DDS, Journal Craniomandibular Practice

A Critical Review of Dr. Charles S. Greene's Article titled "Managing the Care of Patients with Temporomandibular Disorders: A New Guideline for Care" and A Revision of the American Association of Dental Research's 1996 Policy Statement on Temporomandibular Disorders, Approved by the AADR Council in March 2010, published in the Journal of the American Dental Association September 2010.

H. Clifton Simmons III, DDS, Journal of Craniomandibular Practice 30(1): 9-24, 2012

Abstract: Dr. Charles Greene's article, "Managing the Care of Patients with TMDs A New Guideline for Care", and the American Association for Dental Research (AADR) 2010 Policy Statement on Temporomandibular Disorders, published in the Journal of the American Dental Association (JADA) September 2010, are reviewed in detail.  The concept that all temporomandibular disorders (TMDs) should be lumped into one policy statement for care is inappropriate.  TMDs are a collection of disorders that are treated differently, and the concept that TMDs must only be managed within a biopsychosocial model of care is inappropriate.  TMDs are usually a musculoskeletal orthopedic disorder, as defined by the AADR.  TMD orthopedic care that is peer-reviewed and evidence-based is available and appropriate for some TMDs.  Organized dentistry, including the American Dental Association, and mainstream texts on TMDs, support the use of orthopedics in the treatment of some TMDs.  TMDs are not psychological or social disorders.  Informed consent requires that alternative care is discussed with patients.  Standard of care is a legal concept that is usually decided by a court of law and not decided by a policy statement, position paper, guidelines or parameters of care handed down by professional organizations.  The 2010 AADR Policy Statement on TMD is not the standard of care in the United States.  Whether a patient needs care for a TMD is not decided by a diagnostic test, but by whether the patient has significant pain, dysfunction and/or a negative change in quality of life from a TMD and they want care.  Some TMDs need timely invasive and irreversible care.

Note:  This Special Report contains the following statements regarding the TMJ Scale (please see the Special Report for a listing of reference citations):

“McNeill also stated that the TMJ Scale (Pain Resource Center, Inc.) is designed for use by dentists assessing TMD (ref 57), and more comprehensive psychological inventories are not necessary for routine screening" (ref 56).

“The TMJ Scale discriminates between dental patients without a clinical TMD and dental patients with a clinical TMD.  The gold standard for test development was a group of 30 TMD dentists in 19 states and Canada utilizing a clinical history and examination guided by a clinical evaluation protocol.” (ref 99) 

“The TMJ Scale is utilized to separate dental patients without clinical TMD from dental patients with a clinical TMD (refs 82, 85, 86, 90, 91, 98).  The accuracy, reliability, predictive values, integrity and effectiveness of the TMJ Scale has been rigorously scrutinized.” (refs 81-86)

“The TMJ Scale can also be used to quantitatively measure the effectiveness of treatment, and therefore outcome, by utilizing the TMJ Compare (Pain Resource Center, Inc.) to calculate differences in TMD symptom intensity before and after treatment interventions.”

“These tests, except for the TMJ Scale, usually do not discriminate between those who need chronic TMD care and those who do not.”

“Prior to undertaking TMD management, the dentist should screen with the TMJ Scale or similar test specifically for oral habits, depression, anxiety, stressful life events, lifestyle changes, secondary gain and overuse of health care (refs 56,57).  More comprehensive psychological inventories are not necessary for routine TMD screening (ref 56).  The TMJ Scale can determine which dental patients have significant TMD symptoms in the physical symptom categories Pain, TM Joint Dysfunction and TM Joint Range of Motion Limitation (ref 82).  Technological diagnostic devices, except for the TMJ Scale, test for specific TMJ and/or associated structure abnormalities, but do not determine who needs TMD care.”

"Brown and Gaudet showed in studies utilizing the TMJ Scale that TMDs are not self-limiting and that they do not resolve with time." (refs 90-92)

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