Management of temporomandibular disorders: concepts and controversies.
BACKGROUND
Controversy continues in the area of epidemiology, etiology, diagnosis, and management of temporomandibular disorders (TMD). The field is replete with testimonials and clinical opinion, but it has been lacking in scientific foundation.


OBJECTIVE
This article reviews the recent temporomandibular disorder and orofacial pain literature and summarizes the concepts published in the 1993 and 1996 American Academy of Orofacial Pain guidelines. Temporomandibular disorders rarely occur as single entities but rather as multiple problems with overlapping symptoms.


CONCLUSIONS
The multicausal nature of these problems and the number of conditions with similar signs and symptoms demand an effective differential diagnostic process. Diagnostic criteria are used from an operational standpoint to establish specific diagnoses based on a multiaxial diagnostic model.


CONCLUSIONS
Because little is known about the natural course of the various classifications of temporomandibular disorders, and because most treatment approaches are reported to be equally effective, a conservative, noninvasive management program is endorsed. The emphasis is on a medical multidisciplinary model similar to ones used for other musculoskeletal disorders that involve the patient in the physical and behavioral management of his or her own problem. This article concludes that a majority of temporomandibular disorder patients achieve good relief of symptoms with noninvasive reversible therapy.
McNeill
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Department of Restorative Dentistry, School of Dentistry, University of California, San Francisco, USA.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy; D002648:Child; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005157:Facial Pain / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology; D008875:Middle Aged; D009135:Muscular Diseases / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D013705:Temporomandibular Joint Disorders / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*