#147 TMD is One Disorder, Not Several Disorders

If you read the textbooks on TMD, or Google TMD, (Temporomandibular Joint Disorder), you will read or see that mainstream dentistry considers TMD a series of similar but unrelated disorders.  There is even a new specialty in dentistry that has been designated, “Oral Facial Pain”, (OFP), by the American Dental Association.   

The thought process for making oral facial pain a specialty goes something like this.   

1. For decades the medical and dental professions have not been able to figure out the cause of the unusual pains associated with the head and face except for the most obvious tooth decay and infection, ear infection, brain tumors and strokes, and various kinds of head and neck cancers.
2. If we can’t figure out what is causing the unusual and less common pains, it must be complicated.  
3. If it’s complicated, then it needs to be treated by a specialist.

This type of logic has several inherent flaws.  The most glaring and egregious one is: “Just because you can’t figure out something, doesn’t make it complicated.”  It just may be they don’t understand some important data that is required to make the solution to the problem rather simple. 

So recently dentistry has started going in a whole new direction in treating oral facial pain.  Instead of doing the basic research looking for the common denominator which might be responsible for causing all the various and disparate symptoms associated with facial pain, professional political groups have been talked into making the problem more complicated than necessary and creating a whole new multi-teared educational process that relies on and centered around old worn-out theories.   

This move by the ADA has complicated the whole area to the extent that there are now three OFP organizations competing to certify dentists as specialists.  (American Academy of Craniofacial Pain, American Board of Oral Facial Pain, and American Academy of Oral Facial Pain) This is totally confusing and unprecedented in dentistry. Each of the actual tried-and-true specialties in dentistry only have one certifying board each.   What is going on is confusion added to a conundrum which is surrounded by mystery.   

This whole problem was generated by the dental schools for the past 70 years teaching that the temporomandibular joint, (TMJ) is a very complicated joint unlike any other in the body.  This is and was the original falsehood which led to everyone thinking any unusual pain in and around the face must be complicated.   

The truth is, almost all unusual pains of the head and neck, not explained by the more easily diagnosed problems, are generated from inflammation within the temporomandibular joint.  So called OFP specialists, the ADA, dental schools, and the dental establishment in general have not read and applied the basic science information already available.  If they turn their attention onto the relationship of chronic joint inflammation to the nervous and endocrine systems, they will find the common denominator responsible. 

Instead of using archaic and meaningless catchall terms such as trigeminal neuralgia, fibromyalgia, myofascial, neuropathic, and migraines, they applied what orthopedic surgeons have known for decades regarding pain generated to distant areas originating from a damaged joint, the specialty for orofacial pain would not only be unnecessary but would appear the folly that it is. 

TMD is a disease that has multiple apparently unrelated disparate symptoms caused by chronic inflammation within a damaged joint.  There is one central, unifying cause for the symptoms, chronic inflammation.   TMD does not have many causes as the so called OFP specialists propose.  Trying to make a disease more complicated than it needs to be does not make the health care provider more important, it makes them appear foolish.