“When You Come to a Fork in the Road--Take It!”

Yogi Berra’s Philosophy”

Used as an Analogy to Explain “TMJ” vs. “TMD” Terms

& Whose Responsibility Is It Anyways? Ó JJAMD Foundation 2001

Written by Milton & Renée Glass, February 10, 2000 – Still being updated and revised –to be continued.

The term “TMD” –a corruption of the historical term “TMJ”-- was created, written, and implemented by the American Dental Association {ADA] as recently as 1982, for whatever their reasons. A great disservice was done to the TMJ population as a result. It changed the perception of this medical disorder to one of a psychological, psychosocial disorder.

The Dental Profession created the terms “TMD” and “Temporomandibular Disorders” in 1982. That did not coincide with JJAMD’s mission--JJAMD coincidentally was also established in 1982--to specifically focus on and to help bring appropriate awareness to the importance of the healthy TemporoMandibular Joints themselves. Concomitantly, our mission was to help bring appropriate awareness, education, and a basic research for the TMJ Disorders affecting these JOINTS, with all of the multifaceted signs and symptoms, that we had come to learn from the TMJ Patients themselves which showed evidence of overlapping with other disease/disorder medical clinical entities that were affecting their entire bodies. Therefore, we soon learned that the new dental terms would collide with JJAMD’s mission. In fact, our name: “Jaw Joints & Allied Musculo-Skeletal Disorders” was created to embrace and to make an instant visual impact for all to be able to find an allied identity, if that were the case. Also coincidentally in 1982, many newly emerging disease/disorder medical entities were emerging, and were being acknowledged by other patient advocacy organizations. They began to reveal a “profile” that bore many of the same signs and symptoms, and mostly the same age and gender population as “The TMJ Profile”. Those other disease/disorder entities, however, have now been acknowledged, legitimized, and embraced by the Medical Profession and their Ancillary Health Care Communities, their Societies, and the Insurance Companies. Not so for the TMJ Patients! And, ironically, if those same patients should have a TMJ component, as well, that component is singled out for discrimination. well as Rheumatologists who have included TMJ along side Fibromyalgia, Chronic Fatigue Syndrome, Tinnitus, Myofascial Pain Syndrome, Irritable Bowel Syndrome, etc., in their new term: “Dysregulated Systems Syndrome, [acronym D.S.S.]; They report out that TMJ affects their whole bodies, that they are being misperceived, misdiagnosed, mistreated, or over-treated This is probably largely a result of the fact that generally the Medical Profession, their Societies, and the Arthritis Foundation are not including the Jaw Joints and TMJ within their paradigms, which stalls the legitimacy of TMJ as a valid medical clinical entity. Their absence has allowed the “Profile of a TMJ Patient” to shift and to be funneled into the Dental Profession who currently tout “TMD Dental-Mental Profile”. The TMJ Patients are caught in a “Catch-22” chaotic controversial situation, and become outcasts not entitled to access necessary health insurance.

And the lack of appropriate input and help from the Medical Profession, for whatever their reasons, further stalls meaningful awareness, education, and research. Although JJAMD sees evidence that the Medical Profession is “peeking in and subtly surfacing”, the tendency is still to refer these difficult patients to the Dental and Psychology disciplines, thereby unfairly reinforcing the TMJ Patient Profile, as if it were mostly a “Dental-Mental” Psychosocial Chronic Pain patient. This has resulted in a chaotic judgmental and punitive inhumane scenario, for which the entire American society is “paying for through the nose” anyway and contributes to excessive high cost of health care. It has forced these desperate and disenfranchised patients to start an expensive time-consuming journey in search for help, hope, and wellness. It has invited a host of disparate treatment modalities, and typically this patient population tends to be sicker than other health populations. It has invited a host of practitioners, with self-vested interests, to be creative about promoting their theories in research, academia, and a myriad of diagnoses and treatments, which has not helped to resolve The TMJ Dilemma. Rather it has compounded the dilemma by making the Jaw Joints and the TMJ Disorder ever more obfuscated, complicated, and controversial. As a matter of fact, one could say the present touted attention to The TMJ Dilemma is out of touch with reality. As a matter of fact, the 1996 NIH TMD [TMJ] Technology Assessment Conference [TAC] hinted at this in their own language. One author pointed out that there are about 25 different names now ascribed to this very same disorder. Those, who might come on to help at this time, are baffled and overwhelmed to do so in such a volatile climate.

It should be noted that there are many who stick to the term “TMJ”, and do not subscribe to the term “TMD” with all the negative futile baggage that jogs along with the self-made self-vested interested gurus, as if all of the TMJ Patients are Dental-Mental Patients. This is based in their biases of Psychosocial Chronic Pain with a Stress Etiology.

Here are some Questions that JJAMD is asking at this time to see if there is another pathway to deal with The TMJ Dilemma. To cut through the futile argument whether or not the clinical term should be “TMJ” or “TMD”, we offer our creative input with the hope that this could become a solution.

• Why Was the term “TMD” “Temporomandibular Disorders” created in 1982 by ADA? Why Was the Medical Profession indifferent?

• What has it achieved?

• Who are the Winners? Who are the Losers? Must we have Winners and Losers in a health situation?

• How many TMJ patients have cured, or even helped? How many have they hurt?

• What problems have they caused?

- perception of profile of the TMJ patient; patients funneled into “Psychosocial Chronic Pain”

- other neuro-muscular-vascular-skeletal problems ignored

• What is needed to return to a more realistic scenario.

• Would the Medical Profession come on board at this time to accept some responsibility for these anatomical Jaw JOINTS and its impact on the entire neuro-muscular-vascular-skeletal systems? Would they help to acknowledge, legitimize, classify, and embrace within their paradigms? Would they help promote awareness and prevention? Would they begin teaching programs within their schools and clinics?

- What must be one to get the Medical Profession--their Orthopedists, Neurologists, E.E.N.T. and all physicians to include Temporomandibular [jaw joints] Joints within their paradigms and practices?

However, JJAMD sees some positive movement to help, and we offer an alternative in the hope that it will help resolve The TMJ Dilemma. We have created an organizational chart for visual impact the form of what we are calling: “Yogi Bear Philosophy”; to whit: “When You Come to a Fork in the Road--take it!”

NAME CHANGING – A BAD HABIT REVISITED [See separate article “What’s In A Name” in the electronic library on this website]

[thoughts taken from newspaper and radio “talk” applicable to our thoughts.]

• The point of Using the Classical Term “TMJ”. The terms “Temporomandibular Joints” and disorders to them as ‘TMJ” are the classical terms used historically from the earliest of time to describe the anatomy and the identification of health problems to this area.

• Until 1982,these names prevailed in all Medical and Dental literature.

• So what happened to cause these name changes, which one author says may be as much as 23. And why are so many more names ascribed to it now? Among the many are, Orofacial Pain, Maxillofacial Pain, Craniomandibular and a host of others

.

But the newest of the many: “Temporomandibular” and “Temporomandibular Disorders [TMD] might signal the “official changing of the guard” from the Medical Profession’s responsibility for the Temporomandibular Joints within their paradigm to that of the Dental and Mental Professions, whose charges and include care of the oral health cavity and surrounding areas, and psychosocial and behavioral paradigms, respectively. In addition, there are those in these two disciplines who have converged to deal with the chosen Dental term “TMD” and treat all TMJ Patients with their chosen perception as if it were only about Facial Pain with a Psychosocial etiology.

• To date and to our knowledge, it is unprecedented in Medical History, to change a classical anatomical name and term to accommodate the will of some. It should be remembered, that TMD and Temporomandibular Disorders are not embraced in medical literature, by the broader community, and especially not by the TMJ Patients themselves.

• To date and to our knowledge, we do not know a single TMJ Patient who has been helped or cured by labeling them as “TMD Patients”. To the contrary, we believe it has caused harm.

• This name changing has only complicated the entire “TMJ Dilemma”, and has unarguably made the environment even more controversial and has further complicated the opportunity and the level playing field for those others who might have come on board by this time to help their TMJ Patients and the entire patient population and society as a whole.

•[We refer to the Boston Globe letter-to-the-Editor Feb 6, 2000 “The Point of Classical. Ballet..] analogy for TMJ. Margaret Samu could easily have been speaking to our argument on TMJ Name Changing, to wit:

“...articles ringing the death knell of classical [TMJ] filled us with disappointment and disbelief. What shocked us the most was that the supposed current leaders in the [TMJ] community, actually seem to believe that abandoning the classical names would be progress, a positive step that will allow the art of [dentistry] to survive.”

In what other [discipline] would leaders be so willing to cut themselves off from the past. Would the Orthopedic profession cut themselves off from the Knee Joints because it doesn’t attract the attention of the media. Any descriptions such as TMJ are essential to the understanding of the progress that has followed. Studying and addressing the classical form of description is essential to the training of future scientists and practitioners. Like professionals in any other discipline, TMJ practitioners need to be familiar with the history of their form of medicine if they are to move intelligently into the future. Understanding of the classical descriptor of TMJ is important to the general public too. How can they appreciate the gravity of the dilemma, unless they know of the attempt to defy it? How can they grasp the innovations without recognizing the classical form on which it is based? That would be like trying to understand “impressionism” with no understanding of the “classical” art form. Those who would deny the Jaw Joints as the primary focus of the disorder seem more concerned with current funding than with the long-term effect on the patients. They will get little out of contemporary research and health education as it becomes more distant from understanding the basic underlying anatomical issue. This will not hold them in good stead for an excellent legacy.

• it’s time to get back on track to a single road

• It’s time to re-join the two roads

• It’s time to get back on the “Main Road to Resolution”

• It’s time to go back to the historical classical terms, using one name and one acronym;  to whit: “TemporoMandibular JOINTS” and “TMJ Disorders [or “TMJ Dysfunction”]

• It’s time for the Medical and Dental Communities to go back to treating the Human Body as one Neuro-Vascular-Musculo-Skeletal System.

• It’s time for the Medical Profession to join hands with the Dental Profession to accomplish this goal.

• It’s time for the Medical Profession to go back to their bible, “Gray’s Anatomy”, and include the JAW JOINTS as part of their paradigm of responsibility for ALL JOINTS, and to live up to their own Hippocratic Oath: “At least do no harm.” To do their duty as “Doctors”, which means: “to teach”. They must teach their patients the importance of the Jaw Joints to good general health, and how to protect and prevent injury, trauma, and disease.

• It’s time for the Medical Community to Legitimize “TMJ” as a medical clinical entity, which will allow Health Insurers to provide appropriate coverage under Medical Health Insurance Plans.

• It’s time for all Government Agencies and the Public Health Sector to help the public with appropriate considerate comprehensive research, public awareness information, epidemiology, and all other matters for which they are charged with the safety and health care of the public.

• It’s time for the Dental Profession to use restraint in touting and treating the TMJ Patients, as if they were “TMD Patients”, with a mostly Psychosocial Chronic Orofacial etiology.

• It’s time for the Arthritis Foundation to embrace Jaw Joints within their reporting.

• It’s time for the Media to provide the public with considerate comprehensive Medical and Dental reporting.

For almost twenty years, the JJAMD Foundation has been collecting data from the TMJ Patients. This study is a report of what they are experiencing. This study should help validate them, help foster knowledge to all, and encourage and excite researchers to enter into this more comprehensive untapped unexplored data and arena.

••This is a pioneer study based on the TMJ Patients--perhaps for the first time--being allowed to tell more about their medical/dental histories more comprehensively and about their sojourns into an unknown, unloved, complicated, complex, controversial uninsured health dilemma. It is admitted by the National Institutes of Health [NIH], and generally by the medical and dental professions, that despite the glut of journal articles, conferences, and information, that there is not yet a universally accepted science-based literature or treatment modalities. This patient evidence-based study, therefore, is perhaps even more relevant and more valid to push for a more scientifically sound basic science from the health care communities.

What is needed is Comprehensive Quality Research from neutral [unaffected] Public Health Care Sector and from the various Medical Discipline Specialties, who are educated and capable of looking at the broader picture of the multifaceted signs and symptoms that go way beyond the scope of the Craniofacial Complex, which lies within the Discipline of Dentistry [??? and which focuses and concentrates on the more narrow view of the Chronic Pain and Psychosocial facets of this health disorder, which they choose to call “Temporomandibular Disorders” [TMD], with considerably more names jostling along.????

This study provides stark evidence that the TemporoMandibular Joints and the TMJ Disorders to them have caused confusion, controversy, and anxiety within the Health Care and Research Communities, Health Insurers, Government and Private Agencies, all of which impacts negatively on the TMJ Patients and society as a whole. The rich data provided by the TMJ Patients themselves in this study, identifies health problems well beyond the craniofacial complex itself. Emerging during the past 30 years, TMJ has become a growing health dilemma, which has tended to confound all who have approached dealing with it. There are numerous reasons for this confusion. Included are the unproven multifactorial etiologies, overlapping signs and symptoms, often relating to other disorders, as well as complex differential diagnoses. Added to this are the conflicting theories relating to both diagnoses and treatments. TMJ Patients are not the only ones troubled by these conditions. Health care professionals and researchers are similarly troubled when attempting to coming to terms with TMJ Disorders. There is growing and vocal controversy within the scientific community where significant questions abound as to the scientific validation for diagnoses and treatments often employed. The result is that for the NIH/NIDCR estimate of 10,000,000--[other studies estimate more]--patients afflicted with TMJ, the pain and/or dysfunction that plague them is very real. The nagging discomfort, the difficulty in chewing and swallowing, or even opening the mouth, are constant companions, which receive most of the attention. The myriad of other signs and symptoms throughout their bodies are rarely reported. Whatever the controversy, the patients suffer with pain, dysfunction, and disenfranchisement, and are forced to live with the reality that something that they believe to be physiologically amiss is being dismissed as mostly “all in the head” syndrome, which is playing havoc with their lives.

Let’s all get back on the TMJ road. Let’s all work together to advance diagnosis, treatment, and prevention.