“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.