TMD… an ‘Illness’ or a ‘Disease’?
Temporomandibular Disorders (TMD) is a collective term that embraces a number of clinical problems involving the masticatory (chewing) muscles, the temporomandibular joints (TMJ) and associated structures. TMD’s are considered as a sub-classification of musculoskeletal disorders.
TMD has also been defined as conditions consisting of alterations in the morphology (shape or form) and/or function of the mandible (jaw) with respect to both its articulation (connection) directly in the joint or with associated muscles.
There is a tremendous controversy in the dental profession regarding the nature, cause and most effective treatment of people suffering from Temporomandibular Disorders (TMD), which significantly affects how people are treated and how insurance carriers consider reimbursements.
At its heart is a significant difference in how two groups categorize TMD. One group, primarily based in some university dental schools and including a number of clinical dentists, believes that TMD is an illness. The other overwhelmingly larger group of dentists in private practice around the world, also includes academics in dental schools. This much larger group considers TMD as a disease.
What is the difference between illness and disease and what is the significance of this classification?
An illness is a “subjective experience” (what a person feels) or self-attribution that a disease is present or something is wrong, yielding physical discomfort, emotional stress, psychosocial disruption and behavioral limitations.
A disease is an objective event (what others can measure, record and analyze) involving disruption of a specific body structure or organ system, caused by pathologic, anatomic or physiological (functional) changes.
In simple terms, an illness is what you feel and its emotional, psychological effects upon you and how it limits you. A disease is a physical, structural and/or functional change in part of your body which may cause changes such as limited movement or pain with or without function.
Why is the difference important?
It is significant because it determines who will treat you and by what means. The illness group believes that treatment should be directed to non-specific symptoms using non-specific therapies, such as stress and anxiety management or reduction.
The goal is to re-establish a state of homeostasis, a feeling of well-being. It is referred to as a biopsychosocial approach to treatment, denying a physical, structural/functional component in the cause and occlusal treatment of TMD.
The disease group believes that treatment should be directed to resolving specific physical and functional components of the TMD. The treatment goal is to improve structure and function of the TMJ joints, neuromusculature (muscles and nerves) and the dentition (teeth). It is an essential tripod consisting of proper function of jaw joints, muscles and teeth.
Many clinicians believe that early successful treatment of the physical, structural, functional disease through physical means may prevent the development of the chronic pain condition, the illness.
Members of the International College of Cranio-Mandibular Orthopedics (ICCMO) believe in the disease concept of TMD and design their treatments to improve structure and function, to relieve the painful and functionally compromising symptoms from which their patients suffer. This is considered a more successful outcome than an endless prescription of medications and psychological counselling.
ICCMO teaches its members treatment based on Neuromuscular Occlusion dental principles, which include the creation of a therapeutic occlusal position (bite) synchronized with relaxed masticatory muscles used to move and position the jaw at rest and in function. Most members use computerized measurement devices to monitor and evaluate jaw function.
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