By Dr. Ronald Auvenshine
The terms of definition of the field of TMD and orofacial pain have gone through several changes over the years. I have actively been involved in the treatment of TMD since 1971.At that time it was simply referred to as TMJ. Later, as we began to further define the various causes of TMJ problems, there was a need to further sub-classify each of the conditions into it's own category. The field of dentistry has struggled with the naming of the umbrella term for TMJ problems and still is in the process of refining and standardizing the nomenclature of the field. I personally prefer the umbrella term Craniomandibular Disorders. However, I am in the minority.
It is not uncommon for a patient to come to their dentist or physician and say, "I think I have TMJ." Sometimes they are told, "Like the knee you actually have two TMJ's." When we refer to temporomandibular disorders, the reference is anything that involves the function, integrity, and the stabilization of the temporomandibular joints.
Any degenerative or traumatic event that can destroy other joints can also affect the temporomandibular joints. Therefore, all of the various forms of arthritis are found within the temporomandibular joints. Osteoarthritis is most often due to the aging process. Secondary Arthritis is most often the result of trauma. Rheumatoid Arthritis, which is thought to be an autoimmune disease, can attack the temporomandibular joints as it does other weight bearing joints in the body. All of these degenerative diseases have less effect on the TMJ's if detected early in their development.
TemporoMandibular Disorders can be subdivided into extracapsular and intracapsular disorders. Extracapsular means that there may be muscle tension or pressure on the joint, but the joint itself is healthy and all the anatomical parts are in place. This is referred to as a Myofascial Pain. If, however, there is an internal problem of the TMJ, this is referred to as an intracapsular problem. Intracapsular problems can be anything from displacement of the intercartilaginous disc, or any degenerative change, which may have affected the joint.
In addition to the classification of intracapsular, and extracapsular, there is a third category of facial pain for which a patient will seek treatment. This category is referred to as Orofacial Pain of non-TMD origin. Such things as trigeminal neuralgia, migraine headache, neuritis, continuous pain disorder, and reflex sympathetic dystrophy are categories of this classification.
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