Most dentists spend their entire career avoiding the TM joints. When dentists think about the traditional TMD patient, the first thought is usually about pain, the second thought is about clenching and grinding due to stress and the third thought is where to refer the patient? As a profession, we have defined TMD patients through pain.
While we assume TMD patients present with pain, the far more common clinical presentation of a TMD patient is some type of malocclusion. Class II occlusions, canted occlusal planes, anterior open bites, cross bites, overbites, overjets, facial asymmetries, compressed airway anatomy and worn teeth are all examples of conditions that are the result of anatomic changes in the TM joints. The clinical reality is that every dentist treats TMD patients every day…we just don’t know we are treating TMD patients.
Since we are treating TMD patients daily, it is a good time to rethink TMD. If we can recognize the role TM joints play in malocclusions, we can increase the predictability of our occlusal, orthodontic, restorative, orthognathic and airway treatment. If we recognize the common clinical presentations of joint based malocclusions, we can develop a treatment planning protocol that will help the patient understand the advantages and disadvantages of different treatment options.