Dentists Need Better Understanding of Jaw Problems

BUFFALO, N.Y. -- Dental schools must increase their efforts to teach students how to interpret and evaluate results of scientific research in the area of diseases and disorders affecting the temporomandibular (jaw) joint, according to a University at Buffalo dental educator.

Norman D. Mohl, D.D.S., Ph.D., SUNY Distinguished Service Professor and chair of the Department of Oral Diagnostic Sciences in the UB School of Dental Medicine, said that despite the growing amount of sound, scientific research about the diseases and disorders -- collectively known as TMD -- published during the past 25 years, too many dentists continue to base their diagnosis and treatment on anecdotal "evidence."

Speaking today (Aug. 5, 2000) at a conference on the diagnosis, treatment and immunologic issues of TMD sponsored by UB's Ernest Witebsky Center for Immunology, Mohl said that a lack of scientific-based research on TMD prior to the 1970s led many practitioners to turn to anecdotal material for guidance, believing that TMD was a relatively rare and singular disorder most likely caused by malocclusion, or improper "bite."

But in the wake of research results published since that time, it has become clear that TMD not only is a significant oral-health problem, but also includes a group of clinical problems involving jaw muscles or joints, Mohl said.

A differential diagnosis is especially important, he noted, since TMD's primary symptom -- acute or chronic pain in the oral, facial or head-and-neck areas -- also may be symptomatic of diseases and disorders unrelated to the jaw muscles and joints.

The research now clearly shows that TMD can be caused by such factors as emotional stress, jaw-joint deterioration caused by disease, and jaw clenching or tooth grinding.

Treatment also varies, ranging from mouth guards and relaxation training to counseling and medication. Surgery has been used, as well as artificial joint implants, in an attempt to correct problems.

Mohl emphasized that scientifically based studies now allow clinicians to pinpoint more accurately the diagnosis and appropriate treatment of not only TMD, but other dental problems as well.

"But the degree to which patients with TMD, as well as those with other dental diseases and disorders, will optimally benefit from scientific studies is dependent on clinicians' ability to interpret and evaluate the research results," he concluded.