Jaws: diversities of gnathological history and temporomandibular joint enterprise
- aDepartment of Neurology, Thomas Jefferson University Medical College, Philadelphia, Pennsylvania, USA, bSection of Neurology, Department of Medicine, Christiana Care Health Systems, Wilmington, Delaware, USA, cDepartment of Neurology and Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Dr William M Landau, Department of Neurology and Neurological Surgery, Washington University School of Medicine, 6605, Euclid Ave, St Louis, MO 63110, USA.
- Received 18 February 1999
- Revised 12 April 1999
- Accepted 28 April 1999
Epitome: etymology, epistemology, aetiology, and epidemiology
Since 1887, temporomandibular dysfunction (TMD) has been a clouded subject with a large penumbra and a complex and ever changing nomenclature (table 1). It is described as a primary disease entity involving the temporomandibular joint (TMJ) with the key symptom of pain ranging from aching and burning to sharp and jabbing. Various concepts of the syndrome(s) have interested, confused, angered, and often frightened potential patients. In addition, prolonged disabilities and expensive radical treatments with serious complications are notorious.16
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Evolution of TMD nomenclature
The common wisdom is that modern concepts of TMD began with three publications by Costen, an otolaryngologist.1-3 However, long before the term TMD originated, pre-Costen authors had already published many of the speculations regarding the disturbed meniscal disc and the associated signs and symptoms that later became known as Costen’s syndrome (tables 2, 3). At first, his “new disease,” allegedly associated with “bony erosions” of the temporomandibular joint (TMJ) and the tympanic plate of the temporal bone, was heralded and enthusiastically accepted by both dentistry and otolaryngology. But by the next decade, this tidy synthesis was undone by well planned studies and the battered meniscal disc vogue was restored.
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2-150 Evolution of TMD: clinical symptoms 1887–1956
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3-150 Evolution of TMD: clinical signs 1887–1983
Over the past half century, much attention was directed toward defining four “gold standard” diagnostic symptoms and signs of TMD: (1) Facial or jaw pains. (2) Tenderness of the muscles of mastication. (3) Sounds (clicks or pops) that originate in the TMJ, often with jaw deviations. (4) Restricted jaw opening (defined in the adult as opening less than about 40 mm).9 Together with these criteria came a flood of diagnostic technology and gadgetry that augmented the practice of TMD clinicians; however, the validity and reliability of these instruments are still unproved.
Dispute concerning …
