Diagnosis and treatment of TMD based on clinical evidence

―― for dental clinicians

Abstract

The early 1990s saw a major shift in the methodology of medical research due to the spread of EBM. The diagnosis and treatment of TMD were strongly influenced by this change. The author describes this shift and outlines the clinical results and natural history of the various treatment methods, showing that TMD is a disease that often relieves symptoms over time. He also discussed the risks of therapeutic intervention when the occlusal position must be altered for prosthetic reasons, focusing on the changes that splint placement can cause in the joint space, and explained the degree of tolerance for bite raising according to Farrar's (Farrar & McCarty, 1982) classification of TMD pathophysiology. This article is based on a review of the general dental clinician's practice—in particular, the diagnosis of TMD and the appropriateness of intervention by general practitioners when changing the occlusal position due to prosthetic reasons.