Abstract
Although much progress has been made in understanding the pathogenesis of temporomandibular joint disorders with various physical symptoms, the precise etiology of this syndrome remains unknown. In our serial clinical studies on TMJ disorders, functional disorders in the central nervous system have been found to play a bigger role in pathogenesis than occlusion. Tricyclic antidepressants have proven very effective for patients who received no benefit from occlusion therapy. “Psycho-social factors, such as the patient's character traits or gain from illness”, have been suggested as an important factor in this disorder, but they have not been incorporated usefully in the actual treatment of the disorders. Patients deny such factors or events, and are wrongly convinced that occlusion is the cause of many systemic disorders. According to these findings, we would like to propose the operation of two types of factor in the pathogenesis of TMJ disorders. One concerns disorders of neurotransmitter systems which may be associated with various physical symptoms. The other involves distorted cognitive processes which relate their symptoms to occlusion, psycho-social factors and so on. We propose that greater attention should be given to abnormal performance of the brain as a causative factor.
The case of a 38-year old housewife who complained of TMJ disorder and many symptoms is described as an example to discuss the efficacy of dsitinguishing between occlusion and character traits in treatment.
