Multiple Views and Bias in the Field of TMD

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The following is the third of 15 responses to questions that I was invited to answer regarding my experience, clinical and research findings on the subjective of “TMDs – Confusion & Consensus: Expert’s Advice“. As one of many globally renowned clinicians, academicians and researchers that participated in answering these 15 exclusive interview question this is my response to the following question.

 3. Multiple views, approaches, and philosophies have been witnessed in the diagnosis, prevention, and treatment of TMDs. What do you perceive the reason behind such bias in this field to be?

A fundamental concept of scientific research is to objectively measure and quantify one’s findings.  The problem within the dental profession is that it has not adequately acknowledged objective measurements as a valid premise in scientific inquiry and research.  To date, no consensus has been agreed upon amongst dental leaders when diagnosing and assessing the patient’s muscle, jaw joint and mandibular postural health.  Scientific requirements for validating measuring instrumentation and protocols have been established with the Food and Drug Administration (FDA) and American Dental Association (ADA), but the dental leaders in academia and clinical dentistry have ignored any measuring approach to further scientific inquiry.  One has to ask WHY? 

Key questions of measurement appropriateness can be responded to with the three scientific requirements for validating measuring instrumentation and protocols:

1. Can the clinician measure a known physiologic parameter?

2. Is the clinician measuring what they say they are measuring?

3. Does that measurement add to the diagnostic information?

If the answer is “yes” to any and all three questions then the approach is a valid and useful.  Measurements adding to the differential diagnosis.  Measurements provide the basic construct to remove chaos that would result without any congruent method of understanding movement, position, shape, form, time and structure.

Because confusion persists within the TMD community as to what approach, method, modality and or device is appropriate to implement when treating TMD problems it is prudent that the clinician test and gather the necessary diagnostics in order to identify the type, combination and severity of the following problems: 1) masticatory dysfunction, 2) temporomandibular joint derangement and 3) tempormandibular pain involved. Subjective assessments seem to be the common norm, but this clinician realizes that subjective assessment is not good enough. This is reason why this dentist has researched and applied scientific methods in his clinical protocols to arrive at better conclusions based on quantifiable data.  Based on my findings, methodologies and approach I am able to define, formulate and re-test along with the support of many practicing dentists around the world to prove the GNM paradigm.  Yes, physiologic parameters can be measured.  Yes, one can accurately measure what they say they are measuring and yes, measuring devices and gathered data add to the diagnostic profile in aiding and guiding the clinician toward a more accurate treatment process to achieve proper form and function. 

Electronic measuring devices give the clinician an eye-opening perspective into the unseen physiologic realm of dentistry. Physiologic health and functional quality are not seen with the naked eye, or felt subjectively with any hand palpation or manipulation techniques. It is important to realize that computerized kineseographic tests are available today to define, measure, quantify and record the quality and level of TMJ dysfunction of a patient who has been identified as having pain and masticatory dysfunction.

Both the ADA Council on Scientific Affairs and FDA have evaluated Myotronics neuromuscular measurement instrumentation and found them to meet each of these criteria.  There is no argument of validity that low frequency  dental TENS (transcutaneous neural stimulation), computerized mandibular scanning (CMS), surface electromyography (sEMG) and electrosonography (ESG) are reliable.  These devices would not have the ADA Seal of Acceptance or FDA 510K clearance if they did not pass scientific scrutiny at the highest levels of governing bodies. Since most within our dental profession refuse to use measuring instrumentation to scientifically diagnose and measure the patients mandibular positioning, muscle health status and temporomandibular joint conditions, a perpetuation of professional opinions, bias of various view- points, approaches and philosophies continue.

Clayton A. Chan, D.D.S. – Founder/Director

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