Etiologic theory and the prevention of temporomandibular disorders

Over the last 75 years, a variety of etiologic factors has been suggested as the cause of pain and dysfunction in the temporomandibular system. The earliest and still-popular etiologic theory proposed that temporomandibular disorders are induced by abnormal structure, usually described as a malocclusion of the teeth or jaws. The fact that this theory was based on mechanical concepts, ignored biologic diversity, and had limited factual experimental evidence to support it as well as extensive evidence in opposition did not seem to matter to its proponents. In the late 1960's and early 1970's, the structural occlusal model for TM Disorders was challenged and has yielded ground to a more multifactorial model of TMD causation. Other etiologic factors for TM disorders--such as anatomical susceptibility of TM tissues to trauma, polyarthritic diseases, joint laxity, repetitive parafunctional behaviors, and stress-related muscle dysfunction--need to be recognized and quantified. Unfortunately, many practicing dentists demonstrate a very poor understanding of and often fail to recognize these etiologic factors as agents that produce TM disorders. This failure is largely due to the fact that the dental profession has spent the last 90 years dealing with a variety of misconceptions about the etiology of temporomandibular disorders. In the 1990's, one of the more formidable challenges we face is acquiring the ability to segregate and define validly the specific TM Disorder of concern and then correctly identify and measure the specific etiologic factors that produce it. Until these problems are solved, it is unlikely that we will be able to prevent disease of the TM apparatus.