Myofascial Temporomandibular Disorders at a Turning Point: Pragmatic or Evidence-Based Management?

Area of Science:

• Biomedical engineering
• Oral and maxillofacial surgery
• Pain research

Background:

• Current understanding of masticatory myofascial temporomandibular disorders (mTMD) etiopathogenesis is based on unvalidated theories.
• Diagnostic modalities like CT, CBCT, and MRI offer limited value in mTMD diagnosis.
• mTMD diagnosis relies on recognizing familiar pain in masticatory myofascial tissue, hindering understanding of the disease process.

Purpose of the Study:

• To highlight the limitations in current mTMD diagnosis and management.
• To advocate for the exploration of emerging technologies for objective mTMD assessment.
• To transition mTMD diagnosis from a pragmatic to an evidence-based paradigm.

Main Methods:

• Review of current diagnostic approaches for mTMD.
• Discussion of limitations in imaging and clinical assessment tools.
• Exploration of potential of emerging technologies for biomarker identification and myofascial tissue physiology assessment.

Main Results:

• Current mTMD diagnostic methods are subjective and lack objective validation.
• Existing imaging techniques provide minimal diagnostic contribution to mTMD.
• Management strategies for mTMD are currently empirical and arbitrary.

Conclusions:

• Objective assessment of myofascial tissue physiology is crucial for advancing mTMD diagnosis.
• Biomarker identification through emerging technologies is key to establishing an evidence-based approach.
• Future research should focus on developing objective diagnostic tools for mTMD.