Temporomandibular joint dysfunction: from Costen to the present

Sixty years ago, James Costen, an otolaryngologist, described a group of signs and symptoms of jaw and ear disturbances that he related to loss of mandibular posterior teeth and lower jaw overclosure. His recommended therapy was to "build up the bite". This review of the literature since that time presents evolving concepts that have primarily refuted Costen's original concepts and have stressed the aetiologic role of muscle function, psychosocial factors, and individual parafunctional habits related to the stress of daily life. Present treatment protocol for temporomandibular joint dysfunction emphasizes the need for an accurate diagnosis by the dentist or physician--as to whether the problem is arthrogenous, neurogenous, myogenous, or a combination of these--prior to the initiation of any therapy.