Diagnosis and treatment of temporomandibular disorders: an ethical analysis of current practices

Abstract

The defining characteristic of a profession - and especially a health-care profession - is that the behaviour of its members is proscribed by a formal code of ethics. The main purpose of such codes is to guide practitioners' interactions with patients, assuring that patient interests are protected. In other words, the ethical code requires practitioners to place their patients' needs for proper diagnosis and appropriate treatment ahead of their own needs for income and advancement. The dental profession has a code of ethics that was developed by the American Dental Association many years ago; in most clinical situations, determination of proper behaviour is self-evident. However, the field of temporoman-dibular disorders (TMDs) has been the subject of considerable controversy for over half a century, and many people have argued that this makes it impossible to evaluate various approaches to treatment of TMDs within an ethical framework. In this article, the authors argue that the large volume of scientific evidence in the contemporary TMD literature provides an ethical framework for the diagnosis and treatment of patients with TMDs within a biopsychosocial medical model. They present a summary of the research with contemporary scientific integrity, which has produced that information over a period of many years. Based on that research, they conclude that dentists may provide conservative and reversible treatments that will be successful for most TMDs and in doing so will comply with the profession's code of ethics. Conversely, the authors claim that those dentists who continue to follow the older mechanistic models of TMD aetiology and treatment are not only out of step scientifically, but are placing their patients' welfare at risk by providing unnecessary irreversible bite-changing and jaw-repositioning interventions. Therefore, debate of these issues should not be solely focused on scientific merit, but also upon the compelling ethical obligations that dentists have as a result of the contemporary scientific literature regarding TMDs.

Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era?

“…First, there is a scarce literature on the topic, and the quality of reviewed articles was, on average, less than optimal. Such finding contrasts with the number of papers on the different strategies to correct purported abnormalities of dental occlusion by means of orthodontics or prosthodontic treatments and calls into question the ethical principles of medicine . Second, there is a wide methodological variability between the different investigations as for the assessed TMD signs and symptoms.…”

Correlation between pressure pain threshold and pain intensity in patients with temporomandibular disorders who are compliant or non-compliant with conservative treatment

“…81 Significant improvements in pain were observed in the participants from both the CG and NCG groups at the end of the study (T2), which might have been caused by the natural history of the disease, a placebo effect or regression towards the mean. 12,13,82,83 Our study benefited from having only one single examiner perform all of the examinations and assessments at all three time points (T0, T1 and T2); thus, all of the examinations were performed in the same manner for all of the participants.…”

“…[5][6][7][8][9][10][11][12][13] Therapeutic modalities include cognitive behavioral therapy, [14][15][16] intra-oral appliances [17][18][19] and therapeutic exercises. 10,20,21 Low-cost therapeutic modalities based on counselling [22][23][24] and selfcare are beneficial and contribute to controlling the signs and symptoms by improving the psychological domains and eliminating deleterious behaviors.…”

Confirming the mechanisms behind cognitive‐behavioural therapy effectiveness in chronic pain using structural equation modeling in a sample of patients with temporomandibular disorders

“…Temporomandibular disorders (TMDs) constitute a relevant subgroup of the musculoskeletal disorders (prevalence 5–13% within general population), characterized by heterogeneous aetiology and symptomatology, which includes pain and psychological complaints (Reiter, Goldsmith, Emodi‐Perlman, Friedman‐Rubin, & Winocur, ). Standard dental therapy commonly applied focuses on approaches of a conservative nature including analgesics and myo‐relaxants in cases reporting acute pain (pharmacological therapy), advice and recommendations to reduce stress and muscular overload on the Temporomandibular joint and muscles (physical therapy), and the use of an intra‐oral splint (occlusal therapy) in most cases (Reid & Greene, ). However, a significant share of these patients does not improve with this standard dental therapy (De Souza, Lovato da Silva, Nasser, Fedorowicz, & Al‐Muharraqi, ).…”