A terminology describing a wide area of dysfunction and pain in the head, neck, and TM Joint, lacks definitive description. Not only the profession can not agree on the definition of the terms, the leading government dental agency NIDCR stated that there is no widely accepted, standard test to correctly identify TMJ problems. If testing is ordered, the NIDCR asks the patient to ask for another independent opinion. It is such a problem quite often healthcare consultants recommend no payment for dentists treating TM Joint problems.
ADA’s website has little information about TM Joint problems and facial pain. The same can be said for websites of NIH, AMA, CDC, AGD, the Pankey Institute and Mayo Clinic. Current literature also contains a confusing array of definitions such as CFP, CFD, MFP, MPD, CMD, CMP, CMDS, TMD, TMJ, TMJD, OFD, OFP, MMD, AFP and many others. Seems like each author somehow coined their own name when publishing articles. Others will use their influential colleague’s coined terms. Terms used are like a moving, morphing target with different meanings depending on who is using the term. Each name means something to some one but means something totally different to others.
However, from this primordial soup of terms, the most unexpected happened. Two definitions may have a fixed meaning.
NIH in the Healthy People 2010 project fixed a definition to one of the
names CFP- Craniofacial Pain. Craniofacial Pain covers every thing from
dysfunction to pain and from tooth decay to genetics of the head and face.
NIDCR defined TMD as temporomandibular disorders as a group of conditions
affecting the jaw joints and the muscles that control the jaw.
It would be difficult not to accept the NIH’s definition of Craniofacial Pain (CFP). Since CFP covers everything that is head, face and jaw. Thus CFP is the umbrella term of all other terms such as CFD, CMP, MFP, MPD, CMD, CMDS, TMJ, TMJD, TMJP, OFD, OFP, MMD, TMD and any other newly coined terms.
By the NIH’s defined term of CFP (craniofacial pain), NICDR definition of TMD is a part of CFP and covers two major areas. They are the TM Joint problems and Jaw Muscles problems. If this parameter is to be followed, all other terms used to describe TM Joint problems can fit into these two groups.
Group I describes problems of the TM joint. Examples are as follow-
TMJD, Temporomandibular Joint Dysfunction/Disorder is a functional problem of mandible specifically related to the temporal area and the TM joint. Putting it differently, T represents Occlusion, M represents Muscle, J represents joints, and D represents dysfunctions. This is the same as TMD as defined by NIDCR.
TMJP, Temporomandibular Joint Pain is a description of pain in the TM joint area.
TMJ, Temporomandibular Joint is an anatomical term only. It should never be used to describe a disease, dysfunctional problem, pain, and or syndrome. TM joint problems can be diagnosis by Tomography, MRI, and arthrography.
Group II is for all the terms related to muscles. Within this group there is two subgroups. All muscle problems can be tested with muscle palpations, ROM measurement both manual or modern computer technology, and nerve testing.
Subgroup One describes the dysfunction problems involving mostly the jaw muscles. All term ending with a D can be put into this group, which includes CFD, MPD, CMD, CMDS, OFD, MMD.
CFD, Craniofacial dysfunction describes the dysfunction between the system related to the face and head. The cranium does not have an easily measurable range of motion, so any measurable dysfunction is in the mandible range of motion. This functional problems has to be related to facial structure and more likely related to how the teeth fit together, how the muscles function and how the joint functions.
MPD, Myofascial Pain dysfunction describes a functional problem of mandible with pain. This functional problem has to be related to disturbed occlusal mechanics, and mostly muscular in origin (Dr. J.Travell).
CMD, Craniomandibular Disorder describes the functional problem of mandible. This functional problem relates to how the teeth fit together, how the muscles function and how the joint functions.
CMDS, Cranio-mandibular Dysfunction Syndrome describes a collage of symptoms indicating abnormal conditions both disease and psychological disorders. The known cause of such has not been discovered yet.
TMD, Temporomandibular Dysfunction describes the dysfunction between the system related to the temporal region of the head and lower jaw. NIDCR defined TMD as a group of conditions affecting the jaw joints and the muscles that control the jaw.
MMD, Masticatory muscle disorder as defined by Dr. J. Okeson as muscle splinting, local muscle soreness, trigger point pain, myospasm, and centrally mediated myalgia.
Subgroup Two describes pain, which can result from muscular dysfunction. All the term ending with P can be included in this group, which includes MFP, CMP, AFP and OFP.
MFP Myofascial Pain is pain in the fascial system of the body and involves muscles. Fascia is the connective tissue found everywhere in your body that holds all of your organs in place. When fascia malfunctions due to injury, illness, surgery or poor posture, it becomes tight and binds down, resulting in abnormal pressure on nerves, muscles, bones or organs of the body. Restriction in one region can put a ³drag² on the fascia in any other direction. In TMJ disorders, professionals tend to look primarily at the muscles of the upper body and head. While this is the main site of pain, the rest of the body should not be overlooked. Myofascial pain occurs throughout the body and affects how healing takes place.
CMP, Chronic Myofascial Pain is myofascial pain in fascia and muscles of the head; neck, all the way to the toe.
OFP, Orofacial Pain is pain in teeth and face including facial muscles.
AFP, Atypical Facial Pain is the pain occurring in the territory of the trigeminal nerve with no specific cause (Dr. James H. Halsey, University of Alabama Medical Center).
What is the proper name for the problems related to the structure of TMJ and recognized by all health care organizations?
The CRANIO, in its January 2005 issue, has assumed a leadership role in identifying the confusion that exists involving the definitions of Orofacial Pain and Myofascial Pain related to TMJD Diagnosis and Treatment. Dr. Joseph Cohen in that issue’s editorial also asked all of the leaders of various groups to communicate with each other to help achieve common goals that will help our patients get the care they need.
May be the Alliance of TMD Organizations (Alliance) can pick up the challenge of CRANIO and Dr. Joseph Cohen (President, American Academy of Orofacial Pain) to take the first step of getting a clear definition of terms to promote a unified understanding of terminology. TMD Alliance might also consider having a joint meeting so that members of all the various organizations could attend lectures outside their own organization to get beyond the confusion and come to a better understanding.
Kenneth Lau DDS, MICCMO, FAACP
Robert O. Uppgaard, DDS, FAGD
This information is FYI only. It is not intended to provide treatment
or recommend treatment by any means or methods. Any health problems need
careful diagnosis by your attending doctors.