Talk:Temporomandibular joint dysfunction

Why

Why the "See also: Fibromyalgia"? Can the resident expert/whoever added that (if available) please explain the relation I'm not seeing, and add that to the article? MCOTWnom

all very interesting, but why the first person?

Also, a definition of the disorder would be helpful. --AxelBoldt---- To my knowledge this is a "syndrome" and therefore the definitions consists of symptoms... but a list of symptoms is also missing. RoseParks

definitely not a disease...TMJ is most often caused by chronic tooth-grinding or jaw clenching. It is characterized by chronic headaches and and can lead to a misalignment of the jaw. JHK

But it is a syndrome and at times a disabling syndrome. And, there is no proof that it comes from tooth-grinding(bruxism) - that I know of. Do you have a reputable source for such a cause? More interesting is that the overwhelming majority of diagnosed patients are female. RoseParks

And what is a temporomandibular joint anyway? The joint that attaches the jaw to the rest of the head? -- Paul Drye

Issue of Subluxation vs TMJD

Recent edit adde to list of symptoms "Popping or clicking when the jaws are opened" and "Popping or clicking when attempting to chew".

• Are these not better categorised as features of TMJ subluxation ?
• Whilst subluxation may induce a "sprain" at the joint causing inflammation and hence an episode of TMJD, is not subluxation possible without having TMJD discomfort ?
• Should there be a separate article on TMJ subluxation, or is it better included in this article given that the consequence (TMJD) and its management are all discussed here ?

David Ruben ^Talk 14:58, 8 March 2006 (UTC)

I thought subluxation was considered a type of TemporoMandibular Joint Disorders, and would thus be appropriate to mention in this article (though it still having its own in-depth article). - Dozenist talk 01:33, 9 March 2006 (UTC)

I'm not a specialist but I would like to see subluxation in this page. And if it's really a detailed subject it could be a separate page also. At least there must be some sentences in this article about subluxation and this article must be linked from subluxation article. Iyigun Cevik 12:30, 30 October 2006 (UTC)

Stub?

Does this article count as a stub?

Thank you for your question. It does not qualify as a "stub" under the present wiki-definition. Therefore I have removed the stub category from the article. pat8722 16:08, 23 April 2006 (UTC)

Arthrocentesis

I am not terribly offended, but I feel the need to express this to you. When it comes to facts about specialized fields, I understand that some knowledge taken for granted by the professionals may sound completely foreign to the general public. Since you are unaware of arthrocentesis, I am assuming you do not have close ties to the dental profession. If you have seen my user page, you would note that my main objective here is in the dental field, and I guess I take for granted that flushing out the TMJ as one avenue of treatment just makes sense. Nonetheless, I feel it would have been considerate to keep a "citation needed" tag to the sentence so that us dental-minded wikipedians would have noted that there was a request for a reference for the information. Otherwise, it would be more difficult to notice that the information was missing from the article, and thus more difficult to add a reference to that specific piece of information. Again, I realize you may not know much about the dental profession, but it may be easier next time there is info you want verified to leave a message on a talk page of someone who is a dentist. Thanks. - Dozenist talk 01:54, 22 May 2006 (UTC)

Your assumptions are all wrong. Of course I am "aware of arthrocentesis". Your mention of it in the article lacked context, and still does, and will have to be fixed. I hope, since you added it, you will make the time to place your addition into context. As to sources, you will see I was held to provide a source on something pretty basic by one who represents himself as being a dentist. [[1]], and I promptly complied. It's really not a problem to add sources, and you shouldn't feel insulted when you are held to providing one, particularly on a topic with as many contradictions and contraindications as this one. pat8722 02:09, 22 May 2006 (UTC)

I think you misunderstand, I am saying that next time using the "citation needed" tag may be more beneficial for the article since the correct information can be included in the article while at the same time bring up the need for a citation. Otherwise, the information may be lost for a while until someone at a later date realizes the omission. This is even a more logical thing to do especially since you say that you ARE "aware of arthrocentesis"--- deleting something you know to be true only because there is no citation would be better handled by just adding a tag saying a citation is warranted. Further, I interpret Davidruben's talk page to say he is a physician, NOT a dentist. And for the record, I did not originally add the statement as you can see here. - Dozenist talk 03:07, 22 May 2006 (UTC)

I think you misunderstand. I deleted it because it was entered both without source and without context. It survives only because you have added a source. Without either source or context the material is misleading/confusing to the reader, at best. It still is misleading, but the reader now has some protection in that they can view the source and assess its credibility. Context is still necessary in the article, and since you are a proponent of leaving it in, I hope you will make the time to add the context, and including opposing treatment philosophies. pat8722 03:20, 22 May 2006 (UTC)

Well, I am disappointed that it appears you are hostile to any effort I make to improve the article. I will not feel it necessary to defend my actions to you, even after you say arthrocentesis makes no sense and the treatment is "bizarre" yet later claim that you were actually "aware of arthrocentesis" and the real reason you deleted pertinent information you knew to be correct was that there was no citation and no context. Well, I have looked at that section of the article and it seems to have perfect context to me since it is one form of treatment. And we all know that different treatments are necessary since most disorders have different causes. Also, if you are an oral and maxillofacial surgeon that treats tmd, I am confused why you would dismiss a less obtrusive treatment than most surgical treatments for tmd, but as I said I will no longer attempt to defend my actions to you since you appear to dismiss them and belittle them. - Dozenist talk 03:46, 22 May 2006 (UTC)

The solution, of course, is to reposition the mandible to its normal position using non-invasive technique (no surgery), and to correct the occlusal surfaces of the teeth, such that the mandible is guided back the correct position when the teeth occlude, as nature intended. Arthrocentesis is obviously no more a "solution" for tmjd, than it would be for a dislocated shoulder.pat8722 15:02, 28 May 2006 (UTC)

Just because you do not understand the different etiologic factors that may cause tmd, the health community does not have to change the way it treats tmd. Arthrocentesis treats tmd when certain factors cause tmd. Furthermore, guiding the mandible back to the correct position will not treat tmd when certain factors are involved. All this makes sense since frequently tmd is more complicated than a dislocated shoulder and also because the tmj functions differently than the shoulder joint. If you are really interested in learning, then just ask, but I have no incentive to help you if you criticize and complain about something you do not understand. - Dozenist talk 19:47, 28 May 2006 (UTC)

There you go, making groundless assumptions and insults again. The point is to improve the article, and where you are the propronent of keeping something in, it is only fair to expect you to add the context, so as not to mislead/confuse the reader. You open yourself up to insults worse than the one's you are making. Of course, it's because I know the factors that "may cause tmjd" that I proposed that you place "context" into the article relative to your addition. Since you are in agreement that "context" is important, you evidence you understood why I deleted your "uncited" reference to it. Rather than making statements that you possess knowledge/expertise, you could you could place what you believe to be "context" into the article, particularly since you have now publicly acknowledged that you understand the significance of "context". You do not disagree that "arthrocentesis is no more a cure for tmjd, than it would be for a dislocated shoulder. Since you are the one keeping a reference to arthrocentesis in this article, it seems only reasonable that you should make the time for adding the context that would make it other than misleading and confusing for the reader.pat8722 15:11, 4 June 2006 (UTC)

I point to what I have already said earlier: "Well, I have looked at that section of the article and it seems to have perfect context to me since it is one form of treatment." And I cannot understand your sentence, but, in order for clarity, arthrocentesis can "cure" tmd because tmd is nothing like a dislocated shoulder. - Dozenist talk 15:54, 4 June 2006 (UTC)

Your statement that "arthrocentesis can cure tmjd" would never survive in the article. Why place falsehood on the talk page? If you want to defend arthrocentesis as "a cure", make your allegation in the article, so I can delete it is as being unsourced. (It is one thing to claim arthrocentesis will alleviate symptoms, and to loosely associate it's use with first "manipulating the jaw", another to claim arthrocentesis is a "cure for tmjd".) Your statement that "tmjd is nothing like a dislocated shoulder" is equally ridiculous - the majority of cases are best understood by the general public when comparing tmjd to a dislocated shoulder, in that the solution is to reposition the mandible to its normal position using non-invasive technique, followed by the additional step of correcting the occlusal surfaces of the teeth, such that the mandible is guided back to the correct position when the teeth occlude, as nature intended. pat8722 16:26, 4 June 2006 (UTC)

Ok, you again demonstrate you have no idea what you are talking about. I have no "allegations" and everything I am saying is supported by the medical/dental community. The general public may compare tmd to a dislocated shoulder, but they are in fact nothing alike. You would know all this if you were an expert in the field. - Dozenist talk 00:21, 5 June 2006 (UTC)

You continue to make false assumptions and mindless insults. You do not put arthrocentesis into the article as a "cure for TMJD" because you know I would delete it, as being unsourced/unsourcable, in that it is not true - and you know it, even as a "24 year old dental student". The comparison to a dislocated shoulder is entirely apt, for reasons I have stated, and you have not countered. You would know all this if you were an expert in the field. You evidence worse than ignorance. pat8722 00:32, 5 June 2006 (UTC)

I agree totally with Pat8722. Successful treatment of TMD requires the treating of it's causitive factors and not it's symptoms. Connective tissue scarring, thinning, perforations and bone spicules of the joint spaces do not develop without a functional pathology elsewhere. Patients with normal occlusion and posture do not develop arthritic changes in the TMJs. Causitive factors of TMD include breating issues as a young child leading to imporper tongue position to accomodate mouth breathing, improper restorative dentistry, tooth loss or breakdown, some orthodontic care, and ascending postural issues that may arise from trauma or injury of the vertebral column (MVAs). Since successful treatment of TMD requires a multidisiplinary approach a unilateral surgical approach will ulitmately fail. Joint damage will resolve without an invasive surgery once the balanced physiologic function is returned to the system with proper orthotic care of the patient's occlusion and cervical alignment of the vertebral colunm with the skull. Arthrocentesis is a tool used by oral surgeons who are faced with helping the patient and who's only tool is a scaple. This does not speak to an unprofessionalism of the Oral Surgeons, but to the general inability of the general dental profession to diagnose and treat TMD.Dr. Curtis Westersund 15:00, 26 July 2006 (UTC)

The fact remains that the craniomandibular articulation is the most complex in the body, because it not only includes a pair of diarthrodial joints but the occlusion of the dentition. This is an immensely difficult area to study. A lot of experts conclude at the moment that TMJDS may not be a distinct clinical entity because of the presence of crepitus and other indicators of joint pathology in a significant proportion of the population who don't complain of pain. Crepitus and deviation really indicators of a disease? Is there any loss of function with crepitus and/or deviation? I wouldn't think so. Why do some people develop pain and others not? A central and unsatisfactorily answered question in my opinion. In fact, there is very little evidence (in the line of interventional studies) supporting the influence of the occlusion on the TMJs, despite its obvious (to me anyway) role. Science is not always intuitive, however and a sound theory is not always sound science. Significantly, there is little evidence supporting the use of occlusal splint therapy (hard or soft) in the treatment of myofascial pain and TMJDS, but these are well known and well accepted treatment modalities.

With respect to arthrocentesis, two of the consultant oral surgeons in my training hospital used to tell us anectdotes of TMJ's that were 'loosened' with arthroscopy alone. A relief of symptoms was experienced by the patient. I would deem this a success because this treatment achieved the dual goals of pain relief and restoration of function.This procedure was reserved for patients for which every other suspected pathology and treatment had been explored. But we deal with evidence not anectdotes. I just use this as an example to shed light on the fact that there is no such thing as NPOV because there is so little evidence to support one thing over another, as far as I am aware. So good luck writing an article! Dr-G - Illigetimi nil carborundum est. 02:20, 18 August 2006 (UTC)

With regards to posture, I would actually be interested in evidence related to postural influence on TMD. I only ask because I know very little of the TMJ myself and I have heard mention of this before. My only problem with this theory is that the mandible is related to only the skull and the hyoid bone and no other osseous structures. I am aware that soft tissue can influence mandibular positioning, but only when the mandible is at rest, or in it's postural position. I fail to see how extraoral soft tissue can influence a solid MIP. If you can direct me to scholarly artcles or texts, I would much appreciate it, as I have an (small) interest in cranio-sacral and alternative therapies in dentistry and also in mainstream neuromuscular dentistry, which did not form a large part of my undergraduate curriculum. (I went to Japan and experienced an oral medicine pain management clinic and they showed us some interesting results using acupuncture and other traditional doctrines in the management of myofascial and psychogenic pain.) Dr-G - Illigetimi nil carborundum est. 02:03, 18 August 2006 (UTC)

comment by David Ruben

re "I was held to provide a source on something pretty basic by one who represents himself as being a dentist" - Thanks for assuming good faith. I have never represented myself as a dentist, nor should it matter whether I was or was not (WP:AGF). My user page clearly indicates I am just a humble General Practitioner. In part, given the lack of availability of NHS dentists in the UK, GPs are often the first point of call for patients with dental problems. Whilst we have no specialised knowledge and certainly do not have any dental equipment, we can provide analgesia and/or antibiotics whilst patients wait to see their dentists (else just strong instruction to see their dentists and not assume that we nice GPs, without "nasty" dental drills/injections but no dental training whatsoever, can help them).

TMJD is something that not infrequently turns up (perhaps maximum of half-dozen cases each year), often after the patient has already seen their own dentist, been examined & X-rayed and informed that their teeth and gums are fine. So I am quite used to prescribing low-dose pain-modifying tricyclic antidepressants (Amitriptyline or Nortriptyline) for this, which often (?approx a third-half) seems to be sufficient to help settle the pain either completely or to such an extent that specialist referral is not desired. Of the remainder, I very readily refer to maxillo-facial surgeons (I guess about 25% of referees find their problem resolves in the 2-3 months it often takes to get an appointment). So I guess (I admit without any hard evidence) that most cases of TMJD in the UK initially present to GPs.

I assumed you were a dentist, both in that you created the article and because I didn't think anyone but a dentist would have deleted technical content on the basis of alleged personal experience, i.e. "backache is not a symptom "I" would normally associated with TMJD." Those with extensive knowledge in the field find it difficult to believe "backache" is not a known symptom to any medical professional who treats either tmjd or backache, or even headache, for that matter.pat8722 15:11, 4 June 2006 (UTC)

To be fair, Dentists in the UK unfortunately have only a limited formulary of drugs they are allowed to prescribe from, and tricyclics are not included given that such use is off-label. Indeed from ibuprofen or paracetamol their next option is Dihydrocodeine 30mg (i.e. no in-between narcotic of codeine, nor the stronger NSAID of Diclofenac).

Whilst I agree TMJ often is not presented as localised pain over the joint, but often difuse non-localised pain over side of head, headaches, dental pain or earache, I had never previously encountered a case presenting to myself or any of my immediate colleagues as being of backache. Maybe we GPS are overlooking the possibility of this differential ? So, as a non-specialist, this had not seemed "something pretty basic". Still that is one of the benefits of wikis in the process of creating good user-friendly articles - non-experts can highlight what to them seems unclear, not obvious or needing clarification :-)

Some points therefore that those with particular knowledge in this field might like to consider adding to the article:

• How common is TMJ in the population ?
• What is typical (untreated) prognosis - i.e. how many will spontaneously settle over 1, 6, 12 months, or ever ?
• How often are tricyclics antidepressants, used as pain-modifiers, alone sufficient ?
• Of the sub-set of cases seen by maxilo-facial surgeons, what percentage are managed with conservative means and how many by surgical intervention ?
• Finally "search for inciting para-functional jaw habits" may be comprehensible for specialists, but baffles me (the corresponding article reads like a dental/medical textbook) - can it be reworded for the rest of us ? Thanks David Ruben ^Talk 23:15, 28 May 2006 (UTC)

I would like to thank Dr. Ruben for his contribution. There is no need for intellectual snobbery here. We need as much help as can be got on these articles. I'm sure Dr. Ruben has more experience treating TMJD than other contributers to this article. As far as associated symptoms of backache, yes patients may have associated symptoms of backache and headache, but there is very little or no evidence to suggest a link at this time. Wide ranging musculoskeletal problems are symptoms of stress, and therefore may not be biomechanically or immunologically related. This is why Dr. Ruben has had success with using low dose antidepressants for treatment of pain (this is a well-studied and oft-used treatment modality for psychogenic facial pain). Therefore, no-one is wrong here. I think you must learn to accept that there may be other points of view than your own pat8722, and that this disease is woefully understudied and poorly understood by medical science! No single point of view is greater than another in this, and my experience is that both specialists and GDPs use their clinical intuition to do something that they either think will work or that they have experienced working in other patients. See my above comments re: arthrocentesis for further expansion on this idea. I think that citation is important here, but understand and expect to find that in this field contradiction exists even in the literature and so all points must be accommodated equally, if they have a citation. With regard to your questions Dr. Ruben, MedLine. Sorry I'm just too lazy to dig for articles that possibly may not exist or are severely outdated. This area as I say is woefully understudied particularly in the areas that you point out. Prevalence in the population depends on your definition of TMJDS (whether pain is a defining characteristic or not). Tricyclics - I had never heard of them being used for TMJD/S but it seems pharmacologically sound. However, as far as I am aware, low doses do not produce anxiolytic and antidepressant effects, which may also be beneficial in the treatment of TMJD/S particularly in light of the contribution of stress. I'm sure some of these questions may be answerable with studies. I'll have a look. Parafunctional habits refer to bruxism (grinding) which tends to be an unconscious action which engages the masticatory system to produce habits that may cause damage to teeth, TMJ and muscles of mastication because of development of excessive forces, repetitive strain and oxygen deficit through overuse and engorgement of muscles. Read that masticatory system article, particularly the piece (which I will rewrite when I dig out my old notes) on mastication motor programme. It explains the massive central contribution to this subset of diseases and why some dentists believe that some myofascial and TMJD treatment lies outside the realm of dentistry, and should belong to neurologists, psychiatrists and psychologists. What is not in dispute is that at the very least, it is a multidisciplinary approach that is required. Dr-G - Illigetimi nil carborundum est. 12:24, 18 August 2006 (UTC)

A. Richard, D. D. S.

Twice now, Jersyko has reverted my edits of sourced material. The information I have added to the article is undisputedlytrue. "TMJ Syndrome: The Overlooked Diagnosis, A. Richard, D. D. S. Goldman Virginia McCullough" is a reliable source for the information that meets all Wiki citation criteria, and was duly cited. Unless you have a source to counter my source, please do not delete this material, as to do so is Wikipedia:Vandalism.pat8722 19:26, 25 June 2006 (UTC)

How dare you call my edits vandalism. The source violates WP:V, which calls for reliable sources. The source is not reliable becuase it's not peer-reviewed, unless you consider the author's secretary (who is one of the only "sources" cited in the article) to be part of the peer-review process. - · j·e·r·s·y·k·o talk · 19:32, 25 June 2006 (UTC)

"TMJ Syndrome: The Overlooked Diagnosis, A. Richard, D. D. S. Goldman Virginia McCullough" meets all wikipedia sourcing criteria. Wikipedia: sources at "What sources to cite" merely says "PREFER... peer-reviewed English-language sources.", not that every published source must be peer-reviewed (the VAST majority of sources, cited in wikipedia or otherwise, are NOT peer-reviewed). As it is undisputable that "backache" is one of the symptoms of TMJD, and as you have not cited a source to dispute it, the most you could reasonably want to do is to add a tag of "source needed", but even that is not justified under the wikipedia rules, as the present source is all that is needed. Also, as you removed the source for "stiffness in the back and shoulders", but not the symptom, what was your source for leaving that one, only, in? pat8722 13:32, 9 July 2006 (UTC)

Edit war regarding symptoms

I've recently seem to have been part of an revert-war over the symptoms of TMJD so its time to try and discuss how best to structure this section. I've listed the individual aspects of this version change so that discussion may follow.

• I think the list need not expand out to every variation of a symptom or occurance in every anatomical position.
  • Hence transient & temporary headaches might be joined on a singe line - the symptom is "headaches" and the text can indicate the various types, rather than listing as separate members of the list.
  • Upper & lower back ache surely can be mentioned in a single sentance ?
  • Neck and shoulder pain are often simultaneously experienced and poorly discriminated between by patients (pains often described as "shoulder" often might be the point to which a pain extends but with an origin half way up the neck, conversely a reported "shoulder pain" might originate from the upper thoracic spine)
  • Backaches (upper or lower) and neck/shoulder pains are both types of musculoskelatal pains beyond the region of the immediate side of the face. Hence I would tend to join them in a single description of "non-localisd" musculoskeletal pains (vs localised pain over the joint itself, or non-pain symptoms such as limited jaw opening or clicking sounds)
    • The article makes no mention as to why upper or lower back pain is claimed as being reported. Other than the single provided link (which I can not read online) - is there (1) any other verification of these symptoms really commonly being a feature of TMJD (the list indicates "include, but are not limited to") (2) any explanation if true - e.g. is this a referred pain or is some other mechanism responsible ?
• What was wrong with expansion given of pains in the head: "The pain may be referred and experienced as earache", such that this is repeately deleted upon reverting my edit ? David Ruben ^Talk 20:26, 23 July 2006 (UTC)

What we've presently got in the article is a list of ten symptoms:

1. Unable to open mouth all the way
2. Pain when trying to close mouth or bite down
3. Feeling as if lower jaw muscles are tensed too tight
4. Popping or clicking when the mouth is opened
5. Transient headache
6. Persistent headache
7. Stiffness in the neck and shoulders
8. Upper backache
9. Lower backache
10. Numbness in the extremities

"Ten" does not amount to unmanagebly sized list. So we've got no reason to be looking to eliminate or combine symptoms or create subcatagorizations on the bases of "reducing the size of the list". We would need to look for an argument that combining symptoms has some benefit of itself.

A "transient headache" is an altogether different symptom than a "persistant headache". The experience, causes and treatments of transient and persistent headache are not the same. Combining them into a single entry would not assist the reader in understanding the different symptoms of tmjd.

Also, as the article is constantly undergoing development, the list of symptoms should remain separated out as to each different symptom for easy argument as to whether each symptom does, or does not, belong on the list. The article as it stands, does not even discuss headache at all, so it is all the more important to avoid the potential for confusion and argument by letting each hold its own place in the symptom list, if it is, in fact, a symptom.

The same is true for upper and lower backache. These two tmjd symptoms are unrelated as to experience, cause, and treatment. There is no reason to subcatagorise by "affected body part" (back) when the list is only ten long, and we would create the false implication that the two symptoms may be related in some meaningful way, which they are not (they are related, as symptoms, only to the tmj, not to eachother). We also have no source to tell us that the lower backache is not experienced as a localized pain versus a diffuse pain, though distant from its source (the tmj).

• I disagree with the logic - yes joint clicking and otalgia are not directely related as symptoms to each other, but to TMJD. But otalgia, neck pain, and upper & lower back pain all seem to be types of experienced referred or atypical (as in not from a direct causse at perceived site) pain in this condition. Whilst I have previously doubted the backpain symptom, having not seemed to encounter it in my professional practice (unlike frequent otalgia), I have not been trying to delete this symptom from wikipedia (once a souce given), just merge it as a class of symptoms. A search of PubMed gives further credence to non-local pain symptoms being experienced further that just as otalgia and for having a common modality of cause in this condition - source found and added to article (Ramírez et al, 2005). (P.S. "Facial pain is a relatively frequent cause of presentation to both general medical and dental practitioners" PMID 16113700) David Ruben ^Talk 00:37, 24 July 2006 (UTC)

You've got no source for "But otalgia [earache, ok? let's use the public term for a public encyclopedia], neck pain, and upper & lower back pain all seem to be types of experienced referred or atypical (as in not from a direct causse at perceived site) pain in this condition".pat8722 02:20, 24 July 2006 (UTC)

As to "stiffness in the neck and shoulders" - they were already combined and I left them that way. The experience, causes, and treatment are the same for tmjd-related "stiffness in the neck" and tmjd-related "stiffness in the shoulders", so we not only don't lose clarity for the reader by combining them in the list of symptoms, we gain it.

As to sources, we only need one wikipedia-qualified source. If you dispute accuracy of the information that is sourced, then you must find a source to dispute it and include it in the article.

If you want to add earache to the sympton list, I would ask that you source it.

• In those patients also dysfunction of the TMJ, otalgia occured in 63% of those with TMJD. Source found and cited (Tuz et al 2003). David Ruben ^Talk 00:37, 24 July 2006 (UTC)

Per Dozenist's deletions of your material below, I have not re-added the earache symptom, but I will not delete your material about earache, if you do re-add your sourced summary material which Dozenist deleted from that first section. pat8722 02:20, 24 July 2006 (UTC)

You have proposed that "I think the list need not expand out to every variation of a symptom or occurance in every anatomical position." As presently constructed, none of the symptoms are variations on others in the list - a lower backache is not a variation on an upper backache, etc. But you do hit upon something important with reference to expanding the list of symptoms based on variation of "occurance in every anatomical position". We could, at some point, add in list form the variations in symptoms as caused by the various different anatomical posiitions of the body, such as lying down, looking up, looking down, looking to the left, looking to the right, etc, which each create a unique torquing effect in the tmj as the damaged teeth occlude at slightly different angles with each position of the head, and with the pull of the muscles as one swallows, the head lies on a pillow, etc, and which accounts for variation in symptoms. That would be a legitimate area of subcatagorization to a symptom list (as not presently being there, but useful in understanding why symptoms vary). pat8722 22:16, 23 July 2006 (UTC)

• I strongly beg to differ re "none of the symptoms are variations on others in the list - a lower backache is not a variation on an upper backache". Surely backache may be divided into lower or upper, to distinguish purely on basis of the adjective rather than the noun seems petty (might as well distinguish mild backache as being totally different from excrutiating backache). See comment above re sdymptom linkage - yes there is evidence that all have same modality of cause. David Ruben ^Talk 00:37, 24 July 2006 (UTC)

I know of no one but you who calls a lower backache a variation on an upper backache. Cite a source which says they are caused, diagnosed, and treated the same. As to your comparison, an excruciating backache may, or may not be, a variation on a mild backache - it depends on the cause of the backache. In tmjd, no link whatsoever has been established between upper backache and lower backache, and therefore we cannot call one a variation on the other, as to do so would constitute original research. You have no source for saying "there is evidence that all [tmjd upper and lower backache] have same modality of cause".pat8722 02:20, 24 July 2006 (UTC)

• Sorry, I was responding (on your talk page) to the personal attack against me in your edit summary of "the shoulder and lower back are different parts of the anatomy. Shame on you", when I stated symptom "occurance in every anatomical position". I had hoped the meaning was clear, but perhaps I should have said instead "occurance in every anatomical location", ie backpain as being in either the upper back or the lower back. I had not meant to imply differences in, say lower back pain, as thr patient changes orientation from sitting to standing, or with head turned to left or the right (and no I don't think such infor would be helpful in a general encyclopaedia - perhaps a textbook on dentistry) David Ruben ^Talk 00:37, 24 July 2006 (UTC)

I have gone through the material in a textbook of mine to add refs and detail to the section on signs and symptoms. The heading of the section was changed to signs and symptoms because signs are an objective finding and symptoms are subjectives ones--- both of which are discussed in the section. Also, I went ahead and avoided making a list, since I remember seeing somewhere in wikipedia that prose is preferable to lists. The order in which the topics in this section is arranged was mirrored from the order of the textbook. Most of the information that was previously there should remain in one form or another. A bit of it might no longer be present because the textbook made no mention of it in the chapter I read, which was pretty extensive. Lastly, Pat8722, I ask you again to not attack fellow wikipedians. I think David Ruben has shown a willingness to work with you by adding citations. - Dozenist talk 01:44, 24 July 2006 (UTC)

Your sections' headers don't describe your sections' content. As you have not clearly or completely identified the known signs and symptoms of TMJD in your major edits to the article, I have re-added the deleted list of such in a prominent place. We want to make it easy for our readers to find the basic information.pat8722 02:20, 24 July 2006 (UTC)

If you choose to try to put the info into another format, be sure to include all the sourced signs and symptoms.

I will be unable to contribute further until next Sunday, as present time committments bind me Monday through Saturday. pat8722 02:20, 24 July 2006 (UTC)

Holy crap, Dozenist's edit was awesome! You're chastising him for providing too much information? Unbelievable. For someone that is such a stickler for sourcing (as we should be, no doubt), I find it perplexing that you insist on inserting an *almost* entirely unsourced list into the article. · j·e·r·s·y·k·o talk · 02:29, 24 July 2006 (UTC)

No, not for providing information, but for the information he left out. I will fully source the symptom list before re-adding it, unless someone beats me to it.pat8722 03:27, 24 July 2006 (UTC)

TMJ:The Overlooked Diagnosis

(1) The TMJ:The Overlooked Diagnosis book was written in the 1980s, bears no evidence of peer review, and contains no citations to scientific articles, studies, or journals. Thus, if using the information from this book does not violate WP:RS and WP:V, it at least is of questionable value in an encyclopedia article written in 2006. (2) The source cited by Dozenist in his expansion of the article is a widely used, peer reviewed, fully cited, and current dentistry textbook. Its status as a reliable source is unassailable. (3) The insertion of the list in the article, which now also contains detailed information on the variety of signs and symptoms, disrupts the article's flow and is duplicative. For what it's worth, I find the article's current breakdown of signs and symptoms into three main groups much more easy to read and informative than a bulleted list, though this is merely an opinion. In any event, since this information is taken from a reliable source and the list is not, the list is inappropriate. (4) Referring to Wikipedia:Vandalism every time the list is re-added is not, in any way, going to aid our discussion here, and it is untrue that any edits related to this list amount to vandalism. If you sincerely believed otherwise, Pat8722, you would have filed a vandalism report. Let's have a rational discussion instead of devolving to the use of implied, empty threats. · j·e·r·s·y·k·o talk · 21:21, 30 July 2006 (UTC)

[02] What is "filing a vandalism report"? Please refer me to the wikipedia policy which provides for doing so, and specifies when it is appropriate to report vandalism, rather than merely reverting it upon explanation, which I always do.

[03]Bad faith is evidenced when you say the material you deleted violates wp: verifiability, as it is eminently obvious it does not. I quote directly from [[wp: v] "'Verifiable' in this context means that any reader must be able to check that material added to Wikipedia has already been published by a reliable source". Obviously you are able to check whether the material added to wikipedia has already been published by a reliable source, because I listed the source. wp: v is, therefore, totally irrelevant.

[04]Bad faith is also evidenced when you say "Tmj Syndrome: The Overlooked Diagnosis" violates wp: reliable sources, as a review of the actual policy proves that it does not. The wp: rs policy says primary, secondary, and tertiary sources are acceptable. Syndrome: The Overlooked Diagnosis qualifies as a secondary source under wikipedia wp:rs as being "produced by [a] scholar.. and published by a scholarly press.. [such presses assumed to be] ... carefully vetted for quality control and can be considered authoritative." McGraw/Hill is a reputable scholarly press, one of the largest publishers in the world, if fact, and even exceeds the standards for the publishers of most sources cited in wikipedia.

[05]The reliability of "Tmj Syndrome: The Overlooked Diagnosis" as a source is further evidenced by the fact that the book has gone through several editions, amd at least up through at least 1989, is still published on the internet as current information, and HAS NEVER ENCOUNTERED ANY PUBLISHED OPPOSITION. ThE symptom you are trying to obscure, BACKACHE is undisputed by anyone. I have never met a dentist who was not fully aware that backache is a symptom of TMJD, nor do I believe it is remotely credible to postulate that there are any who aren't, nor have you yourself alleged that it is not a symptom, so presumably you also know that it is. Until you find a source to dispute my fully sourced, professionally undisputed addition to this article, to delete it is, in fact, vandalism: "Removing ... significant parts of articles ... is a common vandal edit." Furthermore, that you are trying to remove basic information whose ACCURACY IS UNDISPUTED, your removal of the material also qualifies as "a deletion,.. made in a deliberate attempt to compromise the integrity of the encyclopedia." wikipedia: vandalism

[06]Whether the information is in list or prose form, is not a serious issue to me. As a nice succinct list makes it easy for the reader, I prefer that form, but if you prefer a different form, go ahead and make such changes - just don't delete substantive content when you do.pat8722 00:02, 31 July 2006 (UTC)

Why do you feel it necessary to cite to TMD:TOD instead of another source? Why must it be this source, which, despite your assertions to the contrary, doubtfully complies with this portion of the reliable sources guideline: Wikipedia:Reliable sources#Physical sciences, mathematics and medicine? Why can't you simply argue the relevant point instead of throwing out accusations of vandalism and bad faith? · j·e·r·s·y·k·o talk · 00:19, 31 July 2006 (UTC)

[08] I cite the source I cite because it meets all wikipedia criteria, and is also readily available to the public, who may wish to seek more information. If you want to source the material yourself, rather than delete it, I might agree to compromise and let your source stand alone, rather than also include mine. As to arguing the relevant points, I have repeatedly demonstrated the merits of both content and the source (see above discussions), and have repeatedly demonstrated that you had no basis for complaining about my source, which averments above you have not countered. You also have not countered the accuracy of the material you are deleting. After repeated unjustified deletions of substantivesourced content, it becomes necessary to point out the wikipedia: vandalism policy, to civilly discourage those who repeatedly delete substantive sourced content without cause for doing so, from doing so. You have not argued the relevant points on the issue of whether you violated the wikipedia: vandalism policy by repeatedly deleting substantive, sourced material while falsely claiming policies have been violated, which I have shown, by quoting directly from the policies, have not been violated. Because you keep deleting the substantive, sourced content without cause, and refusing to argue the relevant points (i.e. the actual text of wikipedia policies which you falsely claim my source violates, and that fact that it IS substantive material you are deleting) it is time to address it as a vandalism issue, to discourage it from devolving into a mere revert war. There is nothing in Wikipedia:Reliable sources#Physical sciences, mathematics and medicine which overrides the quotations I made above from Wikipedia:Reliable sources in support of my source. If you believe there is, please quote the line therefrom that you believe disqualifies my source. pat8722 01:25, 31 July 2006 (UTC)

Re list - originally article had nothing but the items of this list as the signs & symptoms of the condition (revert-warring by Pat8722 to preserve each item as a separate entry rather than linking like-items together, was matter of editorial styling rather than providing any great explanation to symptoms). However there now is a coherent description of the symptoms in 3 easy-to-read subsections. The list has now served its purpose and is depreciated. David Ruben ^Talk 00:47, 31 July 2006 (UTC)

[10] No, the list is not a matter of mere style, because it contains information which your edits do not cover. It is simply patently false for you to state "there now is a ... description of .. [each of the deleted] symptoms in ... subsections", in that, for instance, "backache", was deleted by you and you did not cover it in the sections you added when you deleted the nice, concise, introductory symptom list. As I stated, if you don't like the idea of a list, you are free to re-state the information in another way, you just must do it in a way that doesn't delete substantive, sourced content, as to repeatedly delete substantive sourced content is wikipedia: vandalism (see paragraph [05], above), and to do so without citing an applicable policy for doing so, and to claim you retained all symptoms (backache) when you did not, is to engage in unproductive revert warring, rather than productive discussion, which is also against wikipedia policy.pat8722 01:25, 31 July 2006 (UTC)

false allegation - backacke was not repeatedly deleted by myself however many times you care to so state - just joining of the separate "Upper backache" and "Lower backache" items on the list to "upper or lower backache" - that's not deleting mention of either, nor vandalism. (see 9th July, 18th July & 23rd July). This amounts to your continued aggressive uncoperative style of interacting with other editors as per the RfC about you.

Full list revertion vs re-adding single items you feel nolonger covered - Please stop being so pedantic as to perserving your entire list when other editors have expanded the symptoms section from being a mere list into descriptive prose that clearly expands the depth & breadth covered in the article. There is no requirement in Wikipedia to duplicated every last item from full lists of data - the job of an encyclopaedia is to sumarise knowledge, and a summary is always shorter than the total amount of source material one may reference as background to an article. If an important symptom has been left off, merely reverting the whole list back in is unhelpful & uncooperative - you should only add back in the individual missing symptoms not included in the expanded text. Ideally, given how other symptoms have now been described, any re-inserted symptoms should be incorportaed into the article's text explaining how and why they occur - very much as Dozenist did. The other editors are citing their reasons for reverting the inclusion of the whole list in their sdit summary comments - if you want a policy of encyclopedic style then, as a starter, see WP:ISNOT#Wikipedia is not an indiscriminate collection of information which states "Wikipedia is not an indiscriminate collection of items of information. That something is 100% true does not mean it is suitable for inclusion in an encyclopedia". If you really do not like the editorial approach being taken by the other current editors, then stop trying to browbeat other editors and simply raise a WP:RfC on this article for a wider opinion. David Ruben ^Talk 03:25, 31 July 2006 (UTC)

3RR does not grant a user the automatic right to disrupt wikipedia process by reverting any and all other editors up to 3 times in a day - such deliberate action (see "Third revert for today, see talk page. See you next Sunday") amounts, I beleive, to further example of Gaming of the three revert rule. WP:AN/3RR therefore raised re Pat8722. David Ruben ^Talk 04:06, 31 July 2006 (UTC)

Classes??

Not looking for a dispute here, but I was wondering if there was someone who could provide more information on the different classes of TMJ disorder? My PCP just told me my jaw was slightly misaligned due to probable TMJ disorder and referred me to a dentist. When I made the appointment they asked if I was "class 1", I told them I guess that's what I was going to them to find out...
I'm guessing my problem developed from grinding and biting habits I have due to OCD and anxiety disorders, so if anyone has information showing a relationship between the two I'd like to know about that as well.
thanks!
Polyphonickat 18:36, 5 May 2007 (UTC)

Past Wisdom Tooth Surgery

Could semi-major (one tooth was completely horizontal and set in deep into the jaw bone) impacted wisdom tooth surgery promote TMJ? —Preceding unsigned comment added by 69.120.93.246 (talk) 11:54, 9 July 2007

Areas where clarification would help

I would hazard a guess that, like me, most people accessing this article will be sufferers or possible sufferers from this condition rather than experts. From that perspective, it seems to me that three issues are far from clear, and that clarification would be of great benefit:

1. From the article, it would appear that TMD comprises the incorrect movement of the mandible in a fore-and-aft direction - but can this also occur laterally, i.e. in such a way that the jaw displaces to the left and/or to the right? My condition seems to have begun as the former (characterised by clicks and pops, as described here), but has now become the latter (characterised by numbness/temporary seizing of the jaw).

2. Again from a lay perspective, what about consequences of TMD? It occurs to me - and I must stress that it occurs to me simply as a lay person - that this disorder could trap not only nerves but also blood vessels. If so, what further symptoms could result?

3. Could TMD result from difficult wisdom tooth extraction?

(In my case, the wisdom tooth had to be cut in half laterally, using some kind of disc cutter, after which the front half was removed. Removal of the back half required a further cutting in half of the remaining tooth in the same way).

It could be that these issues might be answered by an expert contributor, and/or that there could be a reference to a related wikipedia article addressing these issues, if such exists. This could be a great help to non-expert readers. —Preceding unsigned comment added by Vvmodel (talk • contribs) 22:40, 29 February 2008 (UTC)

Do I have this?

For the last few days, I have found it painful to open my mouth very far. Also when I first wake up, I find it painful to close my teeth together, but this goes away after I force them closed a couple times. Do I have this disorder? —Preceding unsigned comment added by 138.87.219.217 (talk • contribs)

Not enough info for diagnosis, but if I were to guess, I would say no. More likely that your wisdom teeth are giving you trouble and you are suffering trismus. However this is a guess and in no way constitutes a diagnosis.Dr-G - Illigetimi non carborundum est. 18:46, 13 September 2007 (UTC)

Areas of treatment

This statement is in the introduction: "Because the disorder transcends the boundaries between several health-care disciplines — in particular, dentistry, neurology, physical therapy, and psychology — there are a variety of treatment approaches." There are no citations for this statement, and no references to many of the areas in the Treatment section. I especially feel to see how psychology comes into play, unless to deal with possible depression from the disorder. However, I don't believe that is direct enough to be mentioned, though a short mention may be warranted with a citation in another area of the article. This is only my opinion, and so I'm not willing to be bold here. - Cyborg Ninja 22:07, 23 January 2009 (UTC)

Problematic section

Temporomandibular_joint_disorder#Relocating_a_dislocated_jaw sounds a lot like a how-to medical treatment guide. Is this really appropriate for Wikipedia, especially since it has no citations as to its origin, veracity, or safety? --Mr.98 (talk) 11:12, 29 October 2009 (UTC)

It's definitely problematic. Wikipedia is not a how-to guide. Even if the information were 100% reliable and safe (which I have no way of knowing one way or the other) it's against policy. 173.66.178.54 (talk) 01:37, 30 November 2009 (UTC)

Since this concern has not really been addressed since Mr.98's comment back in October, I have raised this issue on the talk page for WikiProject Medicine. Please contribute to the discussion there. --Nick—^Contact/_Contribs 04:07, 25 January 2010 (UTC)

Treatment section

This article seems to have been tampered with by persons with financial interests in a given treatment. CranioSacral therapy supposedly "taps into natural rhythms," which is utter poppycock to anyone with scientific or medical training, and the only citations for Feldenkrais methods employing a "unique" understanding of neurology led to a site selling the treatment!

I see this has been discussed before ...

The article doesn't just seem like a manual it is providing direct instructions to readers about what they should and shouldn't do in the first and second person.

It is also very poorly sourced and (I suspect) is coming from the perspective of only one specialism/approach to the problem.

Whilst it can be hard to get citations for all sorts of different aspects of the condition and its treatment, it is definitely not on to talk about the benefits, controversies and risks without finding a reference to back it up.

I think much of the article should be removed and reintroduced as and when someone can do so in a more encyclopedic fashion. —Preceding unsigned comment added by 90.195.131.21 (talk) 17:25, 28 March 2010 (UTC)

Refs

I've added a couple more books, both with google previews. Have at 'em! LeadSongDog come howl! 19:43, 21 October 2010 (UTC)