Psychological considerations

The standard definition of temporomandibular disorder (TMD) - a collective term embracing a number of clinical problems that involve the masticatory muscles, the temporomandibular joints (TMJs), and the associated structures - clearly places the emphasis onto the underlying structures. From a physical diagnostic perspective, this emphasis is of course appropriate and essential. Because TMDs are the most prevalent clinical conditions afflicting the masticatory apparatus, and because they are associated with both pain and limitations in masticatory function, emphasis on structural problems and etiologies can understandably dominate at the time of the clinical consultation. However, current texts [1, 2] emphasize that structural perspectives of TMDs alone are insufficient. Moreover, recent publications focusing on disease classification systems are highlighting the process aspect of pain. These pain classification systems are anchoring the "location" of pain disorders at a broad systems level, involving brain, mind, and the person in addition to pointing specifically at the masticatory system for TMDs [3, 4]. While this broad perspective has been advocated for decades as part of the biopsychosocial model of disease [5-7], new approaches to disease classification are leading to the same conclusions with greater rigor [8].