PERSPECTIVES
J Oral Maxillofac Surg
Temporomandibular Disorders: A
Term Whose Time Has Passed!
Daniel M. Laskin, DDS, MS
Records of the treatment of various temporomandib-
ular joint (TMJ) diseases date back to the fifth century.
Over the subsequent years, conditions such as disloca-
tion, arthritis, and ankylosis were generally managed
by physicians. However, this changed substantially in
1934 when James Costen,1 an otolaryngologist, pub-
lished the first of a series of articles describing a group
of patients with TMJ, ear, and sinus symptoms, which
ultimately came to be termed ‘‘Costen syndrome,’’ that
he claimed were caused by nerve impingement due to
overclosure of the bite. This resulted in 2 substantial
changes: First, it increased the role of dentists in the
diagnosis and treatment of this group of patients,
most of whom were managed by a mechanically based
gnathologic approach to treatment. Second, it
changed the focus from a disease-based to a
symptom-based concept of diagnosis. As a result,
patients with a variety of etiologically unrelated condi-
tions were often treated in a similar manner just
because they had relatively similar signs
and symptoms.
It was not until the 1950s and 1960s that the studies
by Lazlo Schwartz and his colleagues at Columbia Uni-
versity and Laskin2 and his co-investigators at the Uni-
versity of Illinois TMJ and Facial Pain Research Center
showed that there were really 2 different groups of
patients being included under the Costen syndrome
heading—those with pathology of the TMJ and those
with masticatory muscle disorders—and that these
various conditions required different diagnostic and
treatment methods.
Recognizing the existing confusion in the field and
the inappropriate treatment of many patients, in
1982 the American Dental Association organized
The President’s Conference on the Examination,
Professor and Chairman Emeritus, Department of Oral and
Maxillofacial Surgery, Virginia Commonwealth University School of
Dentistry, Richmond, VA.
Conflict of Interest Disclosures: The author has no relevant finan-
cial relationship(s) with a commercial interest.
Address correspondence and reprint requests to Dr Laskin:
Department of Oral and Maxillofacial Surgery, Virginia Common-
496
78:496-497, 2020
Diagnosis, and Management of Temporomandibular
Disorders to find a solution to the problem. Although
it would seem that the logical solution would be to
separate the 2 groups of patients diagnostically and
therapeutically, the conference participants did just
the opposite. As Yogi Berra once said, ‘‘When you
come to a fork in the road, take it,’’ and they did—rec-
ommending combining the 2 groups under the all-
inclusive umbrella term ‘‘temporomandibular disor-
ders’’ (TMD). Although this may have seemed like
the least disruptive solution at the time, in retrospect
it really served no useful purpose and instead has led
to continued confusion.
A review of the literature shows that there currently
are still numerous publications in which the study
populations are defined only as having TMD and it is
impossible to determine the specific condition being
treated. Thus, these publications represent a waste
of time and resources. In addition, one attends lectures
where clinicians still speak of treating TMD patients as
if they were a homogeneous group and leaves without
really knowing to whom one should apply the recom-
mended treatment. Or, one listens to colleagues
discuss the management of a ‘‘TMD patient’’ when it
is never clarified whether the patient has a myogenous
or arthrogenous condition. Certainly, using TMD ter-
minology does not improve communication or the
dissemination of knowledge.
Even the Research Diagnostic Criteria for Temporo-
mandibular Disorders (RDC/TMD),3 which may be
useful as a research tool for studying pain, serve no
purpose as a diagnostic and treatment guide for the
practicing clinician.4 Moreover, the more recently
developed Diagnostic Criteria for Temporomandibular
Disorders (DC/TMD) for Clinical and Research
wealth University School of Dentistry, 521 N 11th St, Richmond,
VA 23298-0566; e-mail: dmlaskin@vcu.edu
Received November 25 2019
Accepted November 25 2019
Ó 2019 American Association of Oral and Maxillofacial Surgeons
0278-2391/19/31370-9
https://doi.org/10.1016/j.joms.2019.11.038
DANIEL M. LASKIN 497

Table 1. MUSCULOSKELETAL CONDITIONS OF

the point where we are able to recognize most of
TEMPOROMANDIBULAR COMPLEX the diseases and disorders that can affect the TMJ
and the masticatory muscles (Table 1). The American
Muscle Problems Joint Problems Association of Oral and Maxillofacial Surgeons should
take a leadership role in organizing an international
Myalgia Congenital anomalies conference that brings together the groups of interest
Myofascial pain Developmental anomalies to develop the diagnostic criteria for the various
Myositis Traumatic injuries
musculoskeletal conditions and a consensus regarding
Myospasm Ankylosis
Hyperkinesia Arthritis
treatment guidelines.
Hypokinesia Neoplasia
Hypertrophy Internal derangements
Contracture Subluxation and/or dislocation
References
Daniel M. Laskin. Temporomandibular Disorder Terminology. J
Oral Maxillofac Surg 2020. 1. Costen JB: Syndrome of ear and sinus symptoms dependent upon
disturbed function of the temporomandibular joint. Ann Otol Rhi-
nol Laryngol 43:1, 1934
Applications, created in an attempt to make the RDC/ 2. Laskin DM: Etiology of the pain-dysfunction syndrome. J Am Dent
TMD more user-friendly for clinicians, are still defi- Assoc 79:147, 1969
3. Dworkin SF, LeResche L: Research diagnostic criteria for temporo-
cient in the muscle disorders to be considered and mandibular disorders. Review, criteria, examinations and specifi-
continue to combine the unrelated muscle and joint cations, critique. J Craniomandib Disord 6:301, 1992
conditions.5 The time has come to completely elimi- 4. Steenks MH, de Wijer A: Validity of the Research Diagnostic
Criteria for Temporomandibular Disorders axis I in clinical and
nate the term TMD and to consider the myogenous research settings. J Orofac Pain 23:9, 2009
and arthrogenous conditions as independent musculo- 5. Schiffman E, Ohrbach R, Truelove E, et al: Diagnostic criteria for
skeletal problems. temporomandibular disorders (DC/TMD) for clinical and
research applications: Recommendations of the international
Whereas in the distant past, it may not have been RDC/TMD consortium network and orofacial pain special inter-
possible to accomplish this, we have now reached est group. J Oral Facial Pain Headache 28:6, 2014