School of Dentistry, University of Western Australia, Nedlands, WA, Australia.
Centre for Advanced Dental Education, Saint Louis University, Saint Louis, MO, USA.
J Oral Pathol Med. 2020 Jul;49(6):461-469. doi: 10.1111/jop.13080. Epub 2020 Jul 2.
After over 80 years of much obsession as well as avoidance of the subject of temporomandibular disorders (TMDs), the dental profession is still divided over what they are and how to deal with them. Over this period, nearly every discipline in dentistry has played some role in the development of this field. Unfortunately, a significant amount of this information has been based on personal opinion, experience-based philosophies, or poorly conducted research. Furthermore, each dental specialty has been responsible for contributing to the concepts of the etiology and management of TMDs with their own professional bias; for example, orthodontists describe these problems in orthodontic terms and offer orthodontic treatments or solutions for their patients. As various treatment approaches were found to be effective at least some of the time, this has further led to misinformation and confusion within the profession. Advances in research from diverse fields, including neurophysiology, pain pathophysiology, genetics, endocrinology, behavioral sciences, and psychology, have significantly altered our understanding of TMDs and how they should be managed. The rigid mechanical and dental-based model of the past has been gradually replaced by a biopsychosocial medical model for the diagnosis and treatment of TMDs as well as other acute and chronic pain disorders. This paper discusses the evolution of our understanding of TMDs since they were first described 85 years ago. Contemporary scientific findings and their implications are presented in some detail for clinicians who wish to provide the appropriate management for their orofacial pain patients.
经过 80 多年的痴迷和对颞下颌紊乱（TMD）的回避，口腔医学专业仍然对其性质和治疗方法存在分歧。在此期间，口腔医学的几乎每个学科都在该领域的发展中发挥了一定的作用。不幸的是，这些信息中有很大一部分基于个人意见、经验主义哲学或研究不当。此外，每个牙科专业都用自己的专业偏见对 TMD 的病因学和管理概念做出了贡献；例如，正畸医生用正畸术语描述这些问题，并为患者提供正畸治疗或解决方案。由于各种治疗方法至少在某些时候都被证明有效，这进一步导致了专业内部的信息混乱。来自神经生理学、疼痛病理生理学、遗传学、内分泌学、行为科学和心理学等不同领域的研究进展极大地改变了我们对 TMD 的理解以及如何治疗它们。过去僵硬的机械和牙科模型逐渐被生物心理社会医学模型所取代，用于 TMD 以及其他急性和慢性疼痛障碍的诊断和治疗。本文讨论了自 85 年前首次描述 TMD 以来，我们对其认识的演变。为了为口腔颌面部疼痛患者提供适当的治疗，本文详细介绍了当代科学发现及其对临床医生的影响。
