Temporomandibular Treatment Outcomes Within Five Diagnostic Categories
Gerald B. Wexler, B.Sc., D.D.S.; Michael W. McKinney, M.A., Ph.D.
ABSTRACT: This study of temporomandibular disorder
(TMD) treatment outcomes examines 274 consecutive patients in five
diagnostic categories and a 25 patient comparison group to determine
relative levels of symptom improvement. Employing a psychometric
outcome measure, the TMJ Scale, it was found patients receiving active
TMD treatments manifest statistically significant symptom
improvements. Untreated patients reported minor and statistically
insignificant symptom variations. Patients with intracapsular TM joint
dysfunctions exhibited higher levels of improvement in pain and other
TMD symptoms than patients presenting with primarily muscle symptoms.
This research supports the hypothesis that TMDs are not self-limiting
and require active treatment interventions. It is suggested that some
studies cited to show that TMDs are self limiting have major
methodological limitations, relying upon unvalidated and subjective
assessments of symptom levels. This research also outlines a procedure
for TMD practitioners to measure treatment efficacy and the relative
effectiveness of differing treatment modalities in a valid, consistent
and unbiased manner.
0886-9634/1701-030
The Journal of Craniomandibular Practice, Copyright © 1999 by Chroma, Inc.
Manuscript received August
14, 1998; revised manuscript received November 23, 1998; accepted
November 24, 1998.
Dr. Gerald B. Wexler received
his B.S.C. and D.D.S. degrees from McGill University, Montreal,
Quebec. He has been in private dental practice in Ottawa, Ontario
since 1970,and has been treating temporomandibular joint problems
since 1979. He is a fellow in the Academy of General Dentistry, a
member of the American Equilibration Society, and a member of the
American Academy of Orofacial Pain. He is consulting staff of the
Ottawa Civic Hospital Dental Department, where he directed operation
of the Temporomandibular Joint Treatment Clinic from 1984-1993.
Dr. Michael W. McKinney received M.A. and Ph.D. degrees
from the University of Maryland , Division of Behavioral and Social
Sciences, College Park, Maryland. He has been a full professor of
public administration and has taught graduate and undergraduate
courses in social science research methodology and applied statistics
at Georgia Tech University, North Carolina State University, and North
Carolina Central University. Dr. McKinney has been a Woodrow Wilson
Scholar and a visiting scholar at the University of North Carolina in
Chapel Hill. He is codeveloper of the TMJ Scale and is a regular
contributor to TMDiary. He is currently vice president of Pain
Resource Center Inc.