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<p>Bertrand, DC, USN, Captain John F. Johnson, DC, USN,<br>and Captain A. Dale Ehrlich, DC, USN<br><br>Introduction<br>The purpose of this clinical update is to explain the evolution of Orofacial Pain as a discipline from the dental profession’s tradi-tional concepts of temporomandibular disorders (TMDs) and to discuss its current status within Navy healthcare. A future clinical update will discuss the most contemporary diagnostic and management paradigms.<br><br>Background<br>Dentistry assumed the primary role for treating patients with pain in the region of the temporomandibular joint (TMJ) based upon an article published in 1934 by Dr. James Costen, an otolaryngologist. After presenting eleven anecdotal case reports, Costen theorized that “abnormal pressure” on the TMJ due to occlusal deficiencies from ill-fitting dentures was a frequent cause of periauricular pain and headache. Despite its limitations, the Costen paper was widely accepted and prompted the dental and medical professions to apply traditional dental principles to the diagnosis and management of periauricular pain and headache.<br><br>Over the ensuing years, numerous contradictory and sometimes injurious therapies have been employed in the treatment of TMDs. As a result of extensive patient suffering following several methods of treatment, and bitter controversies swirling be-tween and within various healthcare professions, the National Institutes of Health (NIH) convened a Consensus Conference in May 1996. At its conclusion, the conference panel summarized that the etiology, scope of symptoms, and effective treatment for TMDs had not yet been demonstrated. Now, nearly 6 years later, still no universally accepted concept that explains the pathophysiology of TMDs has been recognized.
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<br>Subjects: Temporomandibular Joint Disorders ; pain</div>
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U.S. Navy. Naval Postgraduate Dental School</div>
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