Reevaluating the Management of Chronic Temporomandibular Pain Are We Treating PTSD with Debridement and Lavage?

ton VA Medical Center, Houston, TX published findings from their randomized, controlled trial demonstrating that sham arthroscopic surgery is as effective as arthroscopic lavage or arthroscopic debridement in treating osteoarthritis of the knee.1 According to the researchers, the cost of such surgeries exceeds $3 billion a year in the United States alone.1 Beyond the specific implications for patients with osteoarthritis of the knee, these findings highlight the importance of maintaining an ongoing dialogue between research and clinical practice in order to control health care costs and improve the health of both veterans and the general civilian population. We believe such an evidencebased approach is needed in another area of health care: the management of temporomandibular disorders (TMDs). Although it’s likely that TMDs rarely are inquired about or addressed by primary care physicians, these chronic pain disorders are second only to odontalgia (tooth or periodontal pain) as the most common problem patients report to their dentists.2 In our experience, they are extremely common in both active-duty military personnel and veterans with posttraumatic stress disorder (PTSD)—especially the latter. According to a National Institutes of Health (NIH) Technology Assessment Conference Statement, however, no data from randomized clinical trials support any of the current dental interventions for TMDs.3 While the overall cost of craniomaxillofacial and orthodontic procedures used to treat or prevent TMDs in the United States is unknown, it may well approach those for arthroscopic debridement and lavage of the osteoarthritic knee. In this article, we suggest that the current prevailing approaches to TMD treatment may be misguided. To achieve optimal treatment, it may be necessary to change the way we view these disorders. In the following brief review, we endeavor to establish the need for more clinical research in this area in order to validate the emerging theories we present here and to translate them into practical clinical advice.