Forty years ago, temporomandibular joint dysfunction was generally treated by grinding the teeth or equilibration, to give it its technical name. The goal was to have the teeth interdigitate evenly when the mandible was closed and then have the cusps of the maxillary and mandibular teeth guide the movements of the mandible. Starting in the late seventies the work of several dentists including Farrar, Gelb, Slavicek and Stack, among others, resulted in a shift of interest to the temporomandibular joints, with consideration of both their intracapsular and extracapsular structures and behavior. Suitable instruments were developed to measure and record joint vibrations, position and movement of the mandibular condyles and particularly the behaviour of the muscles involved. Specialised radiographic techniques are now available to allow more detailed joint analysis. More recently there has been growing interest in sleep apnoea and how this relates to TMJ dysfunction.
All these innovations have helped in our understanding but the focus has been mainly on the mechanics of the joints. The position of the mandibular condyles within the fossae, the position and condition of the articular discs, the state of the joint capsule and ligaments, the level of activity of the masticatory muscles etc. are important but are only part of the story. Adaptation of the glenoid fossae, the formation of the posterior cranial structures, head position relative to the body etc. are equally as important. Somehow we have to incorporate these factors into our thinking. Osteopathic evaluation of the cranium has proved to be a useful and practical way to do this. It also puts the whole joint question into proper perspective. Much of the apparent complexity and mystery about TMJ dysfunction disappears when seen from a different viewpoint.
