TMDs: an evidence-based approach to diagnosis and treatment

  • D. M. Laskin,
  • C. S. Greene &
  • W. L. Hylander
UK: Quintessence price £93.00, pp 560 ISBN 0867154470 | ISBN: 0-867-15447-0

This book is brimming with much of the newest, relevant research information on 'TMDs'. The series was established in 1951 when Sarnat published the symposia and lectures given by some of the pioneers of that time at the University of Illinois. Subsequently, new editions have been published at lengthy intervals but now we have the latest edition. The contributor list is impressive with chapters from well known researcher-clinicians who have noteworthy expertise in their particular subjects. The authors mostly (it must be said) are based in the US and Canada but there is also strong European input with contributions from Scandinavia, the Netherlands and Switzerland. The many subject areas which impinge and relate to TMDs (and help make up the important 'bigger picture' of these conditions with regard to, for example, musculoskeletal and chronic pain conditions) are well represented. There are contributions from biomedical and oral medical scientists; oral and maxillofacial surgeons; pain clinicians; prosthodontists; restorative dentists and radiologists. Furthermore, several share links with behavioural science and psychiatry departments. There can be little doubt then that the book aims to give comprehensive and current coverage of this large topic.

So, does it deliver? By-and-large, the answer is yes on both counts. This is clearly an ambitious text and it is has no intention of going over all the old ground of the numerous controversies in detail. Instead, it assumes some prior knowledge and aims to run with the 'new' approach of placing these conditions into the wider framework of medicine overall. It highlights how innovative work in other, often closely linked conditions has relevance. For example, by showing up flaws in previous work it can open up new, more valuable avenues for research and ultimately treatment than might otherwise be the case if seen only from a 'dental' perspective. However, not everything that is new is classed as good simply because it's new. To give just one example, in chapter 11, in discussing the role of cytokines and inflammatory mediators in certain TMDs, the author explains how some studies on this topic still need to improve by having much better controls.

The book is also logically laid out so in Part I (Biologic Basis) the first chapters deal with anatomy and function while later chapters deal with the pathophysiology of TMDs. In Part II, clinical management is discussed including diagnostic modalities and later chapters deal with therapeutic modalities (including pharmacologic approaches, biobehavioural therapy, physical medicine, management of the occlusion, and oral appliances). The final chapters investigate evidence-based treatment for the various conditions.

So, overall, it was refreshing to find 'beliefs' replaced with a far more questioning and sceptical approach to the evidence that's out there and the authors generally highlighted where evidence is dubious or missing. I would strongly recommend this book for any postgraduate or any clinician who has an interest in TMDs and at any stage in their careers. While it would be hard work for undergraduates to get through alone, it would nevertheless be an invaluable reference text if used carefully and with support from their teachers.