Sir, I read the letter Lack of TMJ knowledge (BDJ 2013; 215: 443) with interest. I completely agree that teaching in diagnosis and management of temporomandibular disorders is sadly lacking in undergraduate teaching and also with the sentiment that 'examination, knowledge and pathology is not well understood and more training ... is warranted'. I do, however, have some issues with the emphasis of the letter. When addressing the issue as a 'Lack of TMJ knowledge' this excludes the implication of the mandibular muscles and the occlusion which are the other two parts of the trilogy. The term temporomandibular disorders (TMD) is a better generic term which involves the articulatory system, not just the joints (TMJ). This letter is written from a surgeon's viewpoint and I feel general practitioners must remain aware that the treatment of TMD falls into a conservative, not surgical, regime. Surgical intervention is necessary in less than 1% of all TMD patients seen on a clinic dedicated to the management of 'TMD' patients who are secondary or tertiary referrals therefore the incidence in general practice of such a necessity is remote. I agree, however, that practitioners should always be aware of the place surgery has to offer in the rare instances it is required. The Cochrane analysis that the author refers to did not include soft splints in its consideration. This therefore does not give justification for suggesting that the soft vacuum formed splint provides a 'good alternative' to a splint specifically designed for an individual patient's needs. It does not.

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