Sir, have you ever heard or seen something that had such a profound effect on you, that you could no longer ignore it? Such an event happened to me over 20 years ago during a one-day seminar on functional jaw orthopaedics. As the last lecturer took to the podium for his 60 minute presentation, I could only think of slipping out quietly and heading for the nearest pub! I am so glad I didn't. His first slide was of an Etruscan mummy depicting severe facial pain; the next was of a patient who was in such pain she could hardly open her mouth. The audience was asked, 'would you want to treat this patient orthodontically? Why would you? Surely it would make better sense to relieve the patient's pain and restore normal mouth opening prior to any orthodontic treatment?'

That lecture changed my entire attitude to orthodontics and from that moment on I was determined to learn as much as I could about temporomandibular joint dysfunction (TMJD). All the years of undergraduate and postgraduate training in orthodontics now gave me a new purpose. It made me realise that orthodontics was a means to an end and not the end in itself. In other words, why undertake treatment on dysfunctional joints with internal derangement? Why then is TMJ function so important, or is it? Part of the answer depends on what extent a practitioner looks for the signs and symptoms attributable to TMJD, which include facial pain, limited mouth opening, ear pain, ear fullness, head pain, pain on chewing; amongst others. Just as a periodontal probe is an absolute necessity for a complete examination for periodontal disease, so the mm ruler is an absolute necessity in the complete examination of a patient for possible TMJD.

The range of motion of a joint is basic information for any patient with a joint disorder. The only way a clinical dentist can exclude him/herself from examining for TMJD is NOT to examine patients.

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