Management of Temporomandibular Joint Degenerative Diseases

It is fashionable in professional circles to deplore the difficulty of intellectual discourse between "academicians" - men of letters, researchers, rationalist- and "practitioners" - surgeons, radiologists, physical therapists. How benefi­ cial it would be if educated non-academicians could speak intelligently about t-tests and chi-square tests and men of academia could appreciate the travail, spirit, and needs of a busy office and practice! Even this suspected gap between "two cultures" came very near together in the wonderful town of Groningen (The Netherlands) as wise men from both practice and scholarship gathered to talk about the unfathomables of the temporomandibular joint. There were keen discussions about the intense bio­ logical changes which occur about the complex temporomandibular joint after excessive use or injury. These papers were followed by talks outlining the experiences of those involved in the imaging and non-surgical and surgical management of patients who were enduring such changes. The pitch and interchange of opinions and evidence as to why a disc or its position could effect little or profound disturbance of the temporomandibular apparatus were en­ lightening to each who listened - and thought. And even more sobering was to hear the report of a well-documented, multiple decades long study of a large number of patients with osteoarthrosis and internal derangement which defined a natural course and eventual end of the disease. With this understanding, one is now faced with the obvious question of how much treatment patients with osteoarthrosis really require.