Time to Eliminate the Third Pathway

As many readers of TMJ News Bites already know from personal experience, the TMJ field is complicated by having so many diverse concepts of diagnosis, etiology, and treatment. As a result, it is difficult for a patient who maybe having a temporomandibular problem to find care – and to avoid the harmful procedures that are often recommended and carried out.

Dr. Charles S. Greene has provided TMJ News Bites with a brief summary of a paper titled, Treating Temporomandibular Disorders in the 21st Century: Can We Finally Eliminate the “Third Pathway”?, which he recently co-authored with Professor Daniele Manfredini. The authors point out that the general management of joint and muscle problems by the medical orthopedic profession is based on a “Two-Track” system of medical and/or surgical treatments. However, those doctors generally do not get involved with TMJ patients and instead refer them to dentists, based on the assumption that a “Third Pathway” exists which only dentists can provide. That third pathway is the authors’ name for the mechanistic concepts of jaw malalignment, bad bites, temporomandibular joint malpositions, and similar ideas that have been the main focus of the TMJ field throughout most of the 20th century. Obviously, those concepts usually require irreversible dental procedures such as jaw repositioning, orthodontics, and various bite-changing procedures as the main forms of corrective treatment.

However, as the title implies, the 21st century thinking in this field has changed dramatically as a result of over 50 years of basic science and clinical research. Most of the elements of the “Third Pathway” have been discredited, and the expert community within the TMJ field has adopted a more conservative model for diagnosis and treatment of TMJ problems. This model is a combination of the traditional orthopedic medical-surgical model, carried out within a biopsychosocial treatment framework that recognizes the pain and suffering of having chronic facial pain. Therefore, the authors conclude that the “Third Pathway” is an artificial creation that originated many years ago within the dental profession, and it is time to eliminate that pathway from the dental profession.

Reference: Greene CS, Manfredini D. Treating Temporomandibular Disorders in the 21st Century: Can We Finally Eliminate the “Third Pathway”? J Oral Facial Pain Headache. 2020 Summer;34(3):206-216. doi: 10.11607/ofph.2608. PMID: 32870949

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