The term temporomandibular disorder (TMD) encompasses pain in the head and face, a condition which can be highly distressing and disabling for the patient. As clinicians, we should focus our attention on the therapeutic approaches than can help those patients. It is increasingly clear that the value of manual therapy, exercise, and needling therapies can be understood through the emerging concepts of pain neuroscience, and that all these interventions come together in a biopsychosocial model. In fact, manual therapy and exercise is probably the therapeutic combination most commonly used by many health care professionals for treating patients with chronic pain. Today, it is universally accepted that the central nervous system plays a critical role in the personal experience and clinical presentation of pain, and that manual therapy, exercise or needling therapies trigger peripheral and central nervous system responses. It was against this background of a growth in understanding of mechanisms that we were inspired to bring together a wide range of contributors from all over the world to provide a comprehensive and practical account of the diverse approaches to assessing and treating TMDs.
In conceiving and editing this book we have adopted the evidence and clinically informed paradigm. We believe that a combination of evidence and clinical experience should guide all clinicians in the management of individuals with chronic pain. The main feature of the evidence-based paradigm is that diagnosis and management should be guided mainly by the best available scientific evidence; however, the relevance of this doctrine can be limited since there is no good evidence for all intervention or diagnostic procedures that therapists use in daily practice. Although evidence-based practice is in continuous evolution, the evidence-informed paradigm is considered more appropriate since the clinician takes the best available scientific evidence and combines it with clinical experience while bearing in mind the patient’s expectations and beliefs.