can always be provoked by orthopedic tests. It is of utmost importance to distinguish between a mainly arthrogenous origin of pain ( dynamic pain dominant ) versus a mainly myogenous origin of pain ( static pain dominant ) at every visit as the origin of pain may change during time of treatment. The two different origins of pain demand completely different approaches from a clinical / therapeutical point of view. If a change in origin of pain is not being addressed or taken into account by the dentist i.e. the dentist does not change his/her initial mind set to treatment, the management / treatment of the functional pain is doomed to fail. This might be the reason why so many patients with CMD /TMD become chronic victims of too many unsuccessful procedures, unnecessary expenses and not to say oral invalidity that detrimentally affects their quality of life.
In the above mentioned perspective I once and for all would like to express my serious concern regarding the use of the world wide recommended diagnostic indices to be used in the individual patient in the clinical situation. Indices may serve in an epidemiological study, but in my opnion they are without any value in the clinical evaluation of the single patient. It is also my opinion that the use of these indices in many clinical studies is one reason why the outcome of dental treatment has not shown any permanent success. However, in A 5-Year Follw-Up of Temporomandibular Disorder Treatment Emphasizing Condylar Asymmetry (Cranio ,October 2006,vol.24.no 4,pp 265-273 ) of our patients in T.A.C. Seriate,Italy we used the orthopedic tests to initially distinguish the origin of pain. We were able to show that our dental treatment was successfull . The results were permanently stable. The patients showed an increase in mouth opening and a significant decrease of dynamic and static pain. The patients also showed a permanent reduction of their initial facial pain. The patients with a condylar asymmetry> 10% and who underwent dental treatment aiming at permanent oral stability, showed the greatest improvement.