Before discussing condylar (a)symmetry, “to be or not to be” my opinion is that in the examination and treatment of orofacial pain the initial step must be to distinguish between a neurological origin of pain versus a functional origin of pain i.e. a functionally induced facial pain.
As dentists and as clinicians we should stay away from the neurological pain. Our education has not given us the information that will make us capable in pin-pointing a neurological diagnosis. We are supposed to know how to examine,to diagnose and to treat the stomatognathic system. Diagnostics and treatment of neurological origin of pain belongs in the field of pharmacology or in the field of neurosurgery.The functional origin of pain in the stomatognathic system can successfully be dealt with in the fields of dentistry,physical therapy and sometimes psychology.
When treating the functionally induced facial pain the function that causes the pain needs to be changed. Besides, a functional change is also a reversible change.When the initially adequate information to the patient and the following reversible approach result in a reduction of pain we are heading in the right direction.When the proper function is normalized the pain remains reduced or sometimes it is even completely gone. Not until the pain is at the 0-level for at least 4-6 months permanent treatment should be concidered if necessary. Very often, when the pain is gone, the function of the stomatognathic system has returned to its normal conditions. The patient has benefited from the nature of adaptation. However, there are also patients who need additional dentistry, some of them even full mouth rehabilitation. Thus, dentistry plays an important role in the maintenance of restored function.
In restoring function the clinicians need to look out for mandibular/ VERTICAL temporomandibular joint (tmj) CONDYLAR (A)SYMMETRY. To focus the vertical condylar (a)symmetry in the clinical approach or management of a craniomandibular disorder / temporomandibular disorder ( CMD / TMD ) is in my opinion a must. It is also my opinion that, if there was not an asymmetrical function or in other words, if there was not one side of the bilateral stomatognathic system that constantly was too much or too little used, there would hardly be any patients with functionally induced pain, except the ones who are bruxing their teeth in an abused protrusion.Therefore, when it concerns the clinical diagnostics of the masticatory muscles and the temporomandibular joints, LOOK FOR ASYMMETRY! When it later concerns the management and treatment of the same muscles and joints ,GIVE PRIORITY TO SYMMETRY!