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October 18, 1976

"The Great Imposter"

Author Affiliations

National Academy of Sciences Washington, DC

JAMA. 1976;236(16):1846. doi:10.1001/jama.1976.03270170012011

To the Editor.—  "The Great Imposter: Diseases of the Temporomandibular Joint" (235:2395, 1976) is timely but misnamed, alerting the medical profession to a problem long controversial in dentistry.As Dr Morgan indicated, "most people with this problem suffer from myofascial pain-dysfunction [MPD] syndrome primarily as a muscle problem." The "problem" is apparent shortening and an increased stretch reflex of the muscles of mastication, referring pain into the joint. "Diseases of the temporomandibular joint" is therefore a misnomer.The apparent shortening of the masticatory muscles is brought on by clenching the jaws and grinding the teeth (bruxism) precipitated by anxiety, and even more by frustration. The solution is to relieve the "spasm," as Dr Morgan indicated (moist heat, soft diet, muscle relaxants, dental splints), and then to treat the anxieties underlying the jaw-clenching.Dr Janet Travell is the nation's expert in the etiology and treatment of MPD syndrome. Her classic articles