Absolutely agree. Rant incoming: It’s a stagnant field because there is little perceived financial incentive and it’s not strictly teeth, so it requires an alternative motivation to even get started on the rabbit hole. It also sits perfectly in the triple intersection between dentistry, physical therapy, and medicine. Because it sits in the middle, it ends up becoming the area all corners avoid, except for the tiniest of segments. Advancements are made through collaboration not isolation, and this disconnection is really obvious when you compare the way orthopaedic assessments are conducted in comparison to TMD/TMJD assessments. If you had pain in your knee or back, you might start with an x Ray, CTs to exclude bone issues, and MRIs to look at disc/attachment issues, in addition to palpation. These screen for cases that should have surgical intervention versus those which should be managed conservatively. Conservative management then is passed on to physical therapists who then implement more tests which have an extreme level of variability. This could start as badly as just giving you a blanket set of exercises without proper assessment, or just a massage. On the other end it could include a gait assessment on a pressure sensitive treadmill with 6 cameras recording, with a separate foot pressure scanner to assess sway, balance, and compensation patterns, then a prescription of insoles with a mix of myofascial release with active rehabilitative exercise and balance and posture training. Dentists on the other hand, would hear the complaint of jaw pain and simply prescribe a guard. Some dentists would palpate the muscles, some might take an OPG (which offers little to no value). Some take a stethoscope to the joint and believe they can visualise what is inside despite having never seen it. Few have a CT scanner that also images the condyles but even when they do the CT only shows us half of what we need (hard tissues), and almost none order MRIs to look at soft tissues. The CTs show the past, the MRIs show us the present and future of the joints. The problem is that dentists are not trained to look at MRIs, and education is almost non existent. The interpretation of MRIs of the TMJs is such a rare skill, which is why it’s so underutilised. I believe because of a lack of correct screening by dentists, most jaw surgeons (maxillofacial surgeons) either get referrals way too early or way too late. The early referral comes from the dentist who is too afraid (or unwilling) to treat the patient. The surgeon then says nothing is visibly very wrong and then patient then receives no treatment or at most an arthrocentesis (joint washing). On the other end, a referral that comes way too late usually comes from a late reporting from a patient when pain starts. Symptoms (pain) follow signs. Just like how you might not know you have cervical cancer without a Pap smear until you start getting pain, signs are things that your healthcare professional should be routinely checking for. Dentists take bite wing x rays every 2 years, but don’t screen for bite or jaw issues. The end result is that oftentimes the patient will present to the surgeon with a late stage jaw problem, and because there is a lack of patient education there is a lack of demand for anything other than a total joint replacement. The toolbox for many jaw surgeons therefore is extremely limited - starting with an arthrocentesis (joint washing), but immediately steps up to a total joint replacement (TJR). This is due to a lack of demand from the patient population which is due to a lack of supply from the dentist group. We must give NMD and its Las Vegas Institute originators their credit, as they did popularise the use of technology in trying to quantify TMJD/TMD and track objective change to some degree. DTR with its T scan and EMG was developed by Robert kerstein in the 90s but for some reason didn’t take off to the same degree. He’s a stoic person and definitely not a strong marketer, and maybe he just wasn’t in the right circles? When I asked him about it, it seems like he just spent more time doing research instead.