Prof. Antoon DE LAAT , DDS, PhD is responsible for the Clinic for Temporomandibular Disorders and Orofacial Pain and for teaching oral physiology and pathophysiology at the Dept. Oral Health Sciences of the Catholic University Leuven, Belgium. His scientific work led to over 200 papers and abstracts. He lectured all over Europe, North and South-America, the Middle and Far East. Prof. De Laat was Associate Editor of the Journal of Orofacial Pain, the European Journal of Oral Sciences and the European Journal of Pain. He is Past-President of the IADR/Neuroscience group, the European Academy of Craniomandibular Disorders, the Belgian Pain Society, and founding Chair of the Special Interest Group on Orofacial Pain of the IASP. He is Curator of the Society of Oral Physiology and President of the Leuven Dental Alumni Society. His research interests are trigeminal neurophysiology, jaw reflexes, orofacial pain and quantitative sensory testing. In 2009, he received a doctorate honoris causa at the Aalborg University, Denmark. From 2011 to 2018, he was Chairman of the Dental Department of the Univ. Hospitals KU Leuven.
Several longitudinal studies on the natural course of temporomandibular disorders have illustrated the benign evolution of most symptoms of pain and dysfunction, even in case of irreversible mechanical problems likeanterior disk displacement without reduction. These results strengthen the general approach of a reversible, non-invasive and low-tech management. However, some questions remain,since prognosis might differ in view of an underlying systemic disease (e.g. rheumatoid arthritis) or in view of risk factors that might predispose to the development of chronic pain. Recent prospective studies like the OPPERA project shed more light on these risk factors that need to be taken into account for everynew patient. The opportunity to “filter out” patients that are more at risk to develop long standing problems will support a more optimal stratification of the management protocol.
In order to support the benign natural course, it is of the upmost importance to involve the patient in shared decision making, explaining the crucial role of the patient in supporting the healing process, fostering the therapeutic alliance and consequently solidifying the compliance. These factors, previously catalogued under “positive placebo effects” are progressively better understood as part of the physiology underlying pain perception and healing, and should therefore be considered significant active tools in the management of every patient.
- Manfredini D, Favero L., Gregorini G, Cocilovo F, Guarda-Nardini L.Natural course of temporomandibular disorders with low pain-related impairment: a 2-to 3-year follow-up study. J Oral Rehabil. 2013;40 : 436-442.
- Glerup M, Stoustrup P, Hauge L, Rypdal V, nordal E et al. Long-term outcomes of temporomandibular joints inJuvenile Idiopatihic Arthritis. J Rheumatol 2019; DOI 10.3899/jrheum.190231Litt MD, Porto FB. Determinants of pain treatment response and nonresponse: identification of TMD patient subgroups. J of Pain 2013; 14 : 1502-1513.
- Meloto CB, Slade GD, Lichtenwalter RN, Bair E, Rathnayaka N, Diatchenko L, Greenspan JD, Maixner W, Fillingim RB, Ohrbach R. Clinical predictors of persistent temporomandibular disorder in people with first-onset temporomandibular disorder. JADA 2019; 150 : 572-581.
- Clark J, Nijs J, Yeowell G, Goodwin PC. What are the predictors of altered central pain modulation in chronic musculoskeletal pain populations ? A systematic review. Pain Physician 2017; 20 : 487-500.
- Sanders C, Dougall AL, Haggard R, Buschang P, Karbowski S, Riggs R, Gatchel R. TMD diagnostic groups affect outcomes independently of treatment in patients at-risk for developing chronicity: a two-year follow-up study. J Oral Facial Pain Headache 2016; 30 : 187-202.
- Porporatti AL, Costa YM, Reus JC, Stuginski-Barbosa J, Conti PCR, Velly AM, De Luca Canto G. Placebo and nocebo response magnitude on temporomandibular disorder-related pain : a systematic review and meta-analysis. J Oral Rehabil 2019; 46 : 862-882.