{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T09:48:46Z","timestamp":1791625726020,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Oral Rehabilitation"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diagnostic errors in temporomandibular disorders (TMDs) contribute to unnecessary procedures and avoidable patient mismanagement despite advances in pain science, diagnostic classification systems, and evidence\u2010based care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To conduct a narrative review and present a dynamic, five\u2010domain framework explaining how diagnostic uncertainty interacts with educational, cognitive, systemic, and ethical factors to produce iatrogenic overtreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Searches of PubMed, Scopus, Web of Science, and Google Scholar (inception to April 2026) identified literature on TMD diagnosis, clinical reasoning, dental education, health system organization, and bioethics. Concepts were synthesized into interacting thematic domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five dynamic, interacting domains were identified: (1) Educational Deficits, (2) Structural Reductionism, (3) Occlusal Overinterpretation, (4) System Fragmentation, and (5) Ethical Dissonance. The model demonstrates how educational gaps foster reductionist diagnostic paradigms, which are amplified by health\u2010system silos and defensive clinical practices, increasing the likelihood of non\u2010indicated, irreversible interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Five\u2010Domain Framework offers a systemic model for understanding diagnostic breakdown in TMD management, providing a structured foundation for educational reform, integrated care pathways, and future empirical research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joor.70294","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:10:18Z","timestamp":1787793018000},"page":"2190-2197","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding Diagnostic Failure in Temporomandibular Disorders: A Narrative Synthesis of Evidence and Five\u2010Domain Framework for Iatrogenic Mismanagement"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4784-3120","authenticated-orcid":false,"given":"Bernardo Correia","family":"Lima","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Prosthesis and Traumatology University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayan Eboli","family":"Fortunato","sequence":"additional","affiliation":[{"name":"Post Graduate Program, Department of Orofacial Pain Arthur S\u00e1 Earp Neto University  Petr\u00f3polis Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3857-0522","authenticated-orcid":false,"given":"Leonardo Br\u00edgido Metello","family":"Neves","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Prosthesis and Traumatology University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8096-738X","authenticated-orcid":false,"given":"Ricardo","family":"Grillo","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Prosthesis and Traumatology University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-4418","authenticated-orcid":false,"given":"Mariana Aparedida","family":"Brozoski","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Prosthesis and Traumatology University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Melhem\u2010Elias","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Prosthesis and Traumatology University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1814-9343","authenticated-orcid":false,"given":"Janey","family":"Prodoehl","sequence":"additional","affiliation":[{"name":"Physical Therapy Program and College of Dental Medicine\u2010Illinois Midwestern University  Downers Grove Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis G.","family":"Mercuri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_16_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102419893823"},{"key":"e_1_2_16_3_1","volume-title":"Temporomandibular Disorders: Priorities for Research and Care","author":"National Academies of Sciences, 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