In August 2010 was an editorial submission written by Dr. Charles S. Greene’s entitled “Diagnosis and treatment of temporomandibular disorders: emergence of a new care guidelines statement” to the journal of Oral Surgery, Oral Medicine, Oral Pathology , Oral Radiology and Endodontology and also presented to the International Association for Dental Research/American Association for Dental Research Guidelines for the treatment of TMD. In a follow up publication in the Journal of the American Dental Association (JADA) Greene’s publication presented another differing explanation for these new guideline standards with unsubstantiate claims as a self appointed authority sending red flag alerts once again to the dental profession of these unscrupulous anti-electro-diagnostic instrumentation politics disguised as good science. These political maneuvers do not go unnoticed and make claims far from the truth.
These anti-instrumentation academics of 1988 have once again reared their heads to try to strategically positioned themselves within the ADA and JADA’s editorial board to continue their rejected position by the ADA Council on Scientific Affairs to taint, infiltrate and over turn what history has already clarified with the highest level of scrutiny the voluminous review of the scientific literature supporting the efficacy of surface EMG, computerized jaw tracking and low frequency TENS for diagnosis and treatment of TMD. After unprecedented scientific scrutiny these devices have been awarded the ADA Council on Scientific Affairs Seal of Acceptance in 1986. (The ADA’s Seal on the Myotronics equipment continues to be recognized in good standing to the present).
Diagnostic Controvesy – Is Electronic Diagnostic Devices Scientific and Valid?
What is at the core of all this controversy of diagnostics is the use of various electronic diagnostic devices, such as electromyography, jaw trackers, and joint sound recorders which according to these self appointed experts as failing to meet standards of reliabilty, validity, sensitivity and specificity. What most readers don’t realize is that these anti-instrumentation advocates have once again tried to reset FDA and ADA precedents which were clearly established years prior substantiating with clear and overwhelming scientific evidence that neuromuscular electro-diagnostic instrumentation was in fact specific, reliable and accurate in their claims. What was at stake once again was a self serving attempt to enforce and infringe on the scientific, intellectual and professional freedom of all dentist to perform the best dentistry possible by a few who want to control the TMD orofacial pain arena with their agenda.
TMD/ Orofacial Pain Politics – Attempts to Pressure the ADA Behind the Scenes
Why would the American Dental Association (ADA) reverse their decision after all these years and contribute to a repeated re-run of Dr. Greene’s predecessors failed history to disparage and distort the fact that these devices have scientific evidence to validate their effectiveness in diagnosis and treatment of TMD beyond any methodologies, protocols and devices reviewed in history? Dr. Greene, his colleageus must be held to the same standards of scientific scrutiny if their psychosocial model is to be accepted as the “Standard of Care” and published to influence our dental profession with an agenda that has not been accountable as to the diagnosis and treatment of TMD. History has exposed a small group from the American Academy of Orofacial Pain (AAOP) who began to put political pressure on the ADA to rescind its seal for the instrumentation. Dr. Norman Mohl years prior was chosen to evaluate these devices for safety and efficacy. His 1988 draft claimed that none of these devices “have the scientific evidence required for their recommendations.” Myotronics submitted an extensive review of literature and supporting documentation to the contrary demonstrating efficacy of its technology. After extensive investigation by the ADA, Myotronics devices were awarded the ADA council on Scientific Affairs Seal of Acceptance. The Mohl Draft report was exposed as a political attack, not an unbiased scientific assessment. The Mohl Draft was rejected by the ADA Council on Scientific Affairs and designated “Draft Only, Not to be Referenced. ” However, the Mohl Draft Status Report appeared once again in some referenced journals over the years, primarlily written my Mohl himself and Dr. Lund.
Anti-NM Instrumentation Proceedings to Subvert the FDA
After their ADA defeat, the anti-instrumentation group improperly and illegally manipulated the regulatory process of the U.S. Government by subverting FDA employees between 1991 and 1994 to use the regulatory process to do what had previously failed through the scientific enquiry at the ADA. According to a 1997 Congressional Panel Investigation conducted by the Office of Inspector General investigating the FDA’s misconduct, Dr. Charles Greene and Dr. Norman Mohl arranged and participated in a nonpublic meeting with the FDA officials in April 1994 to present the views of the IADR, regarding the”potential dangers” and “most important public health issues” of jaw tracking, EMG and joints sound recording devices.
Failing to achieve their political agenda through the American Dental Association, the anti-instrumentation group resorted to improper and illegal distortion of the regulatory process at the FDA level with Dr. Norman Mohl appointed as the panel’s FDA consultant and Charles Bertolami, the former competitor of Myotornics who brought an unsuccessful lawsuit against the company was appointed as chairman, culminating in “rigging” of the October 1994 FDA Dental Advisory Panel convened to classify muscle monitoring devices to a “low” priority for classification by the agency – just the opposite of what a corrupted session of that same panel decided in 1994 in a proceeding so tained that CDRH Office of Device Evaluation director Susan Alpert later had to officially “vacate” it, setting in motion an internal review – and tightening – of panel management.
“Monitor Maker is Changing FDA Ways”
This appeared to put NMD to an end, but a Congressional hearing and an FDA Office of Internal Affairs inquiry, the U.S. House Commerce Oversight Committee and the U.S. Department of Health and Human Services Inspector General exposed the anti-instrumentation group subverting of FDA employees to destroy the manufacturers of neuromuscular instrumentation. Dickenson’s FDA Review in an article entitled, “Monitor Maker is Changing FDA Ways” wrote: “His medical devices [Jankelson brother's Roland and Robert] are not , as the Act puts in, “intended to affect the structrure or any function of the body”. “But after nearly three years of battling FDA, the dental muscle monitors made by [Myotronics, Inc] have already affected the “structure and function” of the FDA body politic – at least with respect to its administration of advisory panels.” The deceitful rigging of the panel was exposed by placing three well known opponents of the Myotronics technology, who had earlier fought unsuccessfully to get the American Dental Association to rescind its approval seals for the firms’ products.
Scientific Truth Prevails – Subverting the Review Process by Deliberately Retarding NM Instrumentation
Three years ago, as the Jankelsons tell it, the panel was under the thrall of a minority clique in orthodontic academia that opposes the therapy techniques that muscle monitors assist. It voted to classify the monitors into FDA’s most stringent regulatory level – Class III.” The clique, which advocates psychometric methods of treating pain caused by temporomandibular joint (TMJ) and related myofacial pain, dysfunction, not only turned the panel meeting into a kangaroo court, but months earlier had allegedly reached inside the Division of General and Restorative Devices at FDA’s Center for Devices and Radiological Health (CDRH) to sway FDA staff against the technology represented in Myo-tronics’ products. The way the Jankelsons tell it, the clique’s professional organiziation, the American Dental Association of Dental Research, and individual members convinced the CDRH division’s lead reviewer of the Myo-tronics products, Dr. Gregory Singleton, of the merits of their philosophy, and he in turned enlisted the aid of the FDA Seattle District officials in CDRH. Far short of bribery, what is similar about the Myo-tronics case – and perhaps about several other device cases is that individual FDA employees and/or “special government employees” working for FDA on advisory panels were accused of subverting the review process by deliberately retarding a disfavored company’s product.”
Read more on the Neuromuscular Battle against the Anti-Instrumentation Psychosocial TMJ Group – Ragging Battles and Rigged Panels
The Jury Is In…
“In Myo-tronics’ case, a “jury” of sorts is “in” and the lessons are accessible to those willing to dig through the Freedom of Information Act process….” “The “jury” was a reassuringly competent report by the Office of the Inspector General in FDA’s parent Department of health and Human Services. It found that reviewer Singlton concealed documents, another Dental Products Advisory Panel executive secretary C. Tylenda was unable to account for confidential materials distributed to panel members, following a complaint that one of its documents were leaked to a panel member who used it to denigrate Myo-tronics devices: as a result, the compromised panel voted to place the devices in Class III. In addition, the chairman Bertolami after being exposed, voluntarily vacated his office and the probe resulted in discipline and dismissal of these FDA employees, including the author of the 1988 ADA Draft Status Report.
For several years since the mid 1990′s, the American Academy of Orofacial Pain and later the American Academy of Craniofacial Pain, continue to submit application for specialty status for orofacial pain with the ADA. Each year it is denied. Their application purposely excludes NM instrumentation from their list of procedures acceptable for the use in diagnosis and treatment of TMD/orofacial pain. It becomes apparent to their agenda. If this specialty would be accepted, clinicians using instrumentation and protocols would be isolated politically by a small group who want to dictate their elite ruling of Orofacial pain psychosocial philosophy of diagnosis and treatment to the greater patient community.
Do You See the Pattern? – Ignoring the Scientific Evidence
The examination of these articles shows a pattern of these authors who continue to claim having the best and latest evidence on the subject. In fact, Dr. Greene and his cohorts attempt to game the system by positioning themselves as self appointed judge and jury to what is acceptable evidence while consistently purposely ignoring the mountainous levels of evidence supporting NMD and its instrumentation. Dr. Greene’s false and seriously biased misleading and opinionated statement which stated, “In addition, it has become accepted widely among pain experts in the medical and dental professions that these types of pain conditions must be managed within a biopsychosocial framework, in which behavioral approaches supplement conservative medical care” is so far removed from the truth and reality of matter.
Not all pain experts widely agree with Dr. Greene’s position, in fact this is purposeful disregard for the fact that the majority of pain experts belong to the American Alliance of TMD Organization a larger group comprising of 9 organizations national and state groups with TMD treatment interests formed in opposition to the TMD/orofacial pain specialty application initiatives. They recognize that a patho-bio-physiologic/ neuromuscular/occlusal model is an effective and reasonable approach to manage the TMD pain conditions.
The American Alliance of TMD Organizations is comprised of the following 9 organizations:
• The American Academy of Gnathological Orthopedics
• The American Academy of Pain Management
• The American Association of Functional Orthodontics
• The American College of Prosthodontics
• The American Equilibration Society
• The American Prosthodontic Society
• The American Society of Temporomandibular Joint Surgeons
• The International College of Cranio-Mandibular Orthopedics
• The Society of Occlusal Studies
These 9 organizations oppose the psychosocial model that Dr. Greene and his associates are advocating as a Standard of Care. Dr. Greene and his coharts of psychosocialists do not align with the perspectives of these ADA recognized organizations and TMD experts. Vigilance is always necessary if professional freedom is to continue. Political underpinings continue with this small group who house themselves under the Academy of Orofacial Pain organization who deny occlusal causality for TMD. They attempt to posture TMD as a psychosocial disease caused by emotional stressors. The 1996 National Institute of Dental Research Consensus Conference clearly defined the biomechanical versus the psychosocial paradigm schism.
Neuromuscular Instrumentation – Advances TMD and TMJ in the 20th Century
Clinicians continue to learn and discover new and advanced techniques using neuromuscular instrumentation. They continue to seek advanced training from centers at Occlusion Connections where they recieve a balanced training of both gnathological concepts as well as neuromuscular teachings to better manage the more complex TMD paining patients. Dentists and their patients will continue to seek advanced clinicians who are willing to think outside the box in providing their patients the best care possible using neuromuscular electro-diagnostic technologies that are safe and make scientific and physiologic sense in years to come.
Does our profession hear the out cries of those suffering TMD paining patients who continue to become the waist heap of undesirables of failed psychosocial TMD model of diagnosis and treatment?
Dr. Clayton A. Chan is considered by many to be the authority on Neuromuscular Occlusion and its application to Clinical Dentistry. His training training and experience as a dental laboratory technician, along with training in the areas of Gnathologics, TMD, Orthodontics and Neuromuscular Occlusion, has helped him convey a unique three-fold clinical message to thousands of dentists, specialists and dental leaders nationally and internationally.
Dr. Chan is noted for his foundational concepts in Dental Occlusion, Bite Management and Bite Transfer techniques, applying both the Gnathological principles with the fundamentals of Neuromuscular Dentistry. He is the author of many articles on Neuromuscular Dentistry and Dental Occlusion. As former Director of Neuromuscular Dentistry at the Las Vegas Institute (2001-2006), he developed Neuromuscular Occlusion programs with his mentors, Dr. Robert Jankelson and Dr. James Garry. Dr. Chan is the Founder of Occlusion Connections, holds Mastership status with the International College of Craniomandibular Orthopaedics, is a founding member of the Appliance Therapy Group and a member of several other dental organizations.
Dr. Chan’s unrivaled expertise and experience have been acknowledged by other dentists who seek him out for help and guidance in Neuromuscular Occlusion and its application in Clinical Dentistry.