Prevalent Philosophies of Treating TMJ

Educated guesses, subjective feelings and speculation does not produce effective, reliable, lasting results. Addressing the source of the problems rather than just treating the symptoms is crucial if one desires to reach maximal dental improvement.

Depending on the dentists “philosophy” of what TMD/orofacial pain is about, you will be diagnosed, provided answers and receive treatment based on either a bio-physiologic neuromuscular perspective or a bio-psychosocial perspective. Two different paths of focus with two different outcomes will result.

What path of treatment and care will you chose?

THREE (3) Areas that are Overlooked By Most When Treating TMD/TMJ (Myofacial Pain Dysfunction):

Structural imbalances
Biochemical/nutritional imbalances
Emotional/psychological imbalances

To date, there is no clear method that has been agreed upon regarding what is “TMJ” (more accurately recognized as TMD – temporomandibular joint dysfunction and its associated craniomandibular and neuro-muscular occlusal issues). Research has been promised, yet our patients who are suffering can’t wait any longer! There lives are at stake and they are looking for answers. Many of the dentists who are familiar with these conditions have discovered effective, objective means to treat the TMD patient, but researchers have not shown a willingness to work with the clinicians who actually contend with these problems daily.

Within the dental profession, there are two prominent philosophies and perspectives to addressing TMD:

A Word of Caution:

Total agreement as to conservative treatment and/or no surgery is to be applauded, but to exclude or limit proper and needful data gathering is certainly going to result in inaccuracies of treatment, diagnosis, increased treatment time, frustration and greater costs.

How can any qualified treating clinician (when treating TM Joint degeneration) be limited to diagnosing a joint disease condition from only a panoramic X-ray, which is merely a surveying film and not specific for the TM Joints? Obscure data and documentation will result in obscure and unpredicatable results!

Note: The NIDCR statement says not to use splints long-term, but criticizes the lack of long-term studies on effectiveness. These are contradictory statements.

Their position states one-sidedly “Research has disproved the popular belief that a bad bite or orthodontic braces and headgear can trigger TMJ”. To the contrary, research and documented clinical evidence has shown the opposite is true. Bad bites that are poorly misaligned can be contributory to masticatory dysfunction leading to intolerable muscle pain and discomfort which are components of TMD. Retractive orthodontics has been shown to lead to numerous signs and symptoms of TMD. These very same conditions have also been shown to be resolved with reversible splint therapy, as documented with tomography and ADA/FDA approved devices that objectively measure such conditions, before and after treatment.

The NIDCR publications states, “Irreversible treatments are of no proven value and may make the problem worse”. This is absolutely false and misleading. It causes the reader to believe that orthodontics to improve the bite or restorative dentistry using crown and bridge work to enhance the bite or occlusal adjustment (re-shaping teeth to bring the bite into balance) is impossible which totally undermines professional ethics.

Their perspective on intraoral splints is contradictory.

Many clinicians nationally who are well versed in treating TMD patients with either acute or chronic conditions have found orthodontic treatment, restorative therapy and/or occlusal adjustments to balance the bite excellent remedies after a thorough investigation and a reversible approach has been taken first. Only after all other conservative means have been exhausted, may the clinician implement these later methods for final stabilization of the TMD patient.

This is totally contrary to the pharmacological approach which seems to be endorsed in NIDCR publications. This supposed “quick-fix” approach fails to recognize the long-term, irreversible, pathologic state medications and drug addiction leaves a chronic, paining, TMD-suffering patient with no final resolution, but rather long term drug/ medication dependency and pain.

For the NIDCR publication to make a blanket statement such as, “Avoid treatments that cause permanent changes in the bite or jaw”… most certainly is an inflammatory statement that undermines doctor/patient relationships. These types of treatments should only be performed by the clinician after need has been demonstrated.

Because there is no American Dental Association (ADA) recognized specialty for TMD and none in medicine, finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone and joints) and who is trained in treating pain conditions should be the focus of the NIDCR in assisting the TMD to find help. Specially trained dentists with expertise in this field can be helpful in diagnosing and treating TMD.

Discussion

If the National Institute of Dental and Craniofacial Research (NIDCR), supports an active research program on TMD and is truly interested in learning more about the cause, symptoms, process and etiology of this disorder, it would seem quite reasonable that they should listen to the numerous dentists treating in this country – doctors who are in the trenches treating their TMD patients with first-hand knowledge and experience diagnosing and rendering care to patients with TMD. These very same doctors employ these modalities in order to pinpoint the factors that lead to chronic or persistent temporomandibular pain. Identifying medications is only one avenue out of many others that should to be thoroughly investigated for conservative and effective long-term help. Research performed by experts in the field should be acknowledged and further investigated when trying to understand the etiology of TMD.

Clinical research using dental practitioners who actually treat the overwhelming majority of TMD patients must be encouraged, mentored and supported by NIDCR.

Patients suffering from TMD should not be denied their illness, but rather they should understand the nature of the illness and the available remedies for it.

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