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Some questions to consider are the following:
- How hands on would the doctor be in addressing the complex TMD case?
- Does the doctor prefer to delegate a lot of procedures and responsibilities to others, ie. his assistants, labs, etc.?
- What philosophy of thought and belief is his/her treatment and diagnostic approach?
- Does the treating doctor believe in a psychosocial perspective or biophysiologic perspective?
Do they believe and practice craniomandibular pain treatment directed mainly as:
- A muscular theorist – trigger points and understand tight muscles need to be balanced (but how?).
- A psychological theorists – most of the symptoms are due to stress, tension or emotional upset leads to increased muscular activity, nocturnal bruxism, with psychological testing, etc, yes, they say muscular imbalance and eventual malocclusion, with some splint treatment (but how?).
- Or as the malocclusion theorists who use splints to prevent premature contact, attempt to relieve pain by revising occlusion.
But there are two schools of thought with the malocclusion theory:
- Occlusal disharmony believers view occlusion as the cause of muscular dysfunction.
- TMJ mechanics believers view the cause of premature contacts is due to trigger points in the muscles – Relieve muscles before splinting, prolonged dental work, stress or trauma and malocclusion can perpetuate trigger point activity, etc. and the vicious cycle continues … (but how do they treat it?).
There is also the various disciplines of chiropractics, osteopathics, physical therapists, massage therapy, cranio therapists, etc. that some doctors may coordinate with or maybe they do not include in their treatment protocol. These are things to also consider, recognize and understand as to what the doctor(s) is about.
Philosophy Matters (The Doctors Thinking Process):
- Does the TMD/orofacial pain doctor believe in occlusion related issues, or perhaps the doctors don’t believe in occlusion related issues? Is the problem just a body alignment issue and or maybe it has nothing to do with teeth?
- Are the emotional factors involved that the clinician and patient should consider when dealing with any of the above?
- Does the dentist recognize the underlying problems presented even if the patient doesn’t tell them everything and the dentist has to figure it all out on his/her own wading through the maze of issues, concerns and history of complaints of what worked and what didn’t work as to what the patient has previously tried.
- Does the clinician believe in diagnostic instrumentation = objective data or do they disparage it because of their lack of understanding?
- Do they believe in muscle relaxation therapy or do they not believe it has any relevance to the 6 dimensions of condyle, disc and muscle alignment to the posture?
- What level of details in occlusal equilibration does the doctor understand – 100 micron adjustment level, 80, 60, 40, 30, 15, 10 microns? ….. and to what is their gnathic training, experience and understanding?
- What is their neuromuscular training, experience and understanding?
- What is their gnathological training, experience and understanding?
- What is their orthodontic or bio-physiologic training, experience and understanding?
- Are they more of a diagnostician (academic?) or is the doctor more of a hands on clinician?
- Do they understand orthodontic/orthopedic concepts and treat cases of that nature in their office?
- Do they understand complex restorative procedures and do those type of procedures?
- Do they understand airway issues?
- Do they understand just one discipline of the afore mentioned, or do they understand just one: TMD, comprehensive restorative and orthodontic/orthopedics?
- Or do they understand and practice all 3 disciplines?
These are just some of the questions I would consider and there is a lot more…but as you can see…One will have to consider these factors when locating a dentist you can trust!
If you can’t trust any of them it is better not to start.
The doctor patient relationship is about trust, it’s about honesty. The relationship is about not talking behind the doctors back, gossiping to others on internet forums (ie., Facebook)….respecting who you choose regardless. And the doctors need to respect one another just as well.
If there is no trust, and or faith in what any dentist does, the case will fail no matter how good the doctor is and no matter how credentialed they are or not.
9061 West Post Road, Las Vegas, Nevada 89148 United States
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Leader in Gneuromuscular and Neuromuscular Dentistry