1. Isn’t this just anterior repositioning of the Mandible?
It is very important to distinguish between the position of the condyle in the healthy patient and unhealthy patient. In a healthy joint complex with asymptomatic patients we usually find the condyle to be sitting in the ideal centered position in the glenoid fossa. There is usually 3mm of space behind and above the head of the condyle. This allows the retrodiscal tissue to nourish the joint complex and room for the articular disc to sit on the head of the condyle and provide the important function of guiding the condyle through its movements. This position is commonly referred to as the “Gelb 4/7″ position as described by Dr. Harold Gelb, New York, widely acclaimed leading authority on TMD. The common finding in symptomatic patients is that the condyle is superiorly and distally retruded, sometimes resting against the back wall of the glenoid fossa. In these situations, the retrodiscal tissues are crushed and the articular disc is pushed forward off the head, which accounts for the clicking and popping during opening. Decompression therapy for retruded condyles does reposition the mandible in a three-dimensional direction towards its normal position of health however it is a position that is determined neurologically by the patient utilizing a sibilant phenome technique. This is not arbitrary anterior repositioning determined by the clinician.
2. Does TMD Treatment pull the jaw out of its socket?
IT IS IMPORTANT TO UNDERSTAND THAT DECOMPRESSION THERAPY, WHEN REQUIRED, IS MOVING MANDIBLES TO A POSITION OF HEALTH …. NOT AWAY FROM A HEALTHY POSITION TO A MORE ADVANCED POSITION. There is great confusion about the concept of joint decompression. Some TMD detractors will try to convince you that the jaw is being pulled out of its socket to create a false dental open bite thereby creating the need for unnecessary dental treatment. Nothing could be further from the truth. In fact the majority of patients who require joint decompression can be weaned off the appliance after about 8-12 weeks of therapy.
3. Why don’t Flat Plane Splints work?
Most dentists have only been trained to use Flat Plane splints. Accordingly, this seems to represent the limit of dental treatment usually provided to patients. Analgesics, exercises and referral to physiotherapy etc. make up the balance of the treatment protocols. Unfortunately, Flat Plane splints can only provide a temporary relief by increasing vertical thereby decompressing the joint complex in the habitual bite position. This is very different than decompressing to a neurologically defined position that the patient dictates. A Flat Plane splint does protect the teeth from traumatic forces however it does not eliminate clenching and grinding at night. The muscles continue to work hard and the joints continue to be compressed in an inflamed state with the disc dislocated in an anterior position. Furthermore research indicates that Flat Plane splints will make the airway 50% worse in 40% of the patients if a sleep disorder is present. The preferred appliance to use at night will be one that reduces inflammation, reduces clenching and grinding and improves the airway. This is accomplished with a decompression appliance that keeps the jaw forward, but that again is determined neurologically by the patient.
4. Do patients ever need jaw surgery for TMD?
RARELY is it indicated or ever successful. Most chronic TMD patients have soft tissue damage and altered mechanical components of the joint complex. All of these situations respond very well to accurately diagnosed and specifically focused treatment with orthotics and supportive care via chiropractors, massage therapy, physiotherapy, etc. Except for fractures or adhesions, oral surgical approaches are used as a last resort approach.
5. Why do we need other health care practitioners?
Dentists cannot do it alone! While it is important for all of us to realize that dentistry plays a vital role in TMD treatment due to our expertise in occlusion, we need to work with our fellow caregivers. Chronic pain wears down the patient’s resistance, builds dependence on medications, limits range of motion, affects self-confidence and eventually leads to chronic depression. Dentists obviously are inadequately trained to treat these special needs. Co-treatment by more than one caregiver provides a synergistic effect as each treatment supports the other and allows the body to focus its healing in a positive manner.
6. How common is TMD and TMJ anyway?
Much more common than you think! Most statistics indicate that 30-50% of adults suffer from some degree of TMD. Most dentists do not regularly ask their patients about headaches and patients often do not mention headaches to their dentist. Every busy dental practice has hundreds of “silent sufferers” just waiting to be discovered and helped.