#105 Successful TMD Treatment Relies on Patient Compliance

Having treated over 4000 TMD/TMJ patients successfully using a non-surgical device and protocol, I consider myself an expert on the problem.  I have experienced just about everything a doctor can experience treating this devastating disease.  I really enjoy the service we provide because of the frequent patients who thank me profusely, ask if they can give me a hug, (a common southern female response to happiness), or on occasion say, “You saved my life”.  I know I didn’t actually save that patient’s life, but I know what was meant. They are trying to tell me they were having a miserable life because of the symptoms and now that the symptoms are gone, they are having a good life again. Although, I have documented 3 patients who did admit contemplating suicide because of the unrelenting TMD/TMJ symptoms. 

Maybe a brain surgeon or a heart surgeon gets similar comments of gratitude from their patients, but practicing oral and maxillofacial surgery for 46 years, and performing thousands of complicated maxillofacial surgical reconstructive procedures I rarely had a patient thank me profusely, ask for a hug, or even say thank you.  I think the rare response of gratitude occurred because these patients fully expected the surgical procedure to do exactly what it was supposed to do and what I told them the outcome would be.   In the case of non-surgical treatment of TMD, patients are only hoping that treatment will be successful because, more often than not, the prior treatment/s offered were either not successful, or only resulted in temporary relief at best. 

When I did surgery to remove a tumor, fix a facial fracture, correct a facial growth or congenital problem, graft a cleft palate, or reconstruct a damaged nerve, both I and the patient expected a good outcome and neither of us were surprised when that happened.  Additionally, the patient usually had little to do on their part except take their antibiotics and pain pills.  Surgery correctly performed relies primarily on the natural healing properties of the body to do most of the work once leaving the operating room. 

What I came to realize, after treating 4000 TMD/TMJ patients with a non-surgical oral device and protocol, was that the non-surgical treatment of TMD/TMJ relied almost exclusively on the willingness of the patient to follow the protocol.  In other words, patient compliance with the protocol is the primary variable determining factor for reaching a successful outcome. 

The way the device works is very predictable and simple.  It unloads the damaged joint allowing the chronic inflammation to dissipate and decrease symptoms like a set of crutches does the same for an injured knee. However, just like the success of crutches for a knee injury is dependent upon the patient using the crutches correctly, our oral device is dependent on the patient following our protocol for use.  Sounds simple doesn’t it. It is simple.  But the rub comes when patients will not follow the protocol. 

The protocol is simple. The patient can talk and drink hot and cold fluids with the device in the mouth. But they must remove the device to chew.  The instructions are to keep the device in the mouth 24/7 for 2months except when eating, and then nighttime/sleep time for the rest of the patient’s life. 

Patients who follow this protocol get better and end with 90 to 100% symptom relief.  Those that follow the protocol partially usually end up with partial relief.  And those that will not follow the protocol only when the want to, will usually end up with no relief.   

Knowing about this pattern exhibited by patients we see an overall success rate of between 85% and 95%.  Additionally, there is the very rare patient who gets internal or external satisfaction from keeping the TMD/TMJ symptoms.  This patient is very unusual and accounts for only .002% of patients treated. 

So, in contrast to other types of TMD/TMJ treatment, the patient’s compliance with the standard protocol is very predictive regarding the outcome.  I have heard just about every justification for not following the protocol.  Some of them were rational but most of them are not.  Rational justifications are when the dog chewed up the device, or the patient had extensive dental work after beginning treatment and it no longer fit in the mouth.  But having someone make fun of you because you were wearing something in your mouth is not rational allowing someone else determine whether or not you get better. 

Correct patient compliance is the primary variable factor when treating TMD/TMJ with the Urbanek Device and Protocol.