#106 Treating TMD is Easy when you Understand the Cause
TMD (Temporomandibular Joint Disorder) is a devastating disease, not just because the symptoms ruin the person’s ability to enjoy life, but because historically no one could figure out the mechanism causing the symptoms. This left the patient without hope of finding a solution, which frequently created a feeling of depression, which exacerbated the fear and anxiety about the problem, which in turn increased the symptoms. It was just a vicious cycle that increased in intensity over time. That is why TMD is well known as a progressive disease.
It is well known and agreed upon that clenching and grinding the teeth (Bruxism) is the first and most common condition that leads to TMD symptoms. The two other known causes are acute trauma to the face and jaws, and what doctors call functional malocclusions. But it was not known, until recently, how these three conditions create the symptoms of headache, earache, jaw pain, neck pain, ringing in the ears, a feeling of fullness in the ears, (subjective hearing loss), vertigo, upper back and shoulder pain and tightness, arm/hand/finger tingling and numbness, and various kinds of jaw locking.
The previous simplistic and unscientific approach to treating TMD was based on the theory that overusing the muscles of the jaws secondary to bruxism created “tired muscles” and thus jaw and facial pains. This sounds reasonable but did not explain how bruxism caused any of the other well-known symptoms associated with the problem. The doctors and researchers just ignored this fact and tried to treat TMD by any means possible that relaxed the muscles of the face, jaws, and neck. We therefore saw a spike of treatments like Botox (Botulinum Toxin A), dry needling, acupuncture, and various pharmaceuticals all focused on making muscle tissue relax. We even saw a spike in psychiatric and psychologic talk therapy intended to decrease anxiety and therefore decrease bruxism. These treatments have little value because they attempt to treat only one symptom, muscle tightness, and do not address the common denominator which causes all the symptoms. At best, they are only useful to treat one of the many symptoms and only temporarily.
The real breakthrough in treating TMD came 14 years ago, after giving up trying to treat TMD surgically, I decided to do my own research and ignore what was in the textbooks, the “scientific” papers, the professional congresses, and of course the internet. I wanted to see if I could figure out what was really happening with a disease that had at least 10 well known disparate symptoms mystifying patients and doctors alike. Fortunately, my training in dentistry, medicine, cell biology, anatomy, oral and maxillofacial surgery and a research fellowship with the National Institutes of Health, gave me the broad background to see what no one was willing to see.
My research started by interviewing patients who had the problem. There were plenty of them since many patients had been referred to me for surgical relief of their symptoms. But instead of telling the patient what type of surgery I recommended, I asked and encouraged the patients to tell me everything they could about their experience with the disease. Twelve of the first 24 patients told me that if they place their finger, a pencil eraser, their tongue, or a piece of cloth between their front teeth it gave them symptom relief.
So, I decided to make a device that went between the front teeth allowing the patient to speak, drink fluids, and breathe comfortably. The first patient to use the device had 20 years of headache, earache, jaw pain, neck pain, and shoulder pain. I asked her to keep it in place 24/7 except when eating and return in 3 weeks. When I walked in the exam room 3 weeks later, she told me her symptoms were gone. That’s when the real solution to TMD began. The rest is history.
It turns out, chronic inflammation in the joint causes all the symptoms. Chronic inflammation is the common denominator for the disease. And the best way to decrease chronic inflammation in a joint is to rest the joint like a set of crutches rests an inflamed knee. No matter if the cause of chronic inflammation is bruxism, acute trauma, or functional malocclusion, when the chronic inflammation decreases, all the symptoms diminish.
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