#112 TMD was a Mystery Wrapped in a Conundrum inside an Enigma

It has been 90 years since Dr. James Costen, an ENT surgeon from St. Louis first described the symptoms of TMD, (Temporomandibular Joint Disorder), in 1934.  It was not until an Oral and Maxillofacial Surgeon with substantial training and experience in cell biology and anatomy along with both medical and dental degrees having performed 2000 surgical procedures on the temporomandibular joint, and 2 years doing research for the NIH on facial growth and development that the true nature of the disease was identified.  Having identified the true nature of the disease and discovering its common denominator, a simple and effective non-surgical treatment was established. 

What occurred between 1934 and establishing the actual cause of the many disparate symptoms of TMD was a series of dead-end pathways leading to jaded and incorrect conclusions.  These jaded conclusions were developed using emotions versus logic, lack of knowledge about how the other joints in the body operate, and a type of reasoning like that used in Las Vegas to win at the roulette tables. 

Relying on emotions should have nothing to do with medical investigations and treatment.  However, emotions have played and still play a substantial role in how health care providers try to treat TMD.  It depends on how tightly the providers are emotionally connected to what they were originally trained to do.  If they are an orthodontist trained to straighten teeth, they try to treat TMD by straightening the teeth.  If they are a general dentist trained to adjust the bite they treat TMD by adjusting the bite.  If they are an Oral and Maxillofacial Surgeon trained to do surgery, they treat TMD by doing various types of surgery.  MD’s are trained to use drugs so that is what they use.   If they are infatuated with the financial gain and opportunity to inject Botulinum Toxin A in a never-ending cycle every 4 months, they inject Botox. If they are a physical therapist trained to relax a muscle by dry needling they dry needle.  Similarly, the massage therapist, chiropractor and the acupuncturist use their emotionally connected technology instead of finding the cause of the symptoms.    To summarize, if you are emotionally connected to the tools of your trade and what you have is a hammer, every disease will look like a nail. 

Logic played no role in the treatment of TMD until the actual cause and pathologic pathway was determined.  Until the actual disease pathway was determined logic was replaced by throwing something at the wall to see if it sticks. There is nothing wrong with trying things out until you find something that works.  We would not have the light bulb if Edison had not tried a hundred different filaments.  But patients are not filaments, and it isn’t appropriate to treat one like the other.   

The biggest reason why the solution of TMD stayed hidden for so long was simply lack of knowledge by the people who were supposed to be the bastion of knowledge.  The academicians, the professors in dental schools, and the dental school investigators were expected to have a broader understanding of the basic sciences already proven and published but didn’t. They didn’t bother to read what was already in print.  If orthopedic surgeons had maintained control over the treatment of TMD, the mystery of this disease would have been solved 50 years ago.  TMD and tennis elbow are the same disease, just in different joints.  The solution for TMD originated from basic knowledge of how all joints operate in the same manner within the body. 

The final solution for TMD originated using inductive rather than deductive reasoning.  Deductive reasoning is picking out the facts from a thousand different facts that seem to explain a disease.  It’s a hit or miss method unless you are Sherlock Holmes.  But, when patients were asked what makes the symptoms of TMD go away, many responded by saying placing something between the front teeth and gently biting down made it feel better.  The Urbanek Device and protocol was “induced” by the patients telling me what made it feel better.  I did that and it worked.  This is called inductive reasoning. 

The mystery of TMD, wrapped in a conundrum, inside an enigma was solved 

by communicating with patients without emotion, and applying logic, knowledge already in the books and a little bit of inductive reasoning.