#145 The Integration of Dentistry with Medicine and TMD

      The Integration of Dentistry with Medicine and TMD 

There is a growing movement within the dental profession to integrate dental services within the practice of medicine.  Many leaders in dentistry realize the time has come for patients to understand their oral health plays a profound part in their overall health.  The oral cavity and related structures are the first portion of the alimentary canal which prepares food for digestion and plays a profound role in breathing and speech.  It is recognized that significant pathology of the oral structures like cleft lip and palate and jaw growth problems can create lifelong challenges to overall health and well-being. 

The time has come for patients and dentists themselves to put aside the false idea that the purpose of dentistry is to keep 32 teeth pain free, aligned correctly, and “snow-cap” white to achieve the widest smile possible.  A healthy mouth gives a person benefits well beyond cosmetic self-assurance.  

Temporomandibular Joint Disorder, TMD, is the best opportunity to portray why dentistry should be integrated into the practice of medicine. 

Currently, the Temporomandibular Joint, TMJ, is considered the anatomical stepchild of the dental profession.   Dental schools teach the TMJ is a unique and complicated joint.  They justify the inability of the dental profession to adequately understand and treat the disease associated with the TMJ by the fact that it is unique and complicated.  That gets the dental profession off the hook when patients present to the dental office with one or more of the disparate symptoms euphemistically and culturally know as “TMJ”.  It should be obvious to everyone that something must be inherently wrong when everyone refers to a disease by referring to the location of the disease as the disease itself.  Do physicians and patients refer to the various types of heart disease as having “heart”?  Of course not.  But physicians, dentists and patients alike, continue to refer to the problems associated with the TMJ as “TMJ”, the name of the joint itself. 

Dentists and the dental profession, as distinct from the medical profession, was involuntarily given responsibility for treating the TMJ starting in 1934, when an ENT surgeon from ST. Louis wrote the first paper describing some of the symptoms of TMD, attributing them to the lack of dental support for the joint.  At that point the dental profession was given the responsibility to treat TMD.   History proves dentists didn’t know what to do then, and until my recent discovery about the common denominator which creates all the symptoms, don’t know what to do now.  The best the dental profession has been able to do is try and treat each symptom independently and temporarily. 

The fact is, all the well-known symptoms of TMD are directly created by chronic inflammation within the TMJ.  The exact mechanisms of how that happens has been worked out.  Chronic inflammation is also the common denominator for many of the other maladies experienced within the body, including heart disease, lung disease, diabetes, and recently even associated with Alzheimer’s Disease.   

In fact, chronic inflammation within the TMJ can be shown to create the same amount of detrimental effects as chronic inflammation around the teeth, periodontal disease, contributing to the inflammatory response of the heart, lungs, pancreas, and now the brain. 

Treating TMD, Temporomandibular Joint Disorder, is just as important and beneficial as treating any other disease associated with chronic inflammation.  But the treatment of TMD has befallen to dentists alone without full understanding of chronic inflammation and its relationship to the nervous, endocrine, vascular, and musculo-skeletal systems.   

Like any other problem, the solution is derived from education.  Dentists, dental educators, and the profession itself needs to integrate itself into the medical educational system and stop pretending it is separate and distinct from medicine.  The study of medicine is the generic term for understanding how the body works.  Medical doctors, physicians, then specialize in addressing specific areas of responsibility.  The treatment of TMD is the best example of the importance of integrating dentistry and medicine.