#163 Why It Took a Surgeon to Discover the Best Non-Surgical Solution for TMD

TMD, (Temporomandibular Joint Disorder) is a single disorder with multiple symptoms. Its symptoms are constantly confused with other diseases including Migraine Headaches, Meniere’s Disease, and ear infections that have similar symptoms. Therefore, patients with TMD are frequently misdiagnosed and sent on months, years or decades of wild goose missions being treated by an increasing cadre of doctors who look everywhere other than the TMJ (Temporomandibular Joint) as the seat of the disease. In addition to continually being misdiagnosed, the symptoms are commonly categorized with catch all phrases like “Trigeminal Neuralgia” and “Idiopathic Facial Pain” which are a conglomeration of symptoms attributable to multiple theories without any substantive science to back them up. It is interesting to note that the various symptoms covered by these catch all terms are the identical symptoms of TMD.

This is a huge problem with the delivery of medical care. Medical doctors never think of TMD when they are confronted with patients with unusual facial pains, and the dentists know they don’t know how to treat unusual facial pains and usually punt. If TMD is suspected, dentists make a night guard to cover the teeth hoping to prevent damage to the structures beneath.

This rapidly develops into a merry-go-round of primary care physicians, neurologists, neurosurgeons, orthopedic surgeons, general dentists, oral and maxillofacial surgeons, orthodontists, chiropractors, massage therapists, physical therapists, psychologists, psychiatrists, convenient care clinics with physicians assistants and nurse practitioners who distribute a variety of drugs, surgery, and physical manipulations. The most common drugs used like botulinum toxin A (Botox) have little to no long-term effect and proven to be no more effective than saline, while antidepressants, muscle relaxants, anticonvulsants, and narcotics do nothing more than suppress the nervous system and plaster over the symptoms while creating a plethora of very serious side effects.

Having treated TMD for 36 years surgically and over 2000 cases to my credit with varying degrees of success, I was convinced by 2014 that surgery was not the long-term solution to the TMD conundrum. At that point, based on my broad background and training, including a research fellowship with the National Institute of Dental and Cranio-Facial Research in the field of facial growth and development, I began my research journey.

When unencumbered by the “status quo bias” present throughout medicine and dentistry regarding unusual facial pains, I was able to rather quickly align the features that define and explain the disease.

The first, and most important, was what I observed and established during the 36 years and 2000 and 2000 cases performing surgery on the TMJ. It is standard operating procedure, (SOP), to send a piece of tissue from the operative site of each case for review by a Pathologist. Unless the surgeon suspected cancer, the pathology report would be routinely returned in 2 to 3 days containing a description of the tissue as reviewed under a microscope.

What I found, after performing over 2000 surgical procedures for TMD, whether they were open joint procedures or done using an arthroscopic, the fist line of the report was always a description of the cell types involved with chronic inflammation or a simple phrase stating “chronic inflammation present. After 2000 cases it was easy to conclude that TMD was associated with chronic inflammation 100% of the time.

From there, I researched if and how chronic inflammation created all the disparate symptoms of TMD. It turned out that, not only can chronic inflammation create all the symptoms, but tennis elbow and TMD are the same disease, just different joints. The best way to treat both is to rest the joint with a sling for the elbow and the Urbanek Device and Protocol for the TMJ. The rest is history.