#200 Why Do Some Dentists Pretend to Know How to Treat TMD

Here’s the truth about Temporomandibular Joint Disorder (TMD. ) Some dentists pretend to know how to treat TMD when they know in their heart, they have no idea of what they are doing.  They are willfully treating a disease but don’t expect a result.  Shameful, but true.  But dentists have been backed into a corner and placed into an untenable situation. So, we should apply “Grace” in this situation. 

The explanation for this goes back a long way and centers around the difference between how dentists and physicians are licensed to practice their professions.  When physicians finish medical school their MD degree gives them the opportunity to choose whatever field of medicine, they want to work in.  (Family Practice, Internal Medicine, Cardiology, Pediatrics, Pulmonology, or any of the surgical specialties, Orthopedics, General Surgery, Cardiac Surgery, Neurosurgery, Plastic Surgery, ENT Surgery, Anesthesiology, Radiology, Oral and Maxillofacial Surgery, Urology, OB/GYN etc.)  Medical doctors are licensed as MD’s but are not allowed to do things outside their training primarily by the necessity of additional certification in the area they chose.  A young medical doctor cannot do whatever they want under the umbrella of “Medicine”

Dentists on the other hand, once they receive their dental degree, (DDS or DMD, (Both are equivalent degrees) are licensed to do anything that is under the umbrella of “Dentistry”.  And the definition of anything is “Anything considered under the umbrella called dentistry.  This includes TMD 

Temporomandibular Joint Disorder (TMD) was first described by an ENT physician Dr. James Costen in 1934. He theorized that the symptoms of ear pain, tinnitus, dizziness, and jaw pain were caused by the lack of posterior teeth. For the next 20 years, patients with Costen’s syndrome were sent to dentists to replace the posterior teeth with partial dentures.  This theory has since been disproved, but the toothpaste was out of the tube.  The ENT physicians and the orthopedic surgeons who are trained to treat all the other joints in the body except for the TMJ wanted nothing to do with TMD (Costen’s Syndrome) because it had to do with teeth. Therefore, forever after, the study and treatment of TMD was given to the dental profession to handle.

So, patients with TMD ended up being routed to dentists for treatment.  But the dental profession was not used to treating joints, they were used to treating teeth.  Therefore, from the 1970’s the solution proposed by the dental profession centered around doing things to the teeth, straightening teeth, adjusting the bite, covering the teeth with a night guard.  None of this had anything to do with addressing the cause of the symptoms that the orthopedic surgeons had known about for over 70 years.  The dentists did not read the orthopedic literature, and the dental schools taught that the TMD was a unique joint, unlike any other joint in the body. Certainly, this was not true. Then between the 1970’s and the 1990s” the Oral and Maxillofacial Surgeons got involved and tried to do things surgically to the joint in an effort to treat the problem. I was involved during that period and finally decided surgery on the TMJs was not going to be a long-term solution.   

Currently, people who have TMD are stuck seeing dentists who are taught next to nothing about TMD in dental school but are supposed to know about it because they are dentists and licensed to do everything under the umbrella of dentistry, including the jaw joints. These dentists are stuck being referred patients from physicians expecting the dentist to handle the problem.   

Half the dentists admit they don’t know anything about TMD, and one way or another tell the patient to go elsewhere.  They know they don’t know.  The other 49.9 % of dentists prescribe a night guard that has nothing to do with preventing or treating TMD, because a night guard has been the prevailing treatment taught in dental schools for the past 70 years. They confuse treating TMD with protecting the teeth due to TMD.   So literally half the dentists prescribe a night guard and pretend they are treating the TMD, when all they are doing is protecting the teeth from damage due to clenching and grinding (bruxism) which is one of the three causes of damage to the TMJ.  A night guard does not prevent bruxism.  Sometimes it makes bruxism worse. 

And then there is the ½ of 1 percent of dentist who hold themselves out as specialists who only focus on treating the symptoms of the disease instead of the cause. 

The actual cause of all the symptoms of TMD is chronic inflammation within the joint which is created by the three circumstances that damage the joint, of which bruxism is only one.  The other two are acute traumatic events that damage the TMJ, and the third is functional malocclusion where the position of the jaws and the teeth within the jaws are so badly coordinated that the joint becomes damaged.   

Chronic inflammation is the common denominator and cause of all the symptoms.  Chronic inflammation within the TMJ goes away when the joint is unloaded with a device (tool) used with a protocol (treatment).  The definition of TMD should be “Chronic Inflammation within the TMJ” . All the symptoms of TMD are directly driven by chronic inflammation. As the chronic inflammation decreases, symptoms decrease and go away.   A Very simple concept.  Not complicated.