#203 Personal Integrity and TMD

I began my journey on the study and treatment of Temporomandibular Joint Disorder on July 1st, 1973. This was the first day of my internship/residency training program in Oral and Maxillofacial Surgery at Vanderbilt University Hospital, Nashville Tennessee.  After finishing at the top of my dental school class at Indiana University School of Dentistry and completing a degree in cell biology/anatomy at Indiana University School of Medicine I was grateful to be given the chance to further my dreams of becoming a facial reconstructive surgeon at the prestigious Vanderbilt program, one of only two programs in the USA at the time that combined residency training in Oral and Maxillofacial Surgery and medical degree.   

For the next 36 years of my 53-year career, the surgical treatment and reconstruction of the temporomandibular joint, (TMJ) was a significant portion of the various types of facial reconstruction that I performed in my private practice in Nashville/Brentwood. By 2009, I had successfully performed over 2000 TMJ surgical procedures along with thousands of other procedures to harmonize a patient’s appearance and function.   

In the spring of 2009, I spent a weekend gardening and tending to the appearance and function of my plants and shrubs. As I worked, I began to compare the realities of my surgical experience with the realities of my garden.  When I planted or pruned a shrub or talked with a prospective patient or mother of a young prospective patient needing bone, muscle, or nerve reconstruction I was able to accurately portray and predict the expected outcomes of the work without fail. But, regarding the 2000 TMJ surgeries cases I had performed, roughly 1/3rd of the patients would return to my office within 6 months to 2 years with the identical symptoms they started with.  As I shoveled dirt in my back yard, I realized I could not continue to tell my TMD patients, primarily female, (TMD is primarily a female disease because estrogen exacerbates inflammation) that my recommended surgery was going to be successful knowing a third of these patients would return in time suffering the same symptoms.  What made it worse was not knowing which third would not get the results I promised to achieve.  I had lived personally and professionally by the Montra, “Always produce what is promised”.  I realized I was violating my personal integrity.  At that moment, in that garden, in 2009 I decided I needed to make a change.  The next morning, I announced to my staff I would no longer accept TMD patients for surgery and began the investigation that eliminated all previous surgical and professional bias and performed the research that ultimately lead to the full and complete understanding of the disease known as TMD and the creation of a simplified treatment that focused on the cause rather than the symptoms.   

We have now successfully treated well over 5000 TMD patients with a simple device and protocol that decreases the cause of the disease, rather than treating symptoms. It has been proven by independent university study that unloading the TMJ by separating the posterior teeth with an oral device and unloading the TMJ like crutches unloads a damaged knee creates predictable long-lasting results for both  painful and non-painful TMD symptoms.   

As it turned out, all my research and “discoveries” were already written and established in peer-reviewed scientific literature. I did not “discover” anything that was not already in plain sight. Apparently, no one had ever taken the time to piece it all together.  I have often wondered why I was the person who put all the pieces together that explained the TMD conundrum and changed the paradigm that had been the standard of care for over 70 years.   

When I am asked why I quit surgery on the TMJ and gave up a substantial part of my income to replace it with research on the problem without assurance of success, I answer with my definition of Personal Integrity. 

“Personal integrity is knowing what you know. What you know is what you know and what you have observed, and to have the courage to know and say what you have observed, and act on what you have observed. And that is integrity and there is no other integrity.”