#40 Why has TMD/TMJ Been an Enigma and Conundrum for so Long?

This is a very good question. Generally speaking, when it comes to understanding and treating TMD/TMJ, there are as many opinions as there are doctors who treat the problem, and generally speaking, everyone knows when treating TMD/TMJ, nothing works for very long.

There are many treatment avenues that give temporary relief such as non-steroidal anti-inflammatories until all they do is make your stomach hurt, muscle massage, dry needling, Tens Therapy, intermittent heat, opioids, chiropractic therapy, muscle relaxants, botulinum toxin injections, surgical lysis and lavage, arthroscopic surgery, and many other more esoteric methods.

But predictable long-term relief was not available until full understanding of the mechanisms related to TMD/TMJ were understood.

Why did it take so long for these biologic, neurologic, and pathologic mechanisms to become understood?

The answer is TMD/TMJ was given to the dental profession to sort out the problem by default, and the dental profession, dental schools, and dental specialty training programs were totally unprepared to take up the challenge.

From the time TMD/TMJ was first described by Dr. James Costen, (an ENT physician) in 1934, until present time, the dental profession has avoided the responsibility of integrating the oral/masticatory system with the rest of the body and it’s systems. Even today, doctors of dentistry are graduated with the concept that they are tooth mechanics and not the overseers of the first and most complex portion of the alimentary tract.  Gastroenterologists and Gastroenterology surgeons took total control of treating the latter parts of the digestive system. The ENT doctors took control of treating the throat and related structures.  Because the temporomandibular joint is an integral part of the jaw and the teeth are an integral part of the jaw, it followed naturally that it was expected that dentistry take responsibility for treating the joint that operates the first section of the alimentary tract.

Orthopedic surgeons wanted no part treating or even trying to understand the diseases of the temporomandibular joint.  They were very busy and challenged during the last hundred years working out the solutions for problems of the other joints of the body.  Generally, they have succeeded where dentistry has failed. They did not want anything to do with TMD/TMJ.

Since the early 1970’s studies on TMD/TMJ came under the influence of the Oral and Maxillofacial Surgeons.  But OMS’s only wanted to find a surgical solution for the problem and had no interest in finding any solution other than surgery.  The remaining parts of the dental profession found that treating TMD/TMJ was not included in their specialty, they had no interest in treating TMD/TMJ and were busy treating teeth, or if they had interest, found themselves isolated from the concepts that basic medical science had to offer.  At that point, dentistry took off in the totally wrong direction at solving the problem.

The next article in this series will describe exactly where the dental profession got off the rails and why the enigma and conundrum have been allowed to exist for so long.

If you are suffering from the symptoms of the enigma and conundrum of TMD/TMJ you are invited to schedule a consultation with us to hear about the predictable, long term, non-surgical, FDA cleared university study verified solution with its foundation in verified medical science.