Dental Management
Seeking treatment for a TMJ disorder can be confusing, because dental authorities have been unable to agree on regulations, which has made dentists easy targets for all kinds of gadgets that purport to help treat TMJ disorders but have never been shown to be clinically effective - including pulsed TENS to "relax" the jaw muscles, Doppler or joint vibration analysis to evaluate the condition of the TMJs, thermography to identify inflamed muscles, surface EMG to quantify muscle resting tensions, TEK scan to analyze bites, and all the technologies marketed as "neuromuscular dentistry". DNA and RNA appliances are marketed as epigenetic although the changes they produce cannot be inherited. ALF (advanced lightwire functional) appliances are marketed as "regulators of the cranial nerves and the autonomic nervous system", although there is no known mechanism by which pressure from wires could regulate nervous system activity.
A patient with a TMJ disorder in a large city could see a dozen different dentists who advertise treatment of TMJ disorders and receive ten different treatment plans. Some won't ever change the bite, some will move it forward, and some will move it backward. Some will recommend wearing an oral appliance full time without providing any exit plan out of appliance wear. Some will refer to an orthodontist who will simply straighten the teeth without having any way to know how it will affect jaw positions. Some will refer to an oral surgeon when the TMJs show advanced degenerative changes on X-ray but are already in full adaptation and therefore unlikely to ever cause symptoms. Prosthodontists usually treat the problem by crowning all the teeth, without having any way of knowing if that is needed to resolve the symptoms.
In the name of being comprehensive and for the purposes of feeling legally protected, many dentists perform extensive TMJ X-rays and other diagnostic tests that make their medical/dental exam feel very thorough, but they are extremely unlikely to affect treatment. These testing modalties are discussed further in CURRENT TREATMENT and in BITES: CURRENT CONCEPTS under the FOR DOCTORS tab. Most dentists try to manage TMJ disorder symptoms in their patients using nightguards, drugs, physical therapy, and a large variety of supportive treatments to get them through the severe bouts that can occur during the natural course of a TMJ disorder.
The GOOD NEWS is that the symptoms will eventually disappear due to adaptation, and there are many different types of treatments which can enhance that adaptation. We combine treatments that facilitate adaptation with orthopedic principles that also address the problem at its source to prevent it from returning.