Over the past several months, I’ve had the opportunity to host many dental residents in my practice as part of a formal training program. At the same time, I have also worked with a number of practicing dentists from around the country who want to broaden their pain education. From this experience, two things have become very apparent to me.
First, I’d like to focus on the dental residents, who for the most part, are recent graduates. They all have very limited practical knowledge about TMD/TMJ problems and have apparently been told in dental school that never can TMJ patients get better.
There is no reason why recent dental graduates should think that TMD/TMJ patients can never get better and here is why: these problems, though at times attached to challenging patient personalities, are essentially orthopedic in nature. This means that they involve muscles, tendons and joints. When viewed this way the most common diagnoses include muscle strains, muscle fatigue, muscle soreness, joint sprains, inflammation, and ligament- and bone-related compromises (which can include arthritis of one form or another).
The key then is to determine the primary cause of the compromise and whether or not there are other factors responsible for perpetuating the problem. This is where the evaluation process becomes so important and is not accomplished by pen and paper questions, but rather by sitting down and having real conversations with real patients.
Time and listening are what’s necessary to gather the information essential to making the right determinations. Once achieved, TMJ/TMD problems can be addressed with understandable and practical therapies that involve and require doctor and patient participation. The time and listening formula is what distinguishes one practice from another.
Whether the recommended treatment is medication, education, dietary caution, exercises, injections, oral appliances, physical therapy, meditation or surgery, the process of healing can be quick, or can span months.
In my experience I estimate that half of TMJ/TMD problems are straight forward and solved with education and home therapies, one quarter are moderately complicated (but can respond wonderfully to formal treatment), and one-quarter are challenging cases impacted by the nature of the patient’s tissue injuries and his or her medical, social, and/or behavioral profile. I suspect that common knee problems carry with them the same statistics.
After spending a day in my office dental residents often say “I never knew these patients could be helped.” or “I was told in dental school that caring for these patients is unrewarding and endless.” These comments indicate that TMJ/TMD problems are a mystery for our young graduates. Unless dental schools start getting out the right message, nothing will change. In the interim, however, it is encouraging to see how many patients can be helped despite being told somewhere in their travels that there is no answer to their problem.
Practicing dentists with an interest in this area are another story entirely. They often end up in continuing education programs where the instructors preach unscientific dogma about how fixing a patient’s teeth and bite will fix the problem. After they attempt this often-complicated approach a few times in their practices, they usually realize that it simply doesn’t work. At this point, it’s very common for the dentist to stop treating TMJ/TMD problems entirely, leaving behind some very discontented patients.
Long ago I was fortunate to discover that the vast numbers of patients who get relief do so without their teeth being ground-down or built-up. Today I see the frustration on faces of dentists who have tried these seductive approaches and when their patients don’t get better, realized that they were missing something.
The bottom line is that these problems are not big mysteries but rather understandable by practitioners, like myself, who have spent the time to learn and embrace the fact that jaw-related problems are orthopedic problems in nature and the accompanying pain emerges for specific (and often common) reasons. My practice continues to listen to, guide and educate our patients so they can be part of their healing process. And I hope that the time I spend with new graduates and practicing dentists will help to expand their understanding, as well.