During a recent meeting with a new colleague, a question was posed to me: “What makes us choose to dedicate so much of our practice to the treatment of TMD?” In my mind my initial response was “duhh” it’s only the foundation of all we do in the mouth!
This question struck me strange at first, but after some reflection I realized that it is at the very root of our problems in this profession. Thankfully better judgment stopped me from replying impulsively and I decided to write a more intelligent summary of facts that may answer the question better.
According to the American Dental Association, 34% of the population suffers from symptoms of TM Dysfunction. In my 20 yrs experience of practice I have come to the conclusion that a large part of the population shows signs but not symptoms. The number could be well above 90% of the population.
It is also advocated by the ADA that Dentists should have the primary responsibility to diagnose and treat TMD. The problem is that most dental schools do not offer courses to give enough confidence to the students to diagnose and treat this issue (hence the colleagues initial question).
While our profession has done a great job in teaching dentists how to deal with teeth and their support structure, there has been a void in the area of TMJ.
TMD can be a serious and life altering problem for many patients. Symptoms may include headaches, neck pain or stiffness, ear aches, congestion or ringing in the ears, cracking, popping or grating noises in the joint, dizziness and fainting, difficulty swallowing, pain behind the eyes, limited opening or discomfort on opening, numbness in the hands, along with shoulder and neck pain.
It seems to me that this should be our moral responsibility to treat these patients.
Most members of the medical community are unprepared to deal with these patients. If the jaw is out of position the disc would be dislocated and only a dentist, one with the proper training, can recapture the disc with a properly designed oral appliance. The medical community is trained to deal with symptoms of TMD with anti-inflammatories, muscle relaxants and even anti-depressants. Indeed many of our patients have become depressed due to the chronic nature of these symptoms, causing some patients to feel helpless in reaching any solution or relief from their pain.
Being that the nature of this paper is not a clinical or scientific one, I will not get into the details of different diagnosis and or categories of this disease. Our patients are confused enough.
The fact that there is no consensus in our profession for the approach to the treatment is a sign of evolution of the field. What is not acceptable is a barrage of pseudo-scientific papers written and published by so called dental experts backed by special interest groups, trying to categorize TMD as a psycho-social disease. The latter has created a large gap between our profession and our medical counterpart. Many physicians that now work and refer to our office have explained that in the past they did not know who or what modality they could trust for their patient’s treatment. Believe me- the pain and suffering of my patients is very real. It is not just in their minds.
What is certain is that we need a greater emphasis in dental schools on this subject and an open and honest discussion for the whole profession.
-Hamid Nassery, DMD, FICOI