Conventional Dental Treatment

Seeking dental treatment for a TMJ disorder can be confusing.  A patient 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 move it forward, some move it backward, and some just manage the symptoms using any of the large variety of medical management techniques described in the file entitled CONVENTIONAL MEDICAL TREATMENT.  

Because dental authorities have been unable to agree on standards for diagnosis, treatment, or anything else related to these disorders; they have been unable to come up with regulations. As a result, any dentist can declare TMJ expertise and employ almost any treatment - even if it is excessive, ineffective, or counterproductive.  Many routinely perform TMJ X-rays and other diagnostic tests that are extremely unlikely to affect treatment.  Some make oral appliances that inadvertently change the bite and thus necessitate subsequent dental work such as crowns or orthodontics just to restore chewing ability.   Some propose orthodontics without understanding that simply straightening the teeth produces esthetic advantages but it may do nothing to improve the relative positions of the jawbones. Some propose extensive treatment for people who have TMJs that are noisy but are already in full adaptation and therefore unlikely to ever cause symptoms.

Well meaning dentists getting mixed messages from so-called experts often don't know what to believe.  To play it safe, they avoid any chanages that cold be considered irreversible.  They usually just "manage" the symptoms using nightguards, drugs, and physical therapy to get the patient through the severe bouts of symptoms that occur during the natural course of a TMJ disorder. 

NIGHTGUARDS are commonly used by dentists as a first line treatment for TMJ disorders, but nightguards are only designed to protect the teeth from wear, and the way they affect a TMJ disorder is random.  Sometimes they relieve the problem, sometimes they make it worse, and sometimes they have no effect on it.  Lower nightguards can disrupt the bite.

The type of ORAL APPLIANCE that a dentist makes for a patient depends more on beliefs of the dentist than the type of TMJ disorder. There are several different TMJ and bite philosophies, and each favors one or two types of oral appliances for almost all patients.  If the oral appliance that is indicated according to the dentist's TMJ philosophy fails to relieve the symptoms, the patient may be sent to a physical therapist, a pain clinic, an orthodontist, or an oral surgeon rather than to a dentist with a different TMJ philosophy.   The TMJ and bite philosophies (and the appliances those philosophies dictate) that are most widely accepted by dentists are summarized below. 

CENTRIC RELATION philosophy describes the way most dentists treat bites.  It was developed nearly a century ago for dental laboratory work and then used as a basis for constructing a model of the way bites are supposed to work, even though it is a mechanical rather than a biological model and is not found in the animal kingdom.   Centric relation dentists believe that lower jawbones should always be located as far backward or almost as far backward as possible. They make nightguards and other oral appliances with slopes that tend the slide the lower jawbone backward. 

BIOESTHETIC philosophy is an extension of centric relation philosophy to an unnatural extreme that can be used to justify spending a lot of money to make all teeth look brand new by means of porcelain crowns, veneers, and onlays.  It rests on a number of false assumptions, such as the idea that nocturnal bruxism is caused by a faulty bite and the idea that any tooth wear is pathological.

"NEUROMUSCULAR" dentistry markets a computerized diagnostic system that looks impressive but provides no clinically useful information.  The equipment often indicates a need for extensive dental work to change a bite that may not be involved in the cause of the problem.  A brief explanation is provided in a NEUROMUSCULAR file under TREATMENTS, and a more detailed explanation is provided in OCCLUSION: CURRENT CONCEPTS under FOR DOCTORS.

 THE BOTTOM LINE is that you need to learn about your condition and the various treatments for it before choosing one.  The confused state of dntal treatment of TMJ disorders necessitates using common sense and asking questions rather than simply following the advice of a dentist that you know and trust but may not know enough about these disorders to provide good guidance.