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.  

One of the reasons for the confusion is that dental authorities have been unable to agree on standards for diagnosis, treatment, or anything else related to these disorders; and therefore 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 just to restore chewing ability.   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 usually just "manage" the symptoms using nightguards, drugs, and physical therapy to get the patient through the severe bouts of symptoms that occur occasionally during the natural course of a TMJ disorder. 

Most TMJ disorder patients are given some type of oral appliance to wear, at least during sleep. Unfortunately the type of oral appliance that is prescribed for a patient's TMJ disorder depends more on the training and beliefs of the dentist than the type of TMJ disorder.   When that doesn't work, they may send the patient to an orthodontist for braces without understanding how straightening the teeth would affect the condition or to an oral surgeon without understanding that surgery is rarely necessary in these cases.

The vast majority of oral appliances made by dentists are simple nightguards - designed only to protect the teeth from wear.  The way they affect TMJ disorder symptoms is random.  Sometimes they help, sometimes they make it worse, and sometimes they have no effect.  Lower nightguards should not be worn during sleep, because they can disrupt the bite and thereby create a requirement for expensive dental work just to re-establish a bite.  Upper oral appliances can cause the same problem if worn full time for a period of months or years.

Most oral appliances made by TMJ disorder specialists are based on one treatment philosophy or another to which the treating dentist adheres.  There is so much disagreement among different philosophies that, if an oral appliance made by a dentist believing in one philosophy is ineffective for a patient, the patient is usually referred to a physical therapist, a surgeon, or a pain clinic rather than to a dentist with a different TMJ philosophy.  The most popular philosophies are summarized below and also described in great detail in OCCLUSION: CURRENT CONCEPTS under FOR DOCTORS.

CENTRIC RELATION philosophy describes the way most dentists treat bites.  It was developed many decades ago for dental laboratory work and eventually embraced by the profession to the extent that it has become almost a religion to many dentists.  Those who believe in centric relation dentistry believe that lower jawbones should always be located 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 dentistry that can be used to justify making all teeth look brand new by means of porcelain crowns, veneers, and onlays.  This technique can be used to market extensive dental work, but 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 is basically a brand name for a computerized diagnostic system which looks impressive to patients 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.