Temporomandibular Dysfunction is a REPETITIVE MOTION DISORDER.
The constant bruxing and clenching of the teeth cause damage to the weakest link in the masticatory (chewing) apparatus. Breakdown of the muscles, TM Joints, teeth and periodontium result.
Rugh has demonstrated that you can not stop bruxing/clenching in a short time in dental students. It IS possible to stop or drastically reduce bruxing/clenching over a longer time period with properly designed and adjusted orthotics (oral appliances).
Gnathological principles do apply! Seating the condyles (joints) will decrease the muscle hyperactivity resulting from accommodation to the CR-CO (bite) discrepancy. The muscles of mastication then decrease their hyperactivity and a normal rest position of the mandible results.
After seating the condyles it is necessary to harmonize the occlusion with the seated condylar position for normal function to be established. What is happening is that an accommodation to an underlying malocclusion is being eliminated once the malocclusion is disclosed by the orthotic (appliance) therapy.
I have done this for 25 years with a high rate of success. Treating chronic TMDysfunction as an acute injury (NSAIDs, muscles relaxants, physical therapy, chiropractic) doesn't address the underlying problem and relapse to the acute phase or continuation of the chronic condition is inevitable.
Your patients deserve to be comfortable! They can be treated effectively!
Dr. Lewis Klapper
TEMPOROMANDIBULAR DYSFUNCTION: The orphan malady!
Modem medical practice is divided into so many areas with each specialist focusing on a different part or aspect of the human body. As a result, Temporomandibular Dysfunction can fall through the cracks between medicine, dentistry and chiropractic disciplines without being adequately diagnosed and treated.
The SYMPTOMS of TMD overlap the symptoms of numerous other maladies treated by medical specialists:
Neurologists: The typical chronic muscle contraction headache (tension headache) is often treated as a component of Migraine by neurologists and medicated accordingly. Since it is not as severe and debilitating as Migraines it merits less individual attention as to causality. This headache often is one component of TMD.
Chiropractors: Tend to see TMD symptoms of cervical and upper back muscle hyperactivity as Upper Cross Syndrome and treat with physical therapy methods, frequently without addressing the possible contribution of TMD to the etiology. They are focused more on the dorsal muscular and spinal components and may overlook the clenching and bruxing of the masticatory apparatus which often contributes significantly to the development of Upper Cross Syndrome.
ENTs: Ear complaints are often a component of TMD because the posterior of the temporomandibular joint area and the external auditory canal are both served by the Auriculotemporal Nerve. Disruptions in the TM Joint often produce symptoms which appear to the patient to be associated with the ear. ENT specialists tend to make the TMD diagnosis/referral by subtraction. If the ear looks healthy they consider TMD.
Rheumatologists: May see symptoms and some of the painful points responding to palpation as part of the constellation of elements used to diagnose patients with Fibromyalgia. There is an overlap of symptoms in these two maladies and a patient may suffer from both or either one.
Dentists: Generally focus on tooth wear from bruxism; fractured teeth; dental pain; periodontal damage to the structures supporting the teeth; facial pain and clicking/locking of the TM Joint. These result from the clenching or grinding by the patient. The standard answer for this is a plastic night-guard which is softer than the enamel of the teeth and reduces some of the damage to the teeth at night. Most patients will learn to clench and grind again with the standard night-guard in place after a period of time. A goodly number of these patients also seek massage therapy or long term chiropractic care for their musculoskeletal complaints in their neck and upper back.
In my own many years of practice I have seen lack of adequate diagnosis and treatment of Temporomandibular Dysfunction lead to continuation of chronic headaches; needless endodontic therapy; single or multiple tooth extractions; Arthrotic Degeneration of the mandibular condyles and general Myalgia/Myositis of the masticatory, cervical and upper back muscles among other things. Chronic NSAID (non-prescription pain medications) and SSRI (psychoactive) medication use are also frequent findings.
I write this letter to remind you to focus on Temporomandiblular Dysfunction in your differential diagnosis of patients as prevalence of various symptoms has been shown to occur in fifteen to twenty percent of the population. As agent Mulder of the X-Files would say, "TMD is out there"!
Dr. Lewis Klapper