TMJ solutions: evaluation and treatment planning

By Michael Boehm, DMDWhen I’m asked about TMJ treatment, it seems that just as many treatments have stayed the same as those that may have changed over the years. Seemingly the level of stress brought on by our recent economic woes as a nation has certainly doubled the number of patients with TMJ dysfunction in my office over the past several years. Many people focus their stress either in their low back, upper back and neck, or facial muscle and jaw joint areas. This has a lot to do with old, unresolved injuries as well as current issues with injury and stress, among others.TMJ dysfunction in its broadest terms is broken down into pure joint and bone issues or muscular issues. Muscular issues tend to be the causative agent more than 90% of the time, which amounts to parafunctional habits such as clenching or grinding of teeth. A vast majority of these abnormal habits are stress-related. The purely bone- and joint-related issues may have degeneration of the cartilage disc or the bony surface of the joint as the cause. Many times an MRI can be a great diagnostic tool if the issues are chronic and severe. But in early stages, many times just simple splint therapy is all that’s required, and it is easily reversible. I remember several decades ago a surgical technique developed to “cure” jaw joint pain and problems permanently. It involved a man-made Teflon disc of false cartilage called the “proplast disc.” Oral surgeons would operate on the painful joints, remove the bad discs of human cartilage, place the proplast disc, and close up the area. Sadly, almost every case ended up with patients in far worse shape within one to two years, and those affected having numerous follow-up surgeries. In most cases, the man-made disc, even though it is slicker than any substance developed to date, was much too abrasive for load bearing of the jaw joint. It had worn through the articular surface of the temporal bone, and had to be removed from patients’ skulls. Certainly it proved a scary outcome for the patients involved as well as something we should remember as physicians: sometimes the simplest solutions are the best, and surgical intervention should be a last resort.Stress, injury, and habits that damage muscle and jaw joints are constants, comparatively speaking. What can be done in this day and age without risky surgical procedures to assist patients with simpler treatments is what we should be providing as solutions to such issues. Numerous courses of treatment are available today, and combinations of such treatments are often synergistic in nature.The first assessment should be determination of how serious an issue does a patient possess, and secondly, is this mainly a muscular issue or a physical joint problem, which perhaps may require different intervention. For jaw joint issues, there may be problems an MRI would reveal. A severely damaged disc and advanced condylar or articular surface damage may very well require surgical intervention, but those cases are truly — and thankfully — few and far between. Suffice it to say, I’m a fan of the alternative in almost every instance. Many widely known treatments are what we’ll describe herein.What I must impress on anyone searching for a means to assist in any of the following modalities is to understand the root cause of most, if not all, “problems” in the body. Mankind must learn or adapt to every circumstance that creates stress. Neanderthals had to deal with getting eaten by saber-toothed tigers. Our stress-creators number like the stars, including finances, marriage, kids, and workplace, to name a few. It’s not that we all have stress — that conclusion is obvious. It’s how we deal with that stress. We either remove it and allow healing or internalize it, which leads to disease or lack of healing. For those not familiar with a very interesting body of work performed by Dr. Masaru Emoto, I would urge you to read his books that are widely available. All are based on water and what happens to water when subjected to nothing more than words and emotions. On a deeper level of understanding, I believe “The Message in the Water” and related books have to do with quantum physics and our ability to change our circumstances simply by using our minds and intentions. It’s a remarkable premise and one that possesses some far-reaching implications for medicine and a myriad of other subjects.Many patients have heard of chiropractic and know of its usefulness. It’s a common recommendation in our office if patients have had positive responses in the past. There are a number of splints primarily made of acrylic and sometimes metal frameworks with plastic superstructures that are often useful. Their basic premise is creation of a device that promotes a reversible change in muscular length to aid in breaking up abnormal muscular patterns. Relief of spasms and protection of the teeth are their main usage. As a classically trained homeopath, I will often employ the use of certain homeopathic remedies in finding relief of muscular problems. The beauty of homeopathy lies in its ease of use/administration and its ease on the wallet as well. Acupuncture is also very useful, although likely a bit more costly. It helps increase energy flow where weakness exists or can reduce energy where abundance in the body is unwanted. When performed on a fairly regular basis, good results are common.The last modality I will mention is osteopathic manipulation. It’s somewhat similar to chiropractic in that skeletal balance is crucial and works with muscle, fascia, and bone, but it can also work within the body’s fluids and energy fields also. This makes it almost a combination of chiropractic, acupuncture, and homeopathy on a number of levels. I can speak from personal experience in all these treatments in reference to my numerous ailments and not only prefer them to surgery but have found relief in a great many ways. They do require some repetition and perhaps more treatments early on, but their effectiveness becomes additive with repetition, which leads to fewer treatments once symptoms lessen.Just remember in closing that success or failure has much to do with one’s attitude. Believing in something often leads to better success, while negativity will surely doom whatever patients may try. Keep your mind open and positive and watch what happens as it just may surprise you.