Tmd

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I meant to say TMJ Dysfunction- thanks for the correction. There are a myriad of things that can contribute to TMD- what I am saying is that in the chiropractic world, we recognize the fact that the displaced structure and forces of the occiput MAY contribute. DC's spend a lot of time looking at the many relationships the spine has with the body- which I would advise not to underestimate. I respect the views and opinions from the dental realm as well though.
 
Dr. Phan,

As far as I know as well, there are no "TMD Specialist's" but rather individuals who have spent more time learning about it and furthering their techniques in dealing with it- and so word of mouth they start to attract those types of patients with referrals...as far as chiropractic treatment goes, I am not advocating it or stating that it is the best way to go about this condition- but rather that it is something we are trained to deal with using a hands on approach while incorporating trigger points, PT, and if a patient presents with a lockout, reduction. We are aware of the arthritic changes that can occur at the joint and how that needs to be addressed via referral. In the event of suspected TMJ, our job is to apply said techniques, but also be aware of other underlying conditions and then refer to the right practitioner.

If a certain practitioner is not effective, one cannot assume every practioner of that field lacks the ability to deal with the problem within their scope of practice. If you refer to a chiropractor that doesn't do a good job, you cannot say "chiropractic is bad", and vice versa for any other field. When people don't like their dentist or doctor, they don't just discount medicine or dentistry, they go find someone they do like that does a better job for them.

At the moment, TMD does not have a ton of research behind- and so many of the approaches are what works in practice- and yes you can get into trouble doing that if something goes wrong and then you are discovered and questioned- that I am aware of. On the same token, many types of medications and surgeries that are performed lack significant scientific evidence supporting their use- but they are still utilized because they work- the mechanism remains foggy.

I think after seeing that many dentists view TMJ as a theory and do not deal with it in practice, my energy will be focused elsewhere. I appreciate all of the input.

Good sir, I believe you are constantly missing the point, or simply not reading the plethora of very good responses to your statements.

Your energy should be focused in not messing with the TMJ if you dont understand the anatomy and mechanics of the joint indepth. You may be opening yourself up to litigation. If I was an attorney would for sure not hesitate to jump down the throat of a chiropractor for messing with a TMJ using 'pressure points' and will be able to call a host of specialists to support my cause.
It's a very tempermental thing, sort of like a bad girlfriend ;better to not start a fight if you're not carrying roses.

And FYI all dentists are(right?) trained to treat a patient who presents with a simple , lockout as you put it with secret pressure points.
 
DC's spend a lot of time looking at the many relationships the spine has with the body- which I would advise not to underestimate. I respect the views and opinions from the dental realm as well though.


Perhaps DC's should spend a little less time looking and a little more time performing Randomized Clinical trials. It's been said several times throughout this thread- you can't make claims that dentists and specialists should work in conjunction with DC's to treat TMD without a shread of half decent evidence as to why. Until that happens, your claims will be more than "underestimated."

"many types of medications and surgeries that are performed lack significant scientific evidence supporting their use"

Uhh seriously? There is a lot of solid clinical research on TMD tx with scientific evidence supporting the use of medication and surgery. You might have want to read before you said that.

All things aside, it is in our best interest to provide great care for our pts and severe TMD can be very difficult to manage. We are more than willing to look at this disease process from views other than the ones we already have. However, we are not going to refer our pts to chiropractors if there is no clinical/ scientific evidence showing positive outcomes.
 
Chiropractic discrimination and being viewed as inferior is prevalent- I know this- but TMD treatment with trigger point and muscle PIR is affective as well as activator use to level the condyles-im afraid it's true that were - an osteopath presenting OMM TMD Tx, the criticism would not have been as heavy. Anyone that disagrees knows that is the truth. There is a hierarchy, and unfortunately DC's are near the bottom-a serious inquiry about TMD, I'm glad it was entertaining. Good day.
 
If I were to tell an attending that TMD can be cured by lisinopril, he would ask me where I got that idea. If I were to justify it by saying

“Read a [pharmacology] book and put it together- that is all the evidence you need. If you want studies, show some interest - it is baffling how no one has any idea about it..PS. You can't bill for a theory.”

My 2 hole would be so ripped apart I could fit a 50fr rectal tube up it sans lube. No one in healthcare can make claims without solid research to back it up.

Crying discrimination against DC because other healthcare providers require some evidence to support your claims is Bush league.
 
I think after seeing that many dentists view TMJ as a theory and do not deal with it in practice, my energy will be focused elsewhere. I appreciate all of the input.

You have it all figured out wrong. Every dentist believes TMD exists - when you have that PITA patient in the chair complaining of pain on opening, headaches, muscle tension, limited range of motion, funny looking condyles on the panoramic xray, etc. etc., the dentist knows this is a TMD patient. The confusion you are having is that when this seemingly complicated patient shows up in a general dentist's office, he/she will not touch this patient and almost always first refer to ANOTHER DENTIST to manage the condition. Who the dentist refers to depends on who practices in your area. In some areas, there are dentists and dental specialists who focus their practice on TMD so the patient may be sent there (these are the doctors who are likely to members of the AAOP/AACFP). In other areas, the patient maybe sent to an Oral Surgeon or an Orthodontist.

Now this secondary practitioner will treat the TMD and try to improve the patient's condition and THEN may or may not refer the TMD patient to a chiropractor for further management. If you want referrals for TMD patients, it will come from this guy. However, it will depend on that dentist's philosophy on managing TMD. Unlike other conditions in dentistry where the answer is same among all dentists (grossly carious root tip = extraction), the treatment for TMD varies greatly among dentists.

I would venture to say that there are probably a lot of patients who probably never get treatment for a TMD because they are lost somewhere in the medical world being treated for headaches and depression when the problem is related to the joint/disc/occlusion. It's not that dentists are ignoring TMD or pretending it doesn't exist, it's just a somewhat muddled field across medicine and dentistry.
 
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TMD = Trash My Day


everybody's favorite patients!
 
You have it all figured out wrong. Every dentist believes TMD exists - when you have that PITA patient in the chair complaining of pain on opening, headaches, muscle tension, limited range of motion, funny looking condyles on the panoramic xray, etc. etc., the dentist knows this is a TMD patient. The confusion you are having is that when this seemingly complicated patient shows up in a general dentist's office, he/she will not touch this patient and almost always first refer to ANOTHER DENTIST to manage the condition. Who the dentist refers to depends on who practices in your area. In some areas, there are dentists and dental specialists who focus their practice on TMD so the patient may be sent there (these are the doctors who are likely to members of the AAOP/AACFP). In other areas, the patient maybe sent to an Oral Surgeon or an Orthodontist.

Now this secondary practitioner will treat the TMD and try to improve the patient's condition and THEN may or may not refer the TMD patient to a chiropractor for further management. If you want referrals for TMD patients, it will come from this guy. However, it will depend on that dentist's philosophy on managing TMD. Unlike other conditions in dentistry where the answer is same among all dentists (grossly carious root tip = extraction), the treatment for TMD varies greatly among dentists.

I would venture to say that there are probably a lot of patients who probably never get treatment for a TMD because they are lost somewhere in the medical world being treated for headaches and depression when the problem is related to the joint/disc/occlusion. It's not that dentists are ignoring TMD or pretending it doesn't exist, it's just a somewhat muddled field across medicine and dentistry.


This is dead on. We used to manage some TMD in our practice and just realized due to multifactorial causes of TMD it just wasn't worth it. I now refer to a group of "TMJ" dentists that have a psychiatrist, neurologist, and physical therapist on staff.

If you want to get dental referrals for TMD, a pain clinic that handles TMD may be the way to do it.
 
This is dead on. We used to manage some TMD in our practice and just realized due to multifactorial causes of TMD it just wasn't worth it. I now refer to a group of "TMJ" dentists that have a psychiatrist, neurologist, and physical therapist on staff.

If you want to get dental referrals for TMD, a pain clinic that handles TMD may be the way to do it.
Healthpartners?
 
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?

On the patients part, I think it would get frustrating not having any answers and the problem not going away; on the clinicians part not having the answer and having to refer them?...I also think that when you start sending a patient here and there and referral to referral they often times just give up and end up living with the condition because they are frustrated, perhaps leading to more chronic conditions that when readdressed, have gone on to cause a multitude of other related issues, and so it takes someone with the time and will power to go back and decipher the problem piece by piece. In reality, I feel like most docs don't have the time to deal with cases like that with a full head of steam...
 
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?

On the patients part, I think it would get frustrating not having any answers and the problem not going away; on the clinicians part not having the answer and having to refer them?...I also think that when you start sending a patient here and there and referral to referral they often times just give up and end up living with the condition because they are frustrated, perhaps leading to more chronic conditions that when readdressed, have gone on to cause a multitude of other related issues, and so it takes someone with the time and will power to go back and decipher the problem piece by piece. In reality, I feel like most docs don't have the time to deal with cases like that with a full head of steam...

And chiropractic holds all the answers?
 
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?

On the patients part, I think it would get frustrating not having any answers and the problem not going away; on the clinicians part not having the answer and having to refer them?...I also think that when you start sending a patient here and there and referral to referral they often times just give up and end up living with the condition because they are frustrated, perhaps leading to more chronic conditions that when readdressed, have gone on to cause a multitude of other related issues, and so it takes someone with the time and will power to go back and decipher the problem piece by piece. In reality, I feel like most docs don't have the time to deal with cases like that with a full head of steam...

The part in bold is EXACTLY WHAT A TMD DENTIST DOES. There are practitioners who have devoted their whole practice to doing just what you wrote because your average general dentist really doesn't have the time and the training to deal with the chronic patients.

I don't understand your point am confused like armorshell how a chiropractor figures into this problem.
 
Is a sham manipulation for placebo different from a "real" manipulation that doesn't do anything? There's the real question.

This made me lol.
 
No one knows how a DC figures in bc you don't seem to understand what we do- deal with MS and spinal problems and those related to the spine- we are also legally responsible for being aware of other non-chiropractic problems and referring - conservative treatment for TMD falls into our scope and we are trained in that- we specialize in spinal pathology- the spine, from cervical to pelvis can affect each other, fixing one often times fixes the other- on that end, the TMJ can be affected by muscle and osseous structure of the neck and skull.
 
the TMJ can be affected by muscle and osseous structure of the neck and skull.

O H M Y H O L Y C R A P.

How do you know? Have you read anything that has been posted. You came on here asking what training we as dentists and dental specialists had as far as the relationship between TMD and the spine.

Most of us, if not all, said we didn't really get any information about the relationship of the two.

We then went on to discuss the lack, if not complete void, of research linking the two issues.

As far as treating TMD, most OMFS and those in dentistry are proficient in treating TMD from a dental standpoint.

These patients are typically treated conservatively at first:
1) Bite guard - made by dentist
2) Soft diet
3) Limited mouth opening - stifling yawns, stretching is avoided, etc.
4) Soft diet
5) Muscle relaxants

If this does not reolve the problem, imaging is done.
1) Panorex - dental office
2) CT scan or CBCT
3) MRI

From these images and from patient complaints and symptoms it can be deduced whether or not the patient has a muscular issue and/or skeletal or none at all.

Some cases of TMD are mysteries.

From here other approaches can be performed - surgical, etc.

The majority (in my experience) of TMD patients are crazy which I would argue is the reason most dentists refer these patients to those who have dedicated their practice to them.

So from here I still don't know what you are asking.

IF DC's routinely helped to cure TMD then wouldn't we as dentists and specialists know about it and refer accordingly? YES. SO why don't we?

1) There is no DATA. I could care less about you talking about your blow hole about ant sup placed skulls and 5mm displacements of spines, all very interesting and it does play a part in health care, BUT UNTIL YOU SHOW ME THE MONEY, I DON'T BUY IT and can legally be held responsible for it.
2)Because of claims made like this, DC's have gotten the reputation of being snake oil salesmen.


If you think this is an area that could potentially help patients suffering from TMD, then i would suggest starting some research in the area. Until then most of us are going to look at you cockeyed when you say that you can play a part in the 'curing' of TMD.

I hope that makes sense. Blunt, hopefully not condescending, and a good topic to explore, but it needs research.
 
No one knows how a DC figures in bc you don't seem to understand what we do.

Really? We have asked you several times to tell us what DC has to offer in terms of TMD tx. From there you have given us several explanations/ tx options. Your explantaions/ tx options have had two things in common up to now: 1) a basic lack of accurate head and neck anatomy 2) a lack of clinical research to back up your claims. Anecdotal evidence and case presentations do not suffice as they don't guide tx protocol for ANYONE in mainstream medicine (that includes dentistry- were not "picking" on you because we belive you are inferior to us- were "picking" on you because no one likes getting asked to swallow the BS that your feeding us :laugh: [I'm kidding about that last part])

There have been several excellent posts describing how we as dentists/ dental specialists treat/ manage TMD. I can tell you that anyone of these posters can back up their proposed tx with peer reviewed clinical research. At this point Im not sure if you "understand what we do."

If you have any more to say on this matter we will be glad to voice our opinions and I encourage you to do so. I wish you luck with your future endevors.
 
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?
...


Greetings,

Since the etiology of TMD can be multi-factorial, you need to take a detailed medical history of the patients and then determine if you need to treat and/or refer them to someone else. I have referred some of my TMD patients to neurologists, psychologists, psychiatrists, OMFS, endodontists, radiologists and others in addition to what I can do for them as a prosthodontist. You do what you were trained and taught. You render treatments based on medically accepted principles and backed up by sound scientific evidence. Consider this example and tell me how you would treat this patient.

Mr. Jones is a 79 year old male who presented to your clinic requesting treatment to the TMJ problem that he has been having. You noticed he is without any teeth. His chief complaint consists of noises on both of his TMJs during functioning and with increasing pain in the past year. He had noticed the symptoms appeared more in severity since his wife of 60 years passed away last fall. He also bought in a long list of medications that include arthritic meds.

I would like to know how you manage this patient from chiropractic point of view. DP
 
Chiropractic discrimination and being viewed as inferior is prevalent- I know this- but TMD treatment with trigger point and muscle PIR is affective as well as activator use to level the condyles-im afraid it's true that were - an osteopath presenting OMM TMD Tx, the criticism would not have been as heavy. Anyone that disagrees knows that is the truth. There is a hierarchy, and unfortunately DC's are near the bottom-a serious inquiry about TMD, I'm glad it was entertaining. Good day.

In my opinion, the reason why some people do not believe in chiropractic treatment for certain conditions is due to the lack of scientific data to support its claim. If you believe chiropractic therapy treats TMD, sleep apnea, impotence or whatever, then encourage fellow DCs to publish papers and convince the medical community on how it works. If you make perfect sense then nobody will ever question your judgments. Until someone in your community steps forward and do this, you are not going to change on how some people perceive the validity of chiropractic therapy. I am not questioning the profession at all and please do not take this as an offense. DP
 
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Mr. Jones is a 79 year old male who presented to your clinic requesting treatment to the TMJ problem that he has been having. You noticed he is without any teeth. His chief complaint consists of noises on both of his TMJs during functioning and with increasing pain in the past year. He had noticed the symptoms appeared more in severity since his wife of 60 years passed away last fall. He also bought in a long list of medications that include arthritic meds.

I would like to know how you manage this patient from chiropractic point of view. DP


This is an interesting case; I would really like to know the onset of the symptoms in order to coorelate when they started with the mechanism that caused it to begin, and whether or not he has had a history of treatment for the TMJ or had ever been diagnosed with TMD.

- wife passed away: I would like to find out if there is an emotional/stress component and elicit him to talk about how he has been feeling and inquire about any changes in habits and/or energy.

-no teeth: I would be concerned about his diet and whether or not he is getting the proper nutrition, and whether or not he prepares food for himself or if his wife did so for him (he may need counseling on food choices and perparation). I would like to know if his diet is mainly liquid or solid. A dental history would be helpful if available.

The arthritic changes that have occured would appear normal due to the aging process. If pain or the inability to use the mandible are present, I would refer to a dentist to evaluate him further. I would not adjust or treat the TMJ but rather make notes of the visit and send them to the dentist.
Treatment at this point consists of evaluating the man for psychological state and diet practice (helping him to create one if needed) and making the proper referral.
 
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