TMD, Oral Orthotics and the Dental Role

I have spent well over 25 years helping to orchestrate co-operative and co-ordinated interdisciplinary diagnostic and treatment models for TMD. The examination, diagnosis and treatment guidelines I outline in www.whiplashandtmj.com work and can make a profound impact on this all too prevalent cause of chronic pain (ranked as second only to low back pain by the NIH in the US). I am hoping that this blog will generate interest and help develop effective treatment teams apart from the “Regional Expert” model. While we need these “TMD experts” and their input, there are far too many sufferers for that model to stand alone.

tmd splintThis is the first of a series of posts on the dental role in treatment of TMD. I’ll start with this; while it has become clear that “malocclusion” is not a cause of TMD and can not be used to predict the eventual onset of TMD, it can perpetuate a TMD once TMD symptoms arise. In that case a dentist can be an invaluable asset to the treatment team as some form of oral orthotic (case specific as to type) may well make all the difference in treatment outcome. PERMANENT CHANGES IN THE OCCLUSION SHOULD NEVER BE MADE WHILE THE PATIENT IS SYMPTOM EXPRESSIVE HOWEVER, AND PERMANENT OCCLUSAL CHANGES ARE RARELY NEEDED TO STABILIZE A SUCCESSFUL TREATMENT RESULT.

tmj splintThis section will be a work in progress and I would love to see a large volume of comments on this topic. It may seem odd that this information comes from a chiropractor but keep in mind that my seminars on this topic were approved for continuing education credits for dentists by the California Dental Board and the “Examination and Diagnosis” section of www.whiplashandtmj.com was reviewed and approved for publication by the University of Michigan School of Dentistry.

Here are three basic, but critically important guidelines… more detailed suggestions to follow:

tmjd splintFirst, and this is an absolute truth that is too often ignored: NO ORAL ORTHOTIC/BITE SPLINT WILL WORK IF THE PATIENT DOES NOT WEAR IT! You must have patient compliance to have any chance of success, no matter what technique or type of orthotic you use. This includes issues such as appearance, comfort, ease of swallowing, interference with speech patterns and more.

Second, when using an oral orthotic in treatment of a TMD you must make sure to avoid unwanted orthodontic movement of the teeth (e.g. extrusion, intrusion, etc.).

tmj splint fittingThird, outside of parafunctional activity (e.g. clenching and grinding), the maxillary teeth contact the mandibular teeth infrequently (about 5 minutes out of 24 hours when swallowing), however, initial occlusal contact influences head/neck posture and head/neck posture influences initial occlusal contact. These facts should be considered by anyone treating TMD patients.

The article below is interesting and I welcome comments:

Warning: “Diagnostic Tools” Proven to be Inaccurate
Scientists have studied the accuracy of electromyography (EMG) of jaw muscles and kinesiographic (KG) recordings that some dentists use to diagnose a TMJ problem. The findings of recent studies show these tools are inaccurate and can provide false positives (indicating that you have a TMD problem when you actually do not). Click here to read a summary of the research findings.

About Dr. Dennis P. Steigerwald

Dr. Dennis P. Steigerwald focused his chiropractic practice on temporomandibular disorders (TMD) for over 25 years and has treated over 10,000 TMD cases including the post-op care and/or management of over 1,000 TMJ surgeries. Dr. Steigerwald served on the editorial staff of 'The Journal of Craniomandibular Practice' (CRANIO) from 1995-2001 and in that capacity he was the only chiropractor in a five doctor panel appointed to review scientific study submissions. He has served as an expert witness in TMD cases in both the personal injury and workers compensation arenas on numerous occasions. Dr. Steigerwald has also authored studies, textbooks and training programs for the chiropractic and dental professions both on TMD and whiplash including the educational website www.whiplashandtmj.com.

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