One of the hottest topics in dentistry has been the ongoing debate regarding the diagnosis and treatment of Temporo-Mandibular Disorder (TMD). TMD has caused more confusion and disagreement among dentists than any other area of dentistry. There are several reasons for that including training and education, variation in symptoms, etiology, as well as philosophy practiced by the dentist themselves. The problem also lies in the definition of what a healthy joint looks like and where it should be when it comes to its position and our past education may have been somewhat misleading depending on the dental school we graduated from. In addition, the presentation of the disorder, as well as related symptoms, can vary from patient to patient, making it even more challenging to diagnose and treat correctly.
Variation in Symptoms
Common TMD symptoms include pain, clicking or popping, crepitus, limited opening, locked jaw, tooth pain, headaches, migraine, facial pain, neck pain, limited range of motion, ear pain, tinnitus (ringing in the ear), vertigo, trigeminal neuralgia, fibromyalgia, numbness in fingers. Depending on the patient, the type of TMD derangement, as well as length of time, symptoms can widely vary and range from none to extreme. Two patients with the exact same type of TMD can present in various different ways with very different symptoms. In addition, even when identical TMD is present in each of those patients, treatment can vary widely depending on many factors. Each case is unique and comes with its own set of challenges.
TMD Etiology
The cause of TMD is also a highly debated topic. There are those who firmly believe that TMD is a neurological condition caused by a hypersensitive central nervous system (CNS). As such, those doctors would likely manage the patient with medications such as anti-epileptic pharmaceuticals that reduce all CNS functions. Then there are those who believe that this is a psychosocial disorder and requires counseling or medical management with psychotropic medications, like antidepressants, anti-anxiety meds, or mood stabilizers. And then there are those (myself included) that the etiology is related to jaw position and teeth relationship when biting down and at rest, and so the treatment would involve correcting the occlusion (the way the jaw and teeth relate). And even among those treating TMD by correcting occlusion, there is massive debate on how exactly that should be accomplished.
TMD Training and Education
Many dental schools teach what’s known as the Centric Relation (CR) philosophy. But even here, there are many different definitions of CR, and there is also little agreement on CR practice methodology. Further, the way CR position is obtained varies and so lies the dilemma of what is the correct jaw position in the first place. To further confuse dentists and patients alike, there are different post-graduate programs one can take to further their education on TMD, each teaching different forms, protocols, and treatments.
Confused Yet?
It’s no wonder that most dentists stay clear of treating TMD cases, especially the more challenging ones and many patients go on suffering with pain only to rely on medications to try and manage their symptoms. Many of the TMD patients we see in my practice have tried many different treatments, all with little or no symptom resolution, and have lost hope. All of us want to help our patients and do what’s best for them, and we provide patients with the options and treatments we believe in. So when I see a patient in my office that has gone to many different professionals and has not had relief, the main focus for me is to determine whether or not I can finally resolve their TMD. If so, we can then discuss the treatment options and expectations of the outcome as well as how to get there. But I do know one thing after years of treating TMD successfully: each case is different and each patient requires a unique approach in order to resolve their condition.
About Dr. Agatha Bis
Oakville Dentist, Dr. Agatha Bis, DDS received her Doctor of Dental Surgery degree from the University of Western Ontario in 1996. With over 25 years of clinical experience creating beautiful and healthy smiles, Dr. Bis offers a unique approach to dentistry, blending modern dental practices with the use of digital technology to optimize health outcomes. With thousands of hours in post-graduate training, her unique focus and expertise in treating TMD and providing options in restorative dentistry, along with digital technology have led to helping numerous patients resolve chronic and debilitating dental challenges.