Dental Management

Dentists use the same medical management tools in combination with oral appliances. However, they can't agree on which to use when. Today a patient with a TMJ disorder in a large city could see a dozen different dentists who advertise treatment of TMJ disorders and receive ten different treatment plans. Most won't ever change the bite. Some will shift all bites forward (myotronics). Some will shift all bites backward (centric relation). Some will recommend wearing an oral appliance full time without providing an exit plan from forever appliance wear, other than seeing an orthodontist who will simply straighten the teeth without having any way to know how it will affect jaw positions. Some will recommend a lower nightguard, even though it can increase the overbite and thereby exacerbate the root problem. Some will refer TMJs that show advanced degenerative changes on X-ray to an oral surgeon, even though those technically arthritic TMJs may have already fully healed and are no longer causing symptoms. Prosthodontists usually treat the problem by crowning all the teeth according to traditional bite techniques, without having any way of knowing if such extensive treatment is needed to resolve the symptoms. In the name of being comprehensive and for the purposes of feeling legally protected, many dentists perform extensive TMJ X-rays and other diagnostic tests, which make their medical/dental exam look and feel very thorough, even though these tests are extremely unlikely to affect treatment. 

The GOOD NEWS is that TMJ disorder symptoms eventually disappear due to adaptation, whether treated or not, because TMJs naturally heal with time. Subsequently, tight jaw muscles can still produce pain and other symptoms as subsets of postural muscle tightness, but the muscle tightness is no longer being caused by the TMJ damage, and it can be treated like muscle tightness in other parts of the body. Some patients tell me that they've had a TMJ disorder for decades, but that requires a continuous source of strain, because they don't naturally last that long.