The TMJ Association - changing the face of TMJ

TMJ Resources - Our Family - Patient Talk

Dr. D

I am a dentist who became a TMJ sufferer in 2000 through an odd circumstance. I came across your web site and your request for patient representatives while researching various aspects of TMJ.

I became interested in occlusion and occlusal muscle harmony after attending a seminar in 1999 presented by a nationally known clinician. I personally had no history of TMJ or Myofacial Pain Dysfunction but a number of my patients had and I was trying to find a way of helping them. This particular clinician had very convincing arguments why his critics including NIH, were completely wrong in there approach to TMJ and neuromuscular harmony. He seemed to have the answers which eluded everyone else. His claim was that through proper equilibration of the dentition, one could restore the neuromuscular harmony of the facial muscles and TMJ. If equilibration alone could not solve the problem in its entirety, then either crown and bridge, orthodontics or surgery could be used to supplement the equilibration process. He was so convincing that I became a disciple of his teachings, taking a number of his courses on occlusion and TMJ. I was so convinced that I had finally found the answers which eluded dentists in the past. It was constantly stressed that equilibration causes no harm and can only benefit the patient.

The procedure was even offered to course participants, for a fee, of course. It was stressed that if you are adjusting your own patients bite, you should have your own adjusted. I so believed in what I was told, that I signed up for the procedure, being assured that this could only be a benefit and could cause no harm. The procedure was done over lunchtime during one of the seminars. What happened to me was unthinkable. My bite was closed down 2 millimeters as a result of the equilibration. This forced my condyles into retrodiscal tissue when I maximally intercuspated, resulting in tremendous pain, spasms and TMJ dysfunction. Most of my natural tooth morphology had been obliterated. I was told that the problem had nothing to do with the equilibration that I was not closed down and the resulting pain and spasms were attributable to clenching and bruxing. I did not believe this theory. The pain started shortly after the procedure was completed. Models I had taken on myself showed the destruction of tooth morphology and the subsequent over closure. Iatrogenic over closure with compression of retrodiscal tissue was subsequently verified by numerous practitioners who I sought second opinions from. MRI studies also confirmed this.

I was left with only three options to decompress retrodiscal tissue and to restore my vertical back to where it was prior to the equilibration: 1) orthognathic surgery to reposition the jaws, 2) full mouth reconstruction with crowns or 3) orthodontics to super erupt the teeth, with no guarantee this would work. For me, it was the lesser of three evils. I began orthodontic treatment in February 2001 and I am currently still in treatment

I know first hand the pain, frustration, loneliness and depression which accompanies the course of such a problem. Further complicating the issue was the nagging realization that I allowed this to be done to me simply as an academic exercise and not as the result of any preexisting TMJ problem. It's too late for me. I learned the hard way. I now realize, through my research, that there is no scientific basis for harmonizing the bite or other forms of irreversible therapy except in very select, isolated cases. The sad part of this is that scores of dentists who attend these seminars are led to believe that this irreversible procedure can only help their patients and can cause no harm.

It is not for me to judge the merits or lack thereof, of occlusal equilibration or of any other irreversible procedure. Individuals are free to choose the type of treatment they wish to pursue but those who choose irreversible treatment, equilibration included, have the right to be told they could be left worse off or irreversibly damaged for life. I was never afforded that luxury.

I would be happy to discuss any ways I could help. There needs to be a uniform, defined standard for the diagnosis and treatment of TMJ disorders otherwise patients are subjected to the whims of every practitioner's pet theory on how it should be treated. Anecdotal testimonies of the success or failure of a particular theory have no scientific validity. Without well organized, independently verifiable studies on the validity of any particular treatment regime, we cannot even begin to have hope.

I would be interested in knowing, for my own peace of mind, if you have come across patients who have had there bites equilibrated and the results of the outcome. I have a strong feeling, I am not alone.