The View From the Other Side of the Chair……A Dentists Journey With TMJ Disorder

We received this email from a dentist and wanted to share his journey with you. The tips he offers come from the perspective of not only a dentist, but also a patient.  


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Hi Stacy,

Before you think, oh, no just someone looking to advertise his prowess in what is (sadly) an already competitive market (excuse my cynicism), I wanted to say what a good idea it was to share your problem with others
 
I was an ordinary (and successful) dentist until about 1997-8 when I started to get head, neck and shoulder pains. I got tired easily (even though I was younger then). I sought help from my friends and they were quite unable to help, indeed most thought I wanted sympathy I think. At about that time our son was completing his orthodontics with a friend of ours. Although I had misgivings, he had 4 teeth removed and was told to use headgear. My wife and I watched his health go downhill (he was VERY active previously) and healthy prior to this. 
 
My own headaches were getting worse and worse and I had to start taking time off – they were like migraines (but I believed they weren’t – they didn’t seem to have the same character) it sounded like TMJ to me but only patients got that and anyway my education had been that this was a psychosomatic illness – all in their head. In the end I told our son to stop wearing the headache (we’ve seen him cry at dinner with the pain from his TMJ) which took some of the immediate severity away.
 
I couldn’t work anymore and at a chance meeting of a dentist in the US  I realized what a reversible and non-invasive oral appliance could do. The next day at about 10 am I was in a lecture I suddenly realized I was no longer in pain – I’d been suffering so long I’d got used to it.
 
Thus my quest started, my wife was understanding and I went to every course/seminar/presentation etc. available. I began to realise that dentists often inadvertently cause or worsen dental treatment. We worked through everything we’d earned or saved. I bean to get a picture of what had been going on. I had been successful previously not because of me, but despite me! One of the worst  offenders is taking out teeth for orthodontics. It narrows the upper arch, entrapping the lower arch of teeth and thereby compressing the TMJ. I opened up the extraction spaces for our son and used an appliance and he became pain free. 
 
Any treatment MUST be reversible and non-invasive as we (dentists) can’t know everything despite all the training we put ourseles through. I took all the TMJ courses in a famous school in Nevada, then started to practice in the UK. Other dentists hated me but the approach made perfectly good sense to my patients.. I took a fellowship in Craniofacial pain and continued to bang my head against the wall in the UK, slowly getting more and more criticism  I moved to Boston and took a fellowship in orofacial pain and sleep, then offered a position there, remained as an instructor before recognising that TMJ and facial pain is related to airway and obstructive sleep apnea. Then I pursued Sleep Medicine while still treating TMJD.
 
The problem is this. Dentists think that because they have a lot of experience, i.e. 30 years it’s good – but it could mean that potentially if they’ve done the wrong thing for 30 years, which doesn’t make it right. Humility is not usually at the top of most dentists’ characteristics, and they don’t like to be told. Dental schools are almost always out of date (like textbooks) and most dentists (even ones advertising TMJ) usually know little, apart from what they’ve learned at a recent course. I mention this because I’ve been there and done that.
 
If I had to make “some suggestions” they would be;
 
  1. Ask questions – you are not going to know if the answers are right, or even if you’re asking the right questions, but you have to start somewhere.  Sometines you get a “feeling” and anyway; it’s more education for later. 
  2. Keep ALL of your records, most of us have more instructions for our refrigerator than ourselves !?
  3. Get a second opinion and use what you’ve learned to phrase your questions. It’s OK if the dentist is not right for you, it’s not personal, you need specialized care that’s all.
  4. You must get a complete exam – and again, you must have copies of the records – keep them in a file.
  5. Just like the Hippocratic Oath “Do no harm” treatment should at least start as NON-INVASVE and REVERSIBLE. You don’t want to make things worse do you? PLEASE don’t have surgery as a first option.
  6. Ask about the big picture. “What if? What would I do then? What options would I have when I was pain free?”
  7. Take counsel with friends too; they rarely have anything sensible or useful to say (unless you’re lucky) but it gets you thinking. 
  8. Don’t get pressured into treatment, obviously you want to get better, just don’t rush into something.
  9. Check costs, a range is OK as treatment may need to be staged anyway. We’re all different.
  10. By all means read up on it; here’s a lot of useful and valuable info’ (as well as rubbish) out there in books and the internet but unless you’re going to become a clinician, try not to get too bogged down.
  11. In my experience, telling patients what’s going on is obvious to them; it’s other dentists that have a problem with it. Who ever treats you must listen to you. It’s about you, NOT them.
  12. Understand that your doctor (MD) probably doesn’t understand, they tend to treat symptoms not the cause – it’s the nature of the beast.
  13. Recognize that TMJD is influenced by many things, airway and sleep disordered breathing is a “biggy”
  14. Don’t give up, accept that your recovery is not going to be linear, it may be slow but it should be going in the right direction. Your dentist will likely use a log (no-one remembers the last 2 weeks – I can’t even remember what I did yesterday half the time) 
  15. Ask your (chosen) dentist questions as you go along, but sometimes treatment takes a while – weeks/months, not years. He may just become your best friend in the whole world.
 
So I’ll get down from my soapbox now. No one knows anything really, we just believe things to be true. Evidence based medicine is based on – what evidence, and based on what? As Einstein said, The greatest hurdle to new learning, is old learning”
 
Stephen

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