The average dentist sees hundreds of patients a year suffering from headaches, muscle pain, and bruxism.1 Most dentists would love to help these patients but many feel overwhelmed when patients present with multiple symptoms of the head and neck. Because of that, many patients seek relief but fail to obtain successful treatment for these symptoms at their general dentist.2
A common problem that misleads many providers is that when they see a patient with several symptoms of the head and neck, they naturally think that multiple symptoms are from multiple causes. This is usually an incorrect assumption.
Simplification is the secret to treating even the most complex occlusal and functional issues. It’s about finding the common denominator — the most likely source of the symptoms — that is causing the patient to suffer.3 Once a provider can do that consistently, the treatment becomes significantly more reliable in its results.
Pain Begins Because of Disharmony
When we hear the term temporomandibular joint (TMJ) disorder it’s incredibly misleading. Most patients and providers would think the condition is a result of some deterioration or injury to the TMJ.
However, when you actually begin treating a significant amount of temporomandibular patients, you find the majority mostly complain about muscle soreness, ear pain, headaches, clenching, and grinding. Its rare that a patient complains of pain at the TMJ alone. Usually the accompanying symptoms are a much more powerful drive for them to seek treatment.
TMJ disorder is a signal of disharmony and it produces a powerful collection of symptoms. Although these symptoms on the surface seem daunting, they are often the result of only one primary cause — not multiple ones.
Success Is Simple
The treatment of TMJ dysfunction is largely misunderstood because it straddles both dental and medical concepts. When a dentist recommends an occlusal guard, it’s a way to protect the teeth from damage caused by clenching or grinding. That’s treating a dental issue.
But what’s causing the patient to clench and grind in the first place? That’s usually an orthopedic issue.4 Now, here’s the key concept — we can’t decouple the dental issue from the medical issue. The point is dentists are experts of the head and neck so we shouldn’t stop short by neglecting the cause and treating only the effect.
Most dentists take the bite for occlusal guards in centric occlusion. If you use the same bite that’s causing symptoms, guess what? You’re going to get the same issues.
To take functional treatment to the next level, we need to test it. This is where orthopedic oral appliances come in. Such an appliance not only protects the teeth, but, more important, allows the mandible to test a new position — a position in which the structures of the head and neck can potentially heal.5
The goal of oral appliances is now less about protecting the teeth and more about treating what is causing the teeth to wear in the first place. When used properly, an oral appliance should represent an opportunity to take the teeth out of the equation and gather feedback to enhance long-term patient treatment with greater precision and predictability.
- Valesan LF, Da-Cas CD, Réus JC, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021;25:441-453.
- Kmeid E, Nacouzi M, Hallit S, Rohayem Z. Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress. Head Face Med. 2020;16:19.
- Laskin D, Greene CS, Hylander WL. Temporomandibular Disorders: An Evidence-Based Approach to Diagnosis and Treatment. Batavia, Illinois: Quintessence Publishing; 2006.
- Kim MR, Graber TM, Viana MA. Orthodontics and temporomandibular disorder: a meta-analysis. Am J Orthod Dentofacial Orthop. 2002;121:438–446.
- Hamata MM, Zuim PRJ, Garcia AR. Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients. J Appl Oral Sci. 2009;17:32–38.
From Decisions in Dentistry. November/December 2023; 9(10):22