As this will be my last post on this forum, and I suspect this will only be up for a short time before the NM dentists have all my posts removed, I’ve decided to give a “State of the Union” type of missive. To those who get the chance to read it, I hope you can take something positive away from this. To those of you who do not “get” my sense of humour, I apologize in advance, as well as for the posts that you thought were ill-mannered. The internet is a terrible place to sometimes put down your thoughts, as inflection, tone and facial expressions are inherent in the spoken word, but are often missed in the written.

First, let’s start by using proper terminology....... we all have TMJ. As a matter of fact, we have 2 of them ! ( Insert winkie face ). The proper term for this collection of maladies is “TMD”, which , in loose terms, means that your lower jaw doesn’t work the way it should with your upper jaw. That is a very loose interpretation, and is not a great descriptor for what is actually happening. Therefore, TMD as an entity has very little meaning as a diagnosis. There are so many structures involved that we must actually identify each and every component that is involved to come up with a proper diagnosis, and eventually, a treatment plan. So many of you are looking for answers from your fellow sufferers, but fail to realize that you may be suffering from completely different problems. Take heart from the fact that people who are suffering may have found a solution, but don’t think this is a “One size fits all” thing.

Treatments. You may be surprised that there is no definitive treatment protocol for many of the issues from which you suffer, even amongst those who “specialize” in TMD therapy. Yes, a splint, or orthotic, or night guard ( all the same ) is one of the first lines of defence that dentists use, but what may really surprise you is that there is no clear science that demonstrates that one is better than another. As a matter of fact, an appliance that doesn’t even change the bite , and has no acrylic on the biting surfaces, has been shown to be effective in 30% of cases. When we are really talking about appliances, you will find that ANY design will work for somebody....maybe many people. And, unfortunately, NO appliance will work for some people, no matter how many different designs they try.

So why do people get TMD ?? There is a lot of science that shows that it isn’t really a structural problem, per se. Yes, the structures can get injured, but it is not the fault of the structures that causes the problem....... they are the collateral damage. Making them the way they use to be, or a dentist’s ( or dental group’s ) idea of ideal does not always, or actually very often, solve the problem. I like the saying, “ It ain’t what you got, but what you do with what you got.”
But it’s more than that..... Whatever structure you have, whatever you do with or to that structure ( grinding, clenching, injuries like whiplash ) that seem to be causing you a world of pain, I will show you 3 people with the exact same structures and injuries who have no pain or dysfunction at all. It seems weird, but there are more complicated problems going on......at a microscopic, biochemical, neurobiological level. We as dentists don’t want to deal with that, because we fix structures. And TMD therapy fits perfectly within a dentist’s scope of practice ... we want all the solutions to your problems to be related to your teeth, because that’s what we fix best !!

It comes down to science. Some on the forum say that science can show you whatever results you want. Well, in a way that’s true. But there is a world of difference between good science and bad science. It’s just that many don’t want to look at the science and make the effort to determine whether it is good or bad....even dentists. To me, that’s a huge cop out .... you can’t get into dentistry without studying science. As dentists, we owe it to you, our patients, that the science we base our treatment philosophies on , is sound. This is not the case....and this forum has provided some to propagate junk science and back it up with nothing more than the “company line” . While the US government has done away with “ Don’t ask, don’t tell” , LVI has adopted that philosophy whole-heartedly.

Ah yes.... LVI...... a Cosmetic Institute that was hugely successful financially due to it’s ability to sell the complete “ Extreme Makeover” package to dentists at a time when money was flowing and everybody desired the “Hollywood Smile”. Until those “Extreme Makeovers” started failing ( as many other comprehensive restorative institutes predicted they would ) , due to a lack of fundamental restorative concepts. Flush with cash (from dentists that wanted to learn how to make pretty smiles only ), LVI needed to adopt a restorative philosophy, and if they could stick it to those who predicted the massive amounts of porcelain failures, all the better. So they aligned themselves with a fringe dental movement that was all but on the way out ..... Neuromuscular dentistry. All the other restorative institutes used a jaw joint position known as “Centric Relation”, which really means that the lower jaw joint ( the ball ) was centered in the “socket” of the upper jaw ( or skull). This was always meant to be a starting point for restoring the the bite, but it evolved to the position the jaw should be for TMD purposes. NM dentistry used a different starting point.... one determined by TENSing the musculature to “de-fatigue” the muscles, and then recording a bite position based on the pulse of the elevators. This trajectory was thought to be the jaws “perfect” alignment for biting, but there is no proof of that.... only conjecture.

Truth is, until your teeth are actually together, there is NO WAY for a splint, orthodontics, restoration ( crowns, veneers ) to actually influence your jaw joint position or your musculature. So the very thing that we’re trying to influence, that being to control the excessive forces caused by function, CANNOT be influenced by any of our treatments until you actually bite. And by then, the forces have already come into play. All the LVI dentists that I have talked to say that they actually stop clenching and grinding by putting in an NM orthotic, but the orthotic has NO influence until you clench into it !!!

Can NM dentistry be useful ..... YES ... of course it can. Just as CR dentistry can be useful. As a restorative concept , it works just as well as any other restorative concept. But it is not a pain concept, because pain is much more complicated than where the TMJ is when the teeth are together. And until all dentists, who decide that changing bites is the way to fix pain problems, come to the realization that there is a huge disconnect between pain and restorative / orthodontic dentistry, then we are going to have a future in dentistry where insurance companies and licensing boards are going to start dictating exactly what kind of treatment you need for your TMD, if you are so unfortunate as to be labelled a TMD patient.

My advice, for what it’s worth, in the short time this post will be available, is this.

Find a TMD practitioner that will deal with your pain as a separate entity from your teeth / bite. Go to the AAOP website for information of where to find members of that organization.

If you wish to have orthodontics or restorative dentistry done ( because you need orthodontic or restorative therapy independently of your pain ), then seek out either a NM dentist or someone who is a member of the AACP since they have experience in dealing with the issues together. If a dentist is Pankey, Dawson, Spear or Kois trained, then they are a good bet also, especially restoratively.

STAY away from any dentist that tells you that you MUST have Phase 2 therapy ( orthodontic or restorative therapy) in order to treat your pain. It simply is not the case.

Avoid TMJ surgery if you can... try all conservative therapies, including drugs, to manage your pain before you consider surgery.


Thank you for the time on this forum. I have limited my practice to TMD and sleep therapy, so I know quite a bit on the subject. I have studied far and wide, on almost ALL the different philosophies. While I haven’t studied NM dentistry to the depth that 2netta has, my best friend / mentor in the field of pain is a former NM instructor and practitioner who has taught me all the concepts, and why they are falling by the wayside in the face of evidence based dentistry. He is , of course, persona non grata, due to the mere fact that he dared to question the concepts. I think it is important for you, the public, to be aware of the internal politics in the field of TMD.

Please seek the guidance and care of an experienced clinician. I am battling my own health issues, and I would never come to a forum like this to ask what the best treatment is. I trust my physicians to do what they are trained to do, and you should seek those I have outlined above. Good luck in your journey, and Holiday Wishes to you all.
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First Helper Hounder
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replied December 23rd, 2010
Experienced User
Thanks for the information, Hounder. Though not everyone might agree with what you have said in the past, it always helps to have a devil's advocate to get a clear view from all angles. Best wishes.
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replied January 1st, 2011
Hounders misinformation
Hounder- It is a sad state of affairs when you speak so negatively about something you know very little about. It is truly a shame that you place a whole group of doctors in a bad light. I am a NM doctor and am proud to change my guests lives for the better as most of my NM colleauges do as well.

It is obvious you are so biased you will never change your opinions, but the readers of your posts should know every dental school in Japan and one half the medical schools use the equipment we do to practice neuromuscular dentistry (NM). Also the countries of Italy, Canada, and Australia have NM docs who are doing great work and helping people universally. And LVI has more than 10,000 attendees who are devot and proud NM docs.

I am sorry to say that it is ignorant and close minded doctors like you who inflame other doctors and patients and prevent them form learning(DDS) and getting (patients) the treatment that they need. I have said this before to some of the giants of dentistry via private emails that NM dentistry will be the norm and the accepted occlusal philosophy for the future of dentistry. If any other docs who read this misinformation from Hounder would want to learn the truth then contact me.

There should be no place in our profession for such negativity and unprofessionalism as Hounder has demonstrated
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replied January 4th, 2011
Hi- I was just wondering my post is uner review?
Thanks
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replied January 5th, 2011
Experienced User
My NMD told me that once I am stabilized into the neuromuscular "sweet spot" that I won't brux anymore.
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replied January 5th, 2011
Experienced User
I do not have an appliance yet. I have made a decision on the dentist to pursue treatment with and am confident (as is he) in his abilities. He told me if my treatment is unsuccessful, then I would be the first. He also told me I am the youngest patient in all of his 20+ years for TMJ treatment.

I am working on putting together a financial plan and I will begin treatment in about a week and a half..
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replied January 6th, 2011
Experienced User
I am a little out of the ordinary when it comes to TMJ sufferers. I am a 24 year old male. I first realized I had TMD when my left ear became permanently stuffy when I was about 21 years old. I have grinded and clenched my teeth since I was VERY young and most dentists that look at me say my molars look like someone who grinds their teeth and is about 50.
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