PHILOSOPHY OF
TREATMENT...
First, let’s discuss the term "TMJ" versus the term
"TMD". The three letters TMJ stand for the name
of the jaw joint. It is named the temporomandibular joint. So...
if you think about it, we all have "TMJ". Actually, each of us
is born with two of them, one on the left and one on the right, located just in
front of your ear.
TMD
stands for temporomandibular disorder. This term is
currently the accepted term to describe the collection of symptoms and diseases
that are generally found in our TMD patients. Now that we have agreed on that
one, let’s talk philosophy.
There is much controversy among health care professionals today concerning the
appropriate methods for the diagnosis and treatment of TMD. Each specialty
group and special interest group within the health care field has developed
their own diagnostic and treatment protocol. Generally speaking, that
protocol emphasizes the skills of that particular group... sometimes to the
exclusion of all other groups. In truth, TM Disorders is a multi-faceted
and complex disease process, most often requiring a multi-faceted approach for
complete and satisfactory resolution of the symptoms.
It is true that the TM Joints, and the associated musculature and ligaments comprise
a unique system within the human body. The temporomandibular joint is
called a ginglymo-arthrodial joint. Don’t let that big word scare
you... it simply means that this joint is unique and different from all of the
other joints in the body. Like all joints it permits movement by means of
simple rotation, or hinge-like movement. However, this unique joint
mechanism also allows translation... a sliding of the entire joint complex from
it's original starting point within the articular fossa of the temporal bone
(joint socket),
forward and laterally down the slope of the articular eminence. This unique
design
allows the shock absorbing mechanism of the joint, the articular disc, to move
along with the bones in a coordinated fashion. This design also allows the jaws
to assume an almost unlimited number of various jaw positions and
postures. When the system functions correctly, a person is able to chew,
speak, bite a fingernail, nip off a piece of thread, and open wide enough to
eat a "Big Mac" sandwich. The TM joints are very
adaptable. They can take an amazing amount of abuse. However, when
they do not function as intended, a wide number of confusing symptoms can
occur. This wide variety of symptoms have come to be lumped together and
called a TM Disorder.
When you go for treatment of a TM Disorder, you may be massaged, medicated, cut upon, stretched,
twisted, manipulated, injected, consoled and counseled, adjusted, restored,
straightened, and have your "bite" adjusted (equilibrated), depending on which special type of professional
practice that you happen to consult. Often, the result is a
frustrating lack of appropriate response. Finally, many of these confusing
symptoms are heaped on the pile of hypochondria, and the patient is judged to
have a mental disorder.
My belief is that a dentist, with additional special knowledge
in the field of cranio-facial pain, is uniquely qualified to treat TMD and to
lead the treatment team. The reason for that belief is simple. In my
opinion, what many practitioners in all of the other medical fields forget to consider
when they provide their various treatments for TMD is the role that the
teeth play in establishing the end point (tight meshing of the teeth) of
closure. As you close your mouth, it is the position of the teeth
that
determines the final position of your lower jaw at tight closure. How does
that affect treatment? Let me give you an absurd illustration.
As you read this... move your lower jaw as far as you can to the left
side. Push it and hold it. Can you feel the strain that this jaw
position places on your face and in front of your ears. Some of you who
came to this site because you are having pain may actually feel increased pain
as you try this little test. Now... try to imagine how you would feel
every day if the position of your teeth was such that it drove you to this exaggerated
position each time you closed your mouth. Should hurt...eh?
Now, suppose that my treatment plan was to give you anti-inflammatory medication for
your pain. As long as your teeth continued to force you to return to this
jaw position each time you closed your mouth.... the medication may make the
pain may go away for awhile, but should you expect it to stay away? No.
This is the foundation for my belief that the role of the dentition (teeth) must
always be considered when treating TMD.
Although it is a unique joint mechanism, our belief is that in the final
analysis, the TM Joint is just another joint. Why
should the TM Joints be treated any differently than any other joint within the
body? I believe that our diagnosis and treatment protocol, developed over the last
fifteen or twenty years, is founded in good, orthopedic principals. CAUTION
and COMMON SENSE are the by-words of this practice. A complete
medical evaluation should always the starting point. Obviously, it is
foolhardy to proceed without ruling out many of the life threatening
pathologies. Fortunately, most of our patients have consulted many
physicians prior to their coming here.
Following a negative medical evaluation, a complete and thorough head and neck
examination must be completed. Once diagnosed, the initial treatment
protocol should always involve NON-INVASIVE, REVERSIBLE procedures
whenever possible. This point agrees completely with the recent (1996) statement
of the National Institutes of Health on the management of tm
disorders. The injured and abused joint structures should be stabilized to
assist the natural healing capacity of the body. Muscle pathology should be
addressed with mobility and strengthening exercises. Complicating factors,
such as cervical (neck) dysfunction, nutritional deficiencies and skeletal deficiencies must also be addressed
and corrected. Muscle spasms and inflammation should be eliminated. Appropriate referrals for physical therapy and stress management
should be made as needed. These allied therapies must be coordinated and
supportive in nature, with all therapists working as a team and communicating in
the patients best interest.
My professional philosophy includes the notion that it is inappropriate
to treat any but the most seriously ill of chronic pain patients with continuing
medication. It has been my experience that this physical management,
neuromuscular approach to treatment almost totally eliminates the need for ongoing medication.
I have found that treatment programs that involve the patient in their own
recovery are always more successful. An extensive explanation of my
findings and diagnosis will be provided for every patient. This question
and answer session may often last twenty or thirty minutes. Armed with a
vast amount of knowledge and understanding about their problem, the patient can
actively participate in their treatment and recovery. From my clinical
observation, I believe that, many times, this is the most important component
that I include in my treatment protocol, and, in my opinion, it is the one that
is most often overlooked by many clinicians.
Injured joints, muscles and ligaments heal slowly. Our patients are
followed closely in this practice. Communication is an important part of
recovery. Patients are followed weekly at first, and then in gradually fewer
visits as we begin to see progressive improvement. Most patients are
asymptomatic in a matter of two to three months. Following an appropriate
healing time, which could be six months or longer, the patient is re-evaluated
to determine the need, if any, for any additional treatment to stabilize and
support the positive result.
So, in short, my practice philosophy is an ongoing evolution. I am very
comfortable with change, if the reasons for that change can be demonstrated to
be beneficial to the patients that we serve. In this office our patients
are treated with dignity and respect. No one is hurried or rushed. This
conservative, non-invasive treatment philosophy has been successful for us in
the vast majority of our cases. Patient acceptance and patient compliance
rates are very high, and that translates to a better quality of life for those
we serve.
copyright © Dr. Sid Holleman, Jr. 2008 All Rights Reserved.