Back in the late 70's and early 80's, I had a problem. I was treating a lot of temporomandibular joint problems and, for a period of time, thought I was quite good at it. I had read just about every book ever written on the subject, and had taken all the post graduate courses offered. Patients would come to me suffering from a myriad of symptoms and I could almost always get them comfortable with in a few days or weeks by constructing an occlusal splint for them. A splint is an acrylic mouthpiece that fits over either the upper or lower teeth and prevents the patient from getting the upper and lower teeth to touch each other. The acrylic could be ground so that all the teeth from the opposing arch would touch the plastic splint at the same time and just like magic, the patients pain would usually go away in a fairly short period of time. It was as though their TMJ problem had been solved. At first, I felt very good about the results we were getting. However, before long some things began to trouble me. My problem was in understanding just how it was that putting a piece of plastic between a persons teeth could make such a tremendous difference in a persons well being by eliminating their headaches and neckaches?
As time passed, more and more questions arose in my mind. Very often, after about a three-year period, patients would return to my office with the same problem, which I felt I had so successfully treated for them previously. Could it be that wearing a splint could be likened to taking an aspirin for a headache? Was it possible that I, and the other dentists, who held themselves out to be TMJ experts, were doing nothing more than treating the symptoms of TMJ? Just what was the underlying problem, which none of us were able to clearly define or identify?
In 1983, I went to Boston to the annual convention of the American Academy of Gnathologic Orthopedics. I'll admit to being at least inwardly arrogant about my knowledge of, and ability to treat TMJ at that time. Little did I know that it would be there that I would meet a true genius who would cause me to scuttle almost all I thought I knew about TMJ with one simple statement. He said, "Maybe we are all wrong about TMJ. Maybe it is not a problem of the lower jaw at all. Maybe it is the upper jaw that is the problem!" My mind began to race! It would make perfect sense. The upper jaw could be shifted to one side, and because the lower jaw is in kind of a sling of muscle, those muscles could shift the lower jaw and teeth to whatever position they needed to be in for the teeth to come together. Even though the teeth would apparently come together properly, the lower jaw would have been forced into an eccentric and strained position.
That was why the acrylic splints worked! The upper jaw no longer could force the lower jaw into an eccentric position! The muscles of mastication would relax and the pain we called TMJ went away! How remarkable! That explained to me why all sorts of splints "seemed" to work! Upper ones, lower ones, thick ones, thin ones, hard ones, soft ones. It did not matter. That is why so many dentists thought they were good at treating TMJ. It made no difference what they did. Everything worked. However, it was really that NOTHING worked, except for giving the patient some relief from symptoms, at least for a period of time.
At that time I began using an occlusal analyzer, which, to the best of my knowledge, was the first device ever used to locate the actual position (in space) of the upper teeth and jaw as related to the skull. What I began to see was that a "side shift" of the upper jaw was not the only problem. Often the upper jaw would be "canted", meaning tipped up on one side. Sometimes this would even be in combination with a side shift. I also began noticing "slants", which is sort of a rotation of the upper jaw in a horizontal plane. It would also sometimes be in combination with one of the other problems. Another frequent finding was that the "slope" of the upper jaw was too steep. Slope is the rotation of the upper jaw in a vertical plane. For the first time ever I was beginning to think of dentistry and orthodontics and orthopedics in three dimensions.
Not only had I learned to solve the underlying problem of TMJ, but I also became more aware of facial asymmetries and observed their true significance as related to wellness. I began seeing them in a lot of people. It is generally believed that facial asymmetries are just something that happens and that there is really nothing that can be done about them. Nothing could be further from the truth. And it can all be done non-surgically and with little or no discomfort.
If you suffer from any of the following TMJ symptoms:
There is a two-part, self-diagnostic test you can perform on yourself. First, put your little fingers (pinkies) into your ears and open and close your lower jaw very slowly. Listen for any joint sounds. Was there a popping or a grinding noise?
Next look at yourself very carefully in a large mirror. Is the mid-point of your chin button lined up with the mid-line of your face, or is it deviated off slightly to one side? Does the mid-line of your lower teeth fail to line up perfectly with the midline of your upper teeth?
If you suffer form any of the above symptoms or answered yes to any of the above questions, then the chances are you do have a TMJ problem to some degree.