TMJ Dysfunction: An Icon for

"A Shortcoming in Dentistry?"

To make my point, I would first like you to consider two gear wheels working together. When everything is perfect, those gears and wheels can accomplish great things, with maximum efficiency and with minimal wear on the gears or stress on the wheel. It can go on indefinitely, especially when it is working in an optimal environment. But, what happens to the synchronicity of the gear wheels when just one of the gears gets broken off or bent. The whole system begins to break down by excessive wear or breaking off more gears. This analogy serves to illustrate where I believe dentistry falls short!

The teeth in our mouths are very much like those gears, and our jaws (or the bones of our jaws) are very much like the wheel. They are perfectly designed to mesh and interface with each other in a beautifully balanced and precise way. Even when for some reason Mother Nature throws us a curve and our teeth are not straight or perhaps some of them are congenitally missing, or when our teeth have been ravaged by dental disease (decay), the blueprint still exists for the appearance of the teeth to be attractive and their function to be harmonious.

The shortcoming in dentistry has its origin in our dental education. Dentistry, like medicine, has a disease-centered system as its foundation. Our dental education taught us extremely well how to repair the damages wrought by dental decay and fracturing of the teeth. It essentially taught us to be good "one tooth" doctors. In other words, we were taught to focus on the one tooth that was causing a problem for the patient. Yes, often it would be more than one tooth, but we were still primarily taught to look at each tooth as an individual tooth, rather than as an integral part of a marvelous and extremely sophisticated system. You know the old saying, "You can't see the forest for the trees." Dental school prepared us extremely well to look after the individual trees (teeth), but not nearly so well to care for the whole forest (teeth, jaws, joint, face, head, neck and body).

Now lets return to our analogy of the gear wheels. Lets suppose we discovered one of the gears (teeth) was badly damaged or broken off. Wouldn't it be a good idea to check all the teeth? (This does usually happen in dentistry.) However, wouldn't it be even wiser to check the wheels also, to see if they were properly aligned and that the shape of the wheel was round and concentric and not flattened or "egged"? How about the shaft that drives the gear wheel? Wouldn't you want to know that it was tight and had no wobble? Unfortunately, the scope of dentistry is not usually this broad. Lets look at the ramifications of what can happen when one tooth is repaired without keeping its effect on the whole masticatory system in mind.

I'll never forget the schoolteacher from Crosby who was referred to me because she was suffering horribly from a full range of TMJ symptoms. She had pain in her jaw joints with popping and grinding on the left side, severe headaches located behind her eyes and temporal headaches that extended all the way up to the top of her head. She also had excruciating neck pain right at the base of her skull at the back of her head, which radiated down into her left shoulder. Some slight dizziness and stuffiness in her left ear were also a problem. She was just about at her wits end trying to cope with all those symptoms.

She had already been to her medical doctor who told her there was no fluid in her ears and found nothing to explain her symptoms. He referred her to an ENT specialist who said her sinuses were clear and had no explanation for her severe headaches. The ENT specialist recommended that she see a neurologist to discover the source of the problem. The neurologist ran exhaustive tests (MRI's, etc.) only to inform her that everything looked okay. He suggested that she check into a chronic pain clinic or perhaps see a psychiatrist to get to the root of the problem.

After doing a thorough orthopedic exam, I was somewhat surprised to find that her upper and lower jaws were well aligned and there were only minimal sideshifts, cants, slants, and slopes to either her upper or lower jaw. In addition to all that, her teeth were very straight. However, I discovered one tell tale sign. The very back tooth on her lower left side had an old porcelain crown on it. Much of the porcelain was fractured off the top of the tooth and there was even a small hole worn through the metal substructure of the porcelain crown. I pointed it out to her and told her the crown was obviously "high" in its occlusion with the upper teeth and appeared to be out of harmony with the rest of her teeth and jaws. She agreed the porcelain crown should be replaced and we scheduled her an appointment.

The day of her appointment arrived and all went well with the procedure. I was extremely careful in placing her temporary to be certain that the bite was correct and that it fit properly. Being concerned as to the effect holding her mouth open so long during the crown procedure, I called her the next day to see how well she was doing. What she said simply amazed me. She said, "From the minute I left your office and the anesthesia wore off, I have not had one single symptom from my TMJ. No headache, no neckache, no pain in the joint, nothing!" Two weeks later when we installed the new permanent crown, and until this day some 8 years later, she is still doing fine.

The above story is very unusual but it illustrates why I believe it is so important to always keep the whole chewing system in mind even when we are just treating one tooth. It illustrates the damage that can be done to a gear system when one tooth is out of harmony. Just think what would happen to a gear system if you took one tooth out of each wheel in a gear system and were somehow able to move all the other teeth so that they would still be evenly spaced. Do you think it would work out well? I don't. The angle that each gear makes with the wheel and the height of each gear tooth would need to be adjusted. Right! Do you suppose orthodontic extractions (taking permanent teeth out of a crowded dental arch) and then using the space created to straighten the remaining teeth could have the same effect as the gear system illustration?