saaraah
07-31-2003, 04:00 PM
today i went to an appointment with my long time dentist who's been treating me for almost 10 years. i had gone to ask for muscle relaxants, and to get his opinion on neuromuscular dentistry.
when i brought it up, you should've seen the look on his face. to make a long story short, he does not believe in it, and thinks that it is deterimental and ineffective. it's a completely different philosophy than what he believes in.
also, he said that many studies and the national institute of health have all demonstrated that neuromuscular dentistry and repositioning splints are not effective. since it's irreversible [which i was not aware of], it should only be used as a last resort and even then it's worrisome.
i really respect my long-time doctor because he's a medical doctor, dentist, and periodontist. he's a very smart guy.. ugh. he's never been opposed to me to seeing other health professionals, so i know that's not his initiative.
bah! i am so confused and upset. now, i dont know if i should cancel my appointment with dr. rondeau because i sure as hell dont want to spend thousands of dollars on an irreversible treatment.
so far, im thinking that i'll go for the diagnostic assessment, and see what he says.. maybe..
any suggestions would be greatly appreciated, and if anyone has any references to studies conducted with neuromuscular dentistry, i'd love to see them.
when i brought it up, you should've seen the look on his face. to make a long story short, he does not believe in it, and thinks that it is deterimental and ineffective. it's a completely different philosophy than what he believes in.
also, he said that many studies and the national institute of health have all demonstrated that neuromuscular dentistry and repositioning splints are not effective. since it's irreversible [which i was not aware of], it should only be used as a last resort and even then it's worrisome.
i really respect my long-time doctor because he's a medical doctor, dentist, and periodontist. he's a very smart guy.. ugh. he's never been opposed to me to seeing other health professionals, so i know that's not his initiative.
bah! i am so confused and upset. now, i dont know if i should cancel my appointment with dr. rondeau because i sure as hell dont want to spend thousands of dollars on an irreversible treatment.
so far, im thinking that i'll go for the diagnostic assessment, and see what he says.. maybe..
any suggestions would be greatly appreciated, and if anyone has any references to studies conducted with neuromuscular dentistry, i'd love to see them.
Sponsor
jimmyt7
07-31-2003, 04:15 PM
i am probably going to have to see one soon but i dont know if i want a repositioning splint. just one that can relax my jaw and ease my muscle tension. i dont know, its very scary having tmj and i sure dont want any irreversible treatment unless i have no choice. sucks big time having this horrible condition. i rather get cancer or get shot in the arm.
totallyconfused
07-31-2003, 04:35 PM
Saaraah,
I agree completely with not wanting an irreversible treatment. I keep asking my dentist to make absolutely sure this splint will not permanently change my jaw position. He says as long as I keep taking it out to eat it will not. Now how long I could keep it up like that I don't know. Initially, he had said 6 months.
Good luck with your decision. I know it is a hard one.
TC
I agree completely with not wanting an irreversible treatment. I keep asking my dentist to make absolutely sure this splint will not permanently change my jaw position. He says as long as I keep taking it out to eat it will not. Now how long I could keep it up like that I don't know. Initially, he had said 6 months.
Good luck with your decision. I know it is a hard one.
TC
DianeTMJ
07-31-2003, 05:38 PM
Wow Saarah -
That is disappointing. Especially since my neuromuscular dentist has completly reversed my symptoms. I know that the other splint I had from my 12th dentist certainly did not work.
I think that each much find what works for them, mine happened to be Neuromusuclar dentistry.
Thanks for information though
Diane
PS here the symptoms I use to have and no longer have:
Fullness in right ear
Ringing in the ear
Pain in the ear
Pain, right side of my face,
Numbness right side of face, running down jaw line to right corner of lip.
Shoulder/neck pain
Dizziness
Vertigo – queasy stomach when that happens, not an upset stomach, just queasy.
Eye Pain
Sensitive to light
Sensitive to noise
Droopy eye, right eye
Headaches, forehead, all over head
What I thought were sinus headaches
Ghost tooth pain, back upper right, sometimes spreading to lower back teeth but not as strong.
Right lymph feeling swollen
Crackling sound in ear
Crackling sound in neck
Watery eye – right one only
Blood shot eye, right one only
Problems with vision in right eye
Temple area pain.
Soft food diet as eating hard things really irritates and makes symptoms worse
Jitters – controlled by no longer taking tylenol
[This message has been edited by DianeTMJ (edited 07-31-2003).]
That is disappointing. Especially since my neuromuscular dentist has completly reversed my symptoms. I know that the other splint I had from my 12th dentist certainly did not work.
I think that each much find what works for them, mine happened to be Neuromusuclar dentistry.
Thanks for information though
Diane
PS here the symptoms I use to have and no longer have:
Fullness in right ear
Ringing in the ear
Pain in the ear
Pain, right side of my face,
Numbness right side of face, running down jaw line to right corner of lip.
Shoulder/neck pain
Dizziness
Vertigo – queasy stomach when that happens, not an upset stomach, just queasy.
Eye Pain
Sensitive to light
Sensitive to noise
Droopy eye, right eye
Headaches, forehead, all over head
What I thought were sinus headaches
Ghost tooth pain, back upper right, sometimes spreading to lower back teeth but not as strong.
Right lymph feeling swollen
Crackling sound in ear
Crackling sound in neck
Watery eye – right one only
Blood shot eye, right one only
Problems with vision in right eye
Temple area pain.
Soft food diet as eating hard things really irritates and makes symptoms worse
Jitters – controlled by no longer taking tylenol
[This message has been edited by DianeTMJ (edited 07-31-2003).]
DianeTMJ
07-31-2003, 06:01 PM
Hi Saraah
Saraah, Oh shoot. I just want to also let you know there is great debate in Canada over regular dentists and neuromuscular dentists. There is a professor at one of the leading schools in Canada that just simply does not believe in that form of help for TMJD. I am not saying that you should not believe your dentist, but it is also important to understand there is always positive and negatives for any treatment. If there is one thing that I found out in my long journey to finally find help and relief, each dentist(13 of them before my NM Dentist) is going to preach about there treatment plans and downplay other branches of dentistry. I will go to the National Institute and find out the articles that are available about NM dentistry.
When I find the information I will let you know. I am so sorry you received this bad news today Saarah
Diane
Saraah, Oh shoot. I just want to also let you know there is great debate in Canada over regular dentists and neuromuscular dentists. There is a professor at one of the leading schools in Canada that just simply does not believe in that form of help for TMJD. I am not saying that you should not believe your dentist, but it is also important to understand there is always positive and negatives for any treatment. If there is one thing that I found out in my long journey to finally find help and relief, each dentist(13 of them before my NM Dentist) is going to preach about there treatment plans and downplay other branches of dentistry. I will go to the National Institute and find out the articles that are available about NM dentistry.
When I find the information I will let you know. I am so sorry you received this bad news today Saarah
Diane
totallyconfused
07-31-2003, 06:47 PM
Hi everyone. I couldn't find anything Saaraah on neuromuscular splints specifically. I did, however, run across something interesting. http://www.nidcr.nih.gov/tmdiwg/researchagenda.pdf
This is a .gov link so should be ok.
On one page of this talking about the joint replacements I think, it basically says that the only thing they could find significantly different between the people who had their Teflon type implants removed and those who did not was that the ones who DID have them removed were found to have an extremely low threshold for pain. That didn't sound very nice to me!! Did they test for that? How would they know about someone's threshold for pain?
Just wanted to pass this on.
TC
This is a .gov link so should be ok.
On one page of this talking about the joint replacements I think, it basically says that the only thing they could find significantly different between the people who had their Teflon type implants removed and those who did not was that the ones who DID have them removed were found to have an extremely low threshold for pain. That didn't sound very nice to me!! Did they test for that? How would they know about someone's threshold for pain?
Just wanted to pass this on.
TC
mdla
07-31-2003, 09:33 PM
I am going to see a 2nd neuro recommended by my TMJ surgeon on Tuesday. Apparently he thinks the neuro approach may be better than cutting for arthroscopy. But gosh Id rather try neuro- I mean if its not reversable I dont care because why would I want to reverse to this, pain, clicking liquid diet, ear ringing.......etc.
DianeTMJ
07-31-2003, 10:19 PM
Hi MDLA -
I couldn't agree more at this point. I have just worked myself up into a frenzy over this. I can not find anywhere on the NIH site where it talks badly of neuromuscular dentistry. WAAA
I called and spoke with my neuro. dentist assistant and she she explained to me how it works. WIth this final splint I am going to have, it will stablize my jaw in the more forward position. The will "heal" somewhat like when we have a broken bone. It is forever. He has not steered me wrong yet. I only know one thing. I am not willing to go back to where I was at the beginning of May. The one big postivie about this final step. The bone loss will stop. I have terrible bone loss and I can not risk the loss of anymore at all. Thank goodness.
Have a good eve
Diane
I couldn't agree more at this point. I have just worked myself up into a frenzy over this. I can not find anywhere on the NIH site where it talks badly of neuromuscular dentistry. WAAA
I called and spoke with my neuro. dentist assistant and she she explained to me how it works. WIth this final splint I am going to have, it will stablize my jaw in the more forward position. The will "heal" somewhat like when we have a broken bone. It is forever. He has not steered me wrong yet. I only know one thing. I am not willing to go back to where I was at the beginning of May. The one big postivie about this final step. The bone loss will stop. I have terrible bone loss and I can not risk the loss of anymore at all. Thank goodness.
Have a good eve
Diane
DianeTMJ
07-31-2003, 10:36 PM
Hi Saaraah
Saaraah, could you ask your dentist what the title is of the publication that stated that neuromuscular is bad? I have looked and looked and I can not find it. Perhaps a publication# or the title or year that it was published. I would really like to read it and give to my neuromuscular dentist to read as well.
Thanks!
Diane
Saaraah, could you ask your dentist what the title is of the publication that stated that neuromuscular is bad? I have looked and looked and I can not find it. Perhaps a publication# or the title or year that it was published. I would really like to read it and give to my neuromuscular dentist to read as well.
Thanks!
Diane
mdla
07-31-2003, 11:49 PM
Hi Diane,
I think the forward thing is the key. For me when I move forward and "click out" my jaw, I can open with a good range of motion, its the moving forward over the dislocated disk that creates the poping and pain. Therefore Im thinking maybe moving it forward will help. I know I tried the Therabite exerciser for TMJ and it didn't help because my click is so early that Im already clicked forward, or out, by the time my mouth is on the plastic. Is your click early, middle or late in your open?
-Mdla
I think the forward thing is the key. For me when I move forward and "click out" my jaw, I can open with a good range of motion, its the moving forward over the dislocated disk that creates the poping and pain. Therefore Im thinking maybe moving it forward will help. I know I tried the Therabite exerciser for TMJ and it didn't help because my click is so early that Im already clicked forward, or out, by the time my mouth is on the plastic. Is your click early, middle or late in your open?
-Mdla
Arleen
08-01-2003, 12:37 AM
Hi Saaraah:
I'm in Ontario and I've had 3 dentists so far mention that there are problems with the way TMJD is being taught at a large university near me (or more like it, not being taught). I was also told by a dentists from the States that the dean of the dental school here seems to have a vendetta against dentists using the neuro approach, so he, the school, the Royal College of Dentists, make it difficult for neuro dentists to practice. This may well be the case, as the neuros I've seen practice outside the city perimeter. There are always people resistent to accepting new ideas, in every field. I can't help but wonder if the old standard dentists feel threatened by this approach, and don't want neuro dentists infringing on their well established practices and taking patients away.
I've had three nightguards made by three different dentists. Having 2 fillings replaced almost 2 years ago caused my bite to become completely off. One dentist actually mentioned that my muscles may be in spasm, but told me to wait it out!! So, these 3 dentists created nightguards following impressions that are based on my current bad bite. All the adjustments in the world aren't going to make these nightguards good. Yet, a dentist who finds out what your muscles are doing before making a nightguard or splint, in my mind, stands a better chance of helping correct my bad bite, and getting it back to where it should be. That's just my opinion and why I've opted for this approach.
Different things work for each of us, and I hope you find the path that will work best for you.
Take care,
Arleen
I'm in Ontario and I've had 3 dentists so far mention that there are problems with the way TMJD is being taught at a large university near me (or more like it, not being taught). I was also told by a dentists from the States that the dean of the dental school here seems to have a vendetta against dentists using the neuro approach, so he, the school, the Royal College of Dentists, make it difficult for neuro dentists to practice. This may well be the case, as the neuros I've seen practice outside the city perimeter. There are always people resistent to accepting new ideas, in every field. I can't help but wonder if the old standard dentists feel threatened by this approach, and don't want neuro dentists infringing on their well established practices and taking patients away.
I've had three nightguards made by three different dentists. Having 2 fillings replaced almost 2 years ago caused my bite to become completely off. One dentist actually mentioned that my muscles may be in spasm, but told me to wait it out!! So, these 3 dentists created nightguards following impressions that are based on my current bad bite. All the adjustments in the world aren't going to make these nightguards good. Yet, a dentist who finds out what your muscles are doing before making a nightguard or splint, in my mind, stands a better chance of helping correct my bad bite, and getting it back to where it should be. That's just my opinion and why I've opted for this approach.
Different things work for each of us, and I hope you find the path that will work best for you.
Take care,
Arleen
J-man
08-01-2003, 01:48 AM
Hi Saaraah,
That's interesting what your dentist said about neuromuscular dentistry and repositioning splints being ineffective. Do you happen to know whether he was implying that both these techniques (used on their own) were not effective methods of treating tmj problems, or whether they are not effective when they are used together to treat tmj problems ?
If the statement was that neither neuromuscular dentistry nor repositioning splints are effective...what does this mean, not effective at all..or not as effective as some other methods of treatment ? Also, I wonder, what exactly would be meant by the term 'neuromuscular dentistry' ? As I understand it, neuromuscular dentistry is a brand of dentistry which recognizes that the teeth,muscles and jaws all need to work together properly. Neuromuscular dentists often believe that in order for your jaw joint to be in the most ideal position, it needs to be supported in that position by the correct 'bite'. As far as the muscles, many of these dentists would believe that doing as much as you can to relax your muscles, also plays an important role in enabling your jaw joints to work like they're supposed to work.
I wonder, would the NIH have a problem with all of the techniques used by neuromuscular dentists dentists, or just some of them ? Likely neuromuscular dentists wouldn't all use the same treatments, but tens is one of the treatments which many of them would use. Would the NIH have a problem with using tens, which basically relaxes your muscles ?
It also seems like the personal experience of some patients who have been helped tremendously by tmj treatments, would contradict the belief that neuromuscular dentistry and repositioning splints are inffective, if that is the position which the NIH is taking. For instance Marlene used to have a very bad case of Tmjd, but now is about 95% normal :-) This was in part due to using a repositioning splint. I realize that a personal experience might not be seen to contradict research studies, but I think that it should give pause for thought. If even one person is significantly helped my neuromuscular dentistry or repositioning splints, then this would lead me to question a wholesale statement that these 2 approaches to helping tmj problems are 'not effective'.
I guess you could say the statements about neuromuscular dentistry have got me going..lol ! I think that these statements can stimulate healthy discussion...which is a really good thing.
It seems to me that the NIH, as a scientific body is wanting to be cautious..they are wanting proof, before they give their endorsement to any particular Tmj treatment methodology. In fact some of the statements that have been put out by the NIH in the past decade have been along the lines of, 'there is no agreement among doctors as to what the best Tmj treatments are'. So in light of those type of statements, is the NIH saying that there is now evidence to show that some treatments are better than others, and in particular are better than neuromuscular treatments, and repositioning splints ? If this is the position that would be taken, which treatments would they now endorse as being better than these 2 treatment approaches ?
I also wanted to touch on the concern voiced that these types of treatments are irreversible. Whenever I hear this statement, I think yes this is a very good ideal..... you want to use a mix of treatments which results in the maximum amount of improvement to your condition, while taking as little risk as possible. So for instance, if you can bring as much relief through a splint as you can through surgery...then the splint is the preferred route to take.
Ok great, but there are 2 points that need to be raised here. First of all the NIH is telling us that there's no agreement among dentists as to what the best form of treatment of Tmjd is, and no evidence to show that any treatment approach is superior to any other.So we might assume that since no treatment aproach has the proper 'evidence' to back it up, then 'doing nothing' may be the safest thing to do... as this is the least reversible form of treatment.
However, what if the present position of your jaw joint is not a good one ? For instance, let's say your jaw is too far back, the condyle is pressing on all your nerves, and this 'bad bite' (or you could say 'bad jaw position') is placing excessive strain on your ligaments and tearing them ? Furthermore, let's assume that this position is putting extra strain on your disk, which causes it to break down and change its shape. If this was your situation, would 'doing nothing' necessarily be a 'reversible form of treatment' ? No it wouldn't, because damage could be taking place that was itself 'irreversible'......
But possibly moving your lower jaw forward to a new position (through a repositioning splint) could reverse the irreversible changes that would otherwise happen in your jaw joints ;-)
Since neuromuscular dentistry seeks to make sure that the teeth, jaws, and muscles are all working well together, couldn't you say that on that basis, most splint treatments are a form of neuromuscular dentistry ? Also, would it be fair to say that any form of treatment at all which seeks to relax chronically tight muscles and to enable damaged jaw joints to function better (which usually results a change in jaw position)...is in some sense an irreversible treatment, as it will change the position of your jaw to some degree ?
I would be interesting in finding out more about what the NIH has said about neuromuscular dentistry, and repositioning splints. If they do have a problem with neuromuscular dentistry, I would be interested in finding out which types of treatments specifically they believe are harmful and ineffective. And if they are not in favour of repositioning splints, I would like to know if they have done studies to compare the harm done to joints through attempting to reposition them, as compared to the harm done to 'out of position joints' , when you choose to leave them in their current position.
Lastly, I think that all Tmj remedies which attempt to help jaw joints and jaw muscles, will result in some degree of repositioning of the bite...so I believe it's fair to say that any treatment at all which is aimed at coaxing tight muscles and damaged joints into a better state ...is in some degree 'irreversible'.
Phew....thanks for putting up with my long post guys...lol !!
John
That's interesting what your dentist said about neuromuscular dentistry and repositioning splints being ineffective. Do you happen to know whether he was implying that both these techniques (used on their own) were not effective methods of treating tmj problems, or whether they are not effective when they are used together to treat tmj problems ?
If the statement was that neither neuromuscular dentistry nor repositioning splints are effective...what does this mean, not effective at all..or not as effective as some other methods of treatment ? Also, I wonder, what exactly would be meant by the term 'neuromuscular dentistry' ? As I understand it, neuromuscular dentistry is a brand of dentistry which recognizes that the teeth,muscles and jaws all need to work together properly. Neuromuscular dentists often believe that in order for your jaw joint to be in the most ideal position, it needs to be supported in that position by the correct 'bite'. As far as the muscles, many of these dentists would believe that doing as much as you can to relax your muscles, also plays an important role in enabling your jaw joints to work like they're supposed to work.
I wonder, would the NIH have a problem with all of the techniques used by neuromuscular dentists dentists, or just some of them ? Likely neuromuscular dentists wouldn't all use the same treatments, but tens is one of the treatments which many of them would use. Would the NIH have a problem with using tens, which basically relaxes your muscles ?
It also seems like the personal experience of some patients who have been helped tremendously by tmj treatments, would contradict the belief that neuromuscular dentistry and repositioning splints are inffective, if that is the position which the NIH is taking. For instance Marlene used to have a very bad case of Tmjd, but now is about 95% normal :-) This was in part due to using a repositioning splint. I realize that a personal experience might not be seen to contradict research studies, but I think that it should give pause for thought. If even one person is significantly helped my neuromuscular dentistry or repositioning splints, then this would lead me to question a wholesale statement that these 2 approaches to helping tmj problems are 'not effective'.
I guess you could say the statements about neuromuscular dentistry have got me going..lol ! I think that these statements can stimulate healthy discussion...which is a really good thing.
It seems to me that the NIH, as a scientific body is wanting to be cautious..they are wanting proof, before they give their endorsement to any particular Tmj treatment methodology. In fact some of the statements that have been put out by the NIH in the past decade have been along the lines of, 'there is no agreement among doctors as to what the best Tmj treatments are'. So in light of those type of statements, is the NIH saying that there is now evidence to show that some treatments are better than others, and in particular are better than neuromuscular treatments, and repositioning splints ? If this is the position that would be taken, which treatments would they now endorse as being better than these 2 treatment approaches ?
I also wanted to touch on the concern voiced that these types of treatments are irreversible. Whenever I hear this statement, I think yes this is a very good ideal..... you want to use a mix of treatments which results in the maximum amount of improvement to your condition, while taking as little risk as possible. So for instance, if you can bring as much relief through a splint as you can through surgery...then the splint is the preferred route to take.
Ok great, but there are 2 points that need to be raised here. First of all the NIH is telling us that there's no agreement among dentists as to what the best form of treatment of Tmjd is, and no evidence to show that any treatment approach is superior to any other.So we might assume that since no treatment aproach has the proper 'evidence' to back it up, then 'doing nothing' may be the safest thing to do... as this is the least reversible form of treatment.
However, what if the present position of your jaw joint is not a good one ? For instance, let's say your jaw is too far back, the condyle is pressing on all your nerves, and this 'bad bite' (or you could say 'bad jaw position') is placing excessive strain on your ligaments and tearing them ? Furthermore, let's assume that this position is putting extra strain on your disk, which causes it to break down and change its shape. If this was your situation, would 'doing nothing' necessarily be a 'reversible form of treatment' ? No it wouldn't, because damage could be taking place that was itself 'irreversible'......
But possibly moving your lower jaw forward to a new position (through a repositioning splint) could reverse the irreversible changes that would otherwise happen in your jaw joints ;-)
Since neuromuscular dentistry seeks to make sure that the teeth, jaws, and muscles are all working well together, couldn't you say that on that basis, most splint treatments are a form of neuromuscular dentistry ? Also, would it be fair to say that any form of treatment at all which seeks to relax chronically tight muscles and to enable damaged jaw joints to function better (which usually results a change in jaw position)...is in some sense an irreversible treatment, as it will change the position of your jaw to some degree ?
I would be interesting in finding out more about what the NIH has said about neuromuscular dentistry, and repositioning splints. If they do have a problem with neuromuscular dentistry, I would be interested in finding out which types of treatments specifically they believe are harmful and ineffective. And if they are not in favour of repositioning splints, I would like to know if they have done studies to compare the harm done to joints through attempting to reposition them, as compared to the harm done to 'out of position joints' , when you choose to leave them in their current position.
Lastly, I think that all Tmj remedies which attempt to help jaw joints and jaw muscles, will result in some degree of repositioning of the bite...so I believe it's fair to say that any treatment at all which is aimed at coaxing tight muscles and damaged joints into a better state ...is in some degree 'irreversible'.
Phew....thanks for putting up with my long post guys...lol !!
John
saaraah
08-01-2003, 10:13 AM
wow.. you guys.. thanks for all of the responses.
i'll try to contact my doctor to see if i can get particular studies about repositioning splints, but i remember that he specifically said that at a 1996 NIH conference, it was discussed and repositioning splints were found to be detrimental.
his feeling is that since the splint changes the occlusion, more problems can occur - orthodontics, etc; however, he didnt outright say that they were ineffective or bad [he told me to read between the lines], since it's against his ethics to bad mouth any dentist in particular. all he did say was that neuromsuclar dentistry is against his philosophical standing - his stance is at the north, and neuromuscular is at the south, for example.
btw, he was only talking about the repositioning splint, and said that it can cause more problems in the end as well as costing thousands. he doesnt like the whole "moving the mandible forward" part - i did not realize prior to my apopintment with him that this is what neuromuscular dentists do with the splints.
i do appreciate self-reports from patients; however, i do not want to be one who has a negative experience. bah! i am so confused!
anyway, im gong to do some more reserach and hopefully make an educated decision.
i agree, tho, that neuromuscular dentistry and its ideals sound very promising: taking into account the joints, muscules, ligaments, etc, so that's why im confused that it could be considered dangerous. altho, on the other hand, permanently changing "something" is always dangerous.
well, thanks again... on with the research!
i'll try to contact my doctor to see if i can get particular studies about repositioning splints, but i remember that he specifically said that at a 1996 NIH conference, it was discussed and repositioning splints were found to be detrimental.
his feeling is that since the splint changes the occlusion, more problems can occur - orthodontics, etc; however, he didnt outright say that they were ineffective or bad [he told me to read between the lines], since it's against his ethics to bad mouth any dentist in particular. all he did say was that neuromsuclar dentistry is against his philosophical standing - his stance is at the north, and neuromuscular is at the south, for example.
btw, he was only talking about the repositioning splint, and said that it can cause more problems in the end as well as costing thousands. he doesnt like the whole "moving the mandible forward" part - i did not realize prior to my apopintment with him that this is what neuromuscular dentists do with the splints.
i do appreciate self-reports from patients; however, i do not want to be one who has a negative experience. bah! i am so confused!
anyway, im gong to do some more reserach and hopefully make an educated decision.
i agree, tho, that neuromuscular dentistry and its ideals sound very promising: taking into account the joints, muscules, ligaments, etc, so that's why im confused that it could be considered dangerous. altho, on the other hand, permanently changing "something" is always dangerous.
well, thanks again... on with the research!
saaraah
08-01-2003, 01:19 PM
i believe that i've found an abstract of the study my doctor was referring to:
2001
Tsukiyama Y, Baba K, Clark GT
An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders.
Journal of Prosthetic Dentistry 86(1):57- 66, 2001 Jul
Temporomandibular dysfunction: therapy
STATEMENT OF PROBLEM: Occlusal adjustment therapy has been advocated as a treatment modality for
temporomandibular disorders. In contrast to this position, a panel at the 1996 National Institute of Health technology assessment conference on TMD indicated that no clinical trials demonstrate that occlusal adjustment is superior to noninvasive therapies.
PURPOSE: This article summarizes the published experimental studies on occlusal adjustments and temporomandibular disorders.
MATERIAL AND METHODS: Eleven research experiments involving 413 subjects with either bruxism (n = 59),
temporomandibular disorders (n = 219), headaches and temporomandibular disorders (n = 91), or chronic cervical pain (n = 40) were selected for critical review from the English dental literature.
RESULTS: Three experiments evaluated the relationship
between occlusal adjustment and bruxism. Six experiments evaluated occlusal adjustment therapy as a treatment for patients with primary temporomandibular disorders. One experiment looked at occlusal adjustment effect on headache/temporomandibular
disorder symptoms; another looked at its effect on chronic neck pain. Most of these experiments used a mock adjustment or a comparison treatment as the control condition in adults who had an existing nonacute general temporomandibular disorder.
Overall, the data from these experiments did not demonstrate elevated therapeutic efficacy for occlusal adjustment over the control or the contrasting therapy.
CONCLUSION: The experimental evidence reviewed was neither convincing nor powerful enough to support the performance of occlusal therapy as a general method for treating a nonacute temporomandibular disorder,
bruxism, or headache.
- saaraah.
2001
Tsukiyama Y, Baba K, Clark GT
An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders.
Journal of Prosthetic Dentistry 86(1):57- 66, 2001 Jul
Temporomandibular dysfunction: therapy
STATEMENT OF PROBLEM: Occlusal adjustment therapy has been advocated as a treatment modality for
temporomandibular disorders. In contrast to this position, a panel at the 1996 National Institute of Health technology assessment conference on TMD indicated that no clinical trials demonstrate that occlusal adjustment is superior to noninvasive therapies.
PURPOSE: This article summarizes the published experimental studies on occlusal adjustments and temporomandibular disorders.
MATERIAL AND METHODS: Eleven research experiments involving 413 subjects with either bruxism (n = 59),
temporomandibular disorders (n = 219), headaches and temporomandibular disorders (n = 91), or chronic cervical pain (n = 40) were selected for critical review from the English dental literature.
RESULTS: Three experiments evaluated the relationship
between occlusal adjustment and bruxism. Six experiments evaluated occlusal adjustment therapy as a treatment for patients with primary temporomandibular disorders. One experiment looked at occlusal adjustment effect on headache/temporomandibular
disorder symptoms; another looked at its effect on chronic neck pain. Most of these experiments used a mock adjustment or a comparison treatment as the control condition in adults who had an existing nonacute general temporomandibular disorder.
Overall, the data from these experiments did not demonstrate elevated therapeutic efficacy for occlusal adjustment over the control or the contrasting therapy.
CONCLUSION: The experimental evidence reviewed was neither convincing nor powerful enough to support the performance of occlusal therapy as a general method for treating a nonacute temporomandibular disorder,
bruxism, or headache.
- saaraah.
J-man
08-01-2003, 02:08 PM
Hi Saaraah,
Thanks for posting this info about Tmj research. It talks about occlusal adjustments, but the research does not say whether it is splints being adjusted or teeth that are being adjusted.
Usually 'occlusal adjustments' refer to small parts of teeth being removed, in order to change the bite, but we can't know for sure, unless we were to find out how exactly the research was being conducted.
I believe most dentists would agree that adjusting teeth (to change your bite), without first making sure you experience long term symptom reduction with a splint, is an unwise practice.
Have a great day !
John
Thanks for posting this info about Tmj research. It talks about occlusal adjustments, but the research does not say whether it is splints being adjusted or teeth that are being adjusted.
Usually 'occlusal adjustments' refer to small parts of teeth being removed, in order to change the bite, but we can't know for sure, unless we were to find out how exactly the research was being conducted.
I believe most dentists would agree that adjusting teeth (to change your bite), without first making sure you experience long term symptom reduction with a splint, is an unwise practice.
Have a great day !
John
saaraah
08-01-2003, 02:36 PM
j-man - i thought occlusial adjustment was one of the main concepts behind neuromuscular dentistry? i guess it depends on how it's done and the various symptoms.
also, i imagine in the full reserach paper, it would say exactly what was done concerning occlusial adjustments; i only posted the abstract. :)
- saaraah.
[This message has been edited by saaraah (edited 08-01-2003).]
also, i imagine in the full reserach paper, it would say exactly what was done concerning occlusial adjustments; i only posted the abstract. :)
- saaraah.
[This message has been edited by saaraah (edited 08-01-2003).]
DianeTMJ
08-01-2003, 03:16 PM
Saaraah,
Would you please post the link to this abstract? If it is .edu or .gov it is okay to post. I need to see the whole thing please.
Thank you
Diane
Would you please post the link to this abstract? If it is .edu or .gov it is okay to post. I need to see the whole thing please.
Thank you
Diane
crystalll
08-01-2003, 03:29 PM
Hi Saaraah,
I realize that you respect this individual, but my question is this; has he actually proposed a treatment for your TMJD (other than muscle relaxants)? I would really like to know what his alternative is to splint therapy.
I would strongly recommend that you get a second opinion from a dentist who has spent numerous hours training in the field of TMJ disorders. There are success stories - you know that.
The last I heard from the NIH is that they hadn't agreed on one specific form of treatment for TMJD. There hasn't been enough research done to make a recommendation. It's also been shown that different patients require different forms of treatment.
Your treatment is in your own hands. I would just suggest that you keep an open mind. Also, Dr. Rondeau isn't a "Neuromuscular Dentist". The end result is basically the same, but his approach is slightly different than the neuro approach.
The splint therapy, or diagnostic phase of treatment should be reversible. As John mentioned, occlusal adjustments ARE NOT made until all of your symptoms have disappeared.
Best of luck with whatever decision you make.
Crystal
I realize that you respect this individual, but my question is this; has he actually proposed a treatment for your TMJD (other than muscle relaxants)? I would really like to know what his alternative is to splint therapy.
I would strongly recommend that you get a second opinion from a dentist who has spent numerous hours training in the field of TMJ disorders. There are success stories - you know that.
The last I heard from the NIH is that they hadn't agreed on one specific form of treatment for TMJD. There hasn't been enough research done to make a recommendation. It's also been shown that different patients require different forms of treatment.
Your treatment is in your own hands. I would just suggest that you keep an open mind. Also, Dr. Rondeau isn't a "Neuromuscular Dentist". The end result is basically the same, but his approach is slightly different than the neuro approach.
The splint therapy, or diagnostic phase of treatment should be reversible. As John mentioned, occlusal adjustments ARE NOT made until all of your symptoms have disappeared.
Best of luck with whatever decision you make.
Crystal
saaraah
08-01-2003, 03:31 PM
dianetmj - in order to see the full article, you have to be a subscriber to "the journal of prosthetic dentistry"; im trying to find a free version somewhere, tho.
btw, i realize that is only 1 research paper, and it's unwise to base an opinion on only 1 paper. :)
- saaraah.
btw, i realize that is only 1 research paper, and it's unwise to base an opinion on only 1 paper. :)
- saaraah.
GenDen
08-01-2003, 03:33 PM
There is a tremendous amount of controversy regarding TMJD treatment. There is not a concensus even in the dental community. Whenever a new medical treatment comes along, the "old guard" is always skeptical. That isn't bad because healthy skepticism promotes reliable studies. It was years before the doctor's theory that H-pylori bacteria was indeed responsible for many stomach ulcers was accepted by the medical community. It is hard to do a double blind study with TMJD treatment, but that is what it is going to take for the medical community who bases treatment on scientific evidence to accept it. If reliable studies show that repositioning splints are an effective treatment for TMJD, it will be accepted.
saaraah
08-01-2003, 03:40 PM
crystall - i've been seeing this doctor for almost 10 years, and i've gone thru a plethora of conservative treatments while being treated by him. it's not like he just dolls out drugs -- it's the opposite, in fact. :) he follows all of the 'normal' guidelines to treat TMJD that i readily see online.
do you have a repositioning splint? my understanding is that that is a permanent type of treatment, since it alters the position of the mandible. however, a stabilizing splint is different; it gives the joints a rest, since the teeth arent touching. it doesnt alter the occlusion, though.
i am keeping an open mind, but i'd also like to keep my warning flags up: ive read too many stories about people getting TMJD treatments that have made them considerably worse. i certinaly do not want to be one of those statistics. :) hearing you guys speak so highly of neuromuscular dentistry, however, really gets me excited. :)
in addition, i have pretty much decided to visit dr. rondeau at least for a consultation. i'll see if i feel comfortable with him, and go from there.
- saaraah.
do you have a repositioning splint? my understanding is that that is a permanent type of treatment, since it alters the position of the mandible. however, a stabilizing splint is different; it gives the joints a rest, since the teeth arent touching. it doesnt alter the occlusion, though.
i am keeping an open mind, but i'd also like to keep my warning flags up: ive read too many stories about people getting TMJD treatments that have made them considerably worse. i certinaly do not want to be one of those statistics. :) hearing you guys speak so highly of neuromuscular dentistry, however, really gets me excited. :)
in addition, i have pretty much decided to visit dr. rondeau at least for a consultation. i'll see if i feel comfortable with him, and go from there.
- saaraah.
GenDen
08-01-2003, 03:53 PM
An occlusal adjustment is grinding the teeth to a new bite position. An occlusal adjust does not move the mandible forward.
I take exception to the statement that a repositioning splint is an irreversible treatment. When you quit wearing it, the jaw will move back to the old position unless your teeth have been altered through braces, or new crowns.
Also, is the NIH opposed to orthodontics? It appears to me that is an irreversible treatment.
Not everyone who sees a TMJD specialist (neuromuscular, functional jaw orthopedics) is a candidate for a repositioning splint. Their testing shows whether the mandible needs to be repositioned forward or not. Some people just need a splint that relaxes the muscles, increases the jaw joint space and allows the joint to heal. You choose a qualified TMJD specialist and let them decide which treatment is best for you.
I take exception to the statement that a repositioning splint is an irreversible treatment. When you quit wearing it, the jaw will move back to the old position unless your teeth have been altered through braces, or new crowns.
Also, is the NIH opposed to orthodontics? It appears to me that is an irreversible treatment.
Not everyone who sees a TMJD specialist (neuromuscular, functional jaw orthopedics) is a candidate for a repositioning splint. Their testing shows whether the mandible needs to be repositioned forward or not. Some people just need a splint that relaxes the muscles, increases the jaw joint space and allows the joint to heal. You choose a qualified TMJD specialist and let them decide which treatment is best for you.
GenDen
08-01-2003, 03:57 PM
Saaraah,
Do you have any explanation why the plethera of conservative treatments by your dentist have not worked for you? What does he recommend?
Do you have any explanation why the plethera of conservative treatments by your dentist have not worked for you? What does he recommend?
J-man
08-01-2003, 04:17 PM
Hi Saaraah,
I believe that the distinction you draw between repositioning and stabilization splints, is an accurate one, in terms what is commonly understood to be the purposes of these 2 types of splints. However, depending on what you believe happens during the course of long term splint treatment, it may be possible that over time, a stabilization splint effectively functions as a repositioning splint.
Dr. Richard Goldman has written a book about Tmjd, which is available online. As far as I can tell, the splint design which he uses in his treatments, would be considered a stabilization splint. In the section where he talks about what 'happens' during ongoing splint treatment, he advances what you might call his 'splint theory'. He believes that the splint produces healing in the joints, and relaxation in the muscles, and this in turn, produces a minor change in the way your teeth contact the splint.
So the idea is that as the splint does its job, your jaw is constantly shifting or changing to a better position, and each time you get your splint adjusted, you are, in a sense, capturing the new and better jaw position/condition in your new bite. Dr. Goldman's 'splint theory', if you will, would suggest that as you continue to use a stabilization splint, your 'bite' will change as a result of the improvement that it makes to the condition of your joints and muscles.
Have a great day and God bless !
John
I believe that the distinction you draw between repositioning and stabilization splints, is an accurate one, in terms what is commonly understood to be the purposes of these 2 types of splints. However, depending on what you believe happens during the course of long term splint treatment, it may be possible that over time, a stabilization splint effectively functions as a repositioning splint.
Dr. Richard Goldman has written a book about Tmjd, which is available online. As far as I can tell, the splint design which he uses in his treatments, would be considered a stabilization splint. In the section where he talks about what 'happens' during ongoing splint treatment, he advances what you might call his 'splint theory'. He believes that the splint produces healing in the joints, and relaxation in the muscles, and this in turn, produces a minor change in the way your teeth contact the splint.
So the idea is that as the splint does its job, your jaw is constantly shifting or changing to a better position, and each time you get your splint adjusted, you are, in a sense, capturing the new and better jaw position/condition in your new bite. Dr. Goldman's 'splint theory', if you will, would suggest that as you continue to use a stabilization splint, your 'bite' will change as a result of the improvement that it makes to the condition of your joints and muscles.
Have a great day and God bless !
John
Al4
08-01-2003, 04:20 PM
There is a link to a 1998 FDA Panel discussion on the safety and efficacy of instruments used in neuromuscular dentistry. It was posted a while back by RobynRose in her post http://www.healthboards.com/ubb/Forum119/HTML/002155.html
Alex
[This message has been edited by Al4 (edited 08-01-2003).]
Alex
[This message has been edited by Al4 (edited 08-01-2003).]
saaraah
08-01-2003, 04:42 PM
thanks everyone for the interesting responses! it really makes me think about all this, and it gives me encouragement.
genden - why has nothing helped me? um, because my body sucks.. i dont know why nothing's worked. the treatments i've done:
- chiropractic
- massage
- PT
- osteopathy
- sleep specialists
- neurologists focusing on migraines
- nightguard
- NTI guard
- psychologist: visualization, relaxation
- hot/cold packs
- soft diet
- medications:
+ muscle relaxants, anti-inflammetories, etc: flexeril, soma [im just starting that], vioxx, celebrex, toradol, ibuprofen
+ anti-depressants for sleeping: amitriptylene, trazodone
+ migraine meds: arthrotec, verapamil, naproxen, feverfew, riboflavin, divalproex [evil drug!]
+ botox
- checked for active inflammation to signal rheumatoid arthritis: negative
- acupuncture
- TENS
as you can see, i've done most if not all of the conservative treatments that are generally listed on websites and suggested by doctors. from what i've read, there's a 80% success rate with regards to the conservative treatments for TMJD -- which i've done.. i guess im in that crappy 20% who dont respond to treatment, which is why im going to a new dentist to see what his opinion is. :)
- saaraah.
[This message has been edited by saaraah (edited 08-01-2003).]
genden - why has nothing helped me? um, because my body sucks.. i dont know why nothing's worked. the treatments i've done:
- chiropractic
- massage
- PT
- osteopathy
- sleep specialists
- neurologists focusing on migraines
- nightguard
- NTI guard
- psychologist: visualization, relaxation
- hot/cold packs
- soft diet
- medications:
+ muscle relaxants, anti-inflammetories, etc: flexeril, soma [im just starting that], vioxx, celebrex, toradol, ibuprofen
+ anti-depressants for sleeping: amitriptylene, trazodone
+ migraine meds: arthrotec, verapamil, naproxen, feverfew, riboflavin, divalproex [evil drug!]
+ botox
- checked for active inflammation to signal rheumatoid arthritis: negative
- acupuncture
- TENS
as you can see, i've done most if not all of the conservative treatments that are generally listed on websites and suggested by doctors. from what i've read, there's a 80% success rate with regards to the conservative treatments for TMJD -- which i've done.. i guess im in that crappy 20% who dont respond to treatment, which is why im going to a new dentist to see what his opinion is. :)
- saaraah.
[This message has been edited by saaraah (edited 08-01-2003).]
CherylLynn24
08-01-2003, 04:58 PM
Saaraah,
My son has a long list similar to yours. After seeing so many people, and trying so many different things, we decided to try the Neuromuscular approach. Unfortunately, you both sound like you're the 20%....hang in there.
Cheryl
[This message has been edited by CherylLynn24 (edited 08-01-2003).]
My son has a long list similar to yours. After seeing so many people, and trying so many different things, we decided to try the Neuromuscular approach. Unfortunately, you both sound like you're the 20%....hang in there.
Cheryl
[This message has been edited by CherylLynn24 (edited 08-01-2003).]
Al4
08-01-2003, 05:12 PM
Cheryl,
Isn't your son improving with the neuromuscular splint? Is that what he is using? Thanks.
Alex
Isn't your son improving with the neuromuscular splint? Is that what he is using? Thanks.
Alex
DianeTMJ
08-01-2003, 05:44 PM
I found the article from the 1996 conference, it is located at: http://consensus.nih.gov/ta/018/018_statement.htm
[This message has been edited by DianeTMJ (edited 08-01-2003).]
[This message has been edited by DianeTMJ (edited 08-01-2003).]
J-man
08-01-2003, 06:39 PM
Hi Diane,
Upon what are you basing your concerns about the neuromuscular treatments you've been receiving ? Is it the 'consensus opinion' rendered by the NIH ? You may want to talk further with Marlene about the repositioning splint. In her case at least, it was a very helpful treatment. Do you feel like you have a lot of confidence in your dentist, based on the treatment he/she has been providing you with so far ?
Take care :-)
John
Upon what are you basing your concerns about the neuromuscular treatments you've been receiving ? Is it the 'consensus opinion' rendered by the NIH ? You may want to talk further with Marlene about the repositioning splint. In her case at least, it was a very helpful treatment. Do you feel like you have a lot of confidence in your dentist, based on the treatment he/she has been providing you with so far ?
Take care :-)
John
DianeTMJ
08-01-2003, 06:53 PM
HI John,
You know, I had researched and reasearched, I felt so lucky when I found my neuromuscular dentist. My confidence with him 150%. All he has done for me is relieve me of every symptom, given my life back to me. I am going forward with my treatment on 8/15, where I will receive my 2 new splints. Reading that article makes me nervous and frightened. But I also know that first of all, this article is 7 years old. 2nd of all, if there is one thing I have learned, politics are involved in medical world and it is all about who pays the most to get their horn tooted and downplay other treatments. And where I read in the same article they see no long term negatives in a person with TMJD taking opiates I just about screamed. So that tells me who's horn is being tooted.
I am sorry John for rattling on, the article and this post has just frightened me. This approach has so worked for me, I am sorry I can not do surgery, I can not take drugs. This is the most "natural" approach I have seen out there. At least when one is as severe as I was.
I gotta stop. So Yep, I believe 150% in my dentist.
Take care
Diane
[This message has been edited by DianeTMJ (edited 08-01-2003).]
You know, I had researched and reasearched, I felt so lucky when I found my neuromuscular dentist. My confidence with him 150%. All he has done for me is relieve me of every symptom, given my life back to me. I am going forward with my treatment on 8/15, where I will receive my 2 new splints. Reading that article makes me nervous and frightened. But I also know that first of all, this article is 7 years old. 2nd of all, if there is one thing I have learned, politics are involved in medical world and it is all about who pays the most to get their horn tooted and downplay other treatments. And where I read in the same article they see no long term negatives in a person with TMJD taking opiates I just about screamed. So that tells me who's horn is being tooted.
I am sorry John for rattling on, the article and this post has just frightened me. This approach has so worked for me, I am sorry I can not do surgery, I can not take drugs. This is the most "natural" approach I have seen out there. At least when one is as severe as I was.
I gotta stop. So Yep, I believe 150% in my dentist.
Take care
Diane
[This message has been edited by DianeTMJ (edited 08-01-2003).]
ryanpaus
08-01-2003, 06:55 PM
I have a couple questions:
1.If he your dentsit doesnt aprove of repostioning splints or neuro splints than what does he recomend for treatment? Just putting you on pain killers and thats that?
2.If neuro splints are reversable than how can you ever come off of them. Surely if that type of splint is reversable than the symptoms will come back after you finish using the splint.
1.If he your dentsit doesnt aprove of repostioning splints or neuro splints than what does he recomend for treatment? Just putting you on pain killers and thats that?
2.If neuro splints are reversable than how can you ever come off of them. Surely if that type of splint is reversable than the symptoms will come back after you finish using the splint.
CherylLynn24
08-01-2003, 07:17 PM
Alex,
He got his splint and broke it after 4 or 5 days. We had to wait for a new one to be made, and just got it today....We'll see. Oh....yes, it is neuromuscular.
Cheryl
[This message has been edited by CherylLynn24 (edited 08-01-2003).]
He got his splint and broke it after 4 or 5 days. We had to wait for a new one to be made, and just got it today....We'll see. Oh....yes, it is neuromuscular.
Cheryl
[This message has been edited by CherylLynn24 (edited 08-01-2003).]
saaraah
08-01-2003, 09:20 PM
dianetmj - i hope that i havent created all of this anxiety for you about *my* worries over repositioning splints! i am new to this stuff, and .. ahh. im sorry :)
also, im curious - why are you getting the new splint when all of your symptoms have been eliminated?
ryanpaus - were those questions directed towards me? forgive me if they werent.
first, most of the things i've done are listed in a post above, which certainly dont only include pain medications. in fact, as you can see, there's a wide range of treatments that the doctor has both suggested and i have discovered, which include alternative and "normal" treatments.
concerning your 2nd question, i believe that repositioning splints are permanent. either you have to wear the splint all of the time, or get bridges and crowns. im sure that someone else can answer that question better than me, tho. :)
- saaraah.
also, im curious - why are you getting the new splint when all of your symptoms have been eliminated?
ryanpaus - were those questions directed towards me? forgive me if they werent.
first, most of the things i've done are listed in a post above, which certainly dont only include pain medications. in fact, as you can see, there's a wide range of treatments that the doctor has both suggested and i have discovered, which include alternative and "normal" treatments.
concerning your 2nd question, i believe that repositioning splints are permanent. either you have to wear the splint all of the time, or get bridges and crowns. im sure that someone else can answer that question better than me, tho. :)
- saaraah.
J-man
08-02-2003, 01:08 PM
Hi everyone,
Like Sarah said, I think the NIH article has generated some good discussion. I'm glad that she posted it :-) It is good to be exposed to what the 'experts' have to say, but then I think it's important to take a step back, and see if they have evidence to support their claims (especially since the NIH is stressing the need for dentists to have evidence to back up the methods they are using with patients)
As we know, experts, like the rest of us, can sometimes be wrong. For instance, here are two experts who have been wrong before, one of whom was one of the greatest minds of the past century :
"The bomb will never go off, and I speak as an expert in explosives." Adm. William Leahy referring to the atomic bomb
"There is not the slightest indication that nuclear energy will ever be obtainable. It would mean that the atom would have to be shattered at will." - Albert Einstein, 1932
Some of the statements made in the NIH report seem to be supported by facts, while others appear to be 'opinions'. Here are some statements made in the NIH report, which I find to be questionable :
"From the data provided, no single treatment or combination of procedures was demonstrated to be effective in randomized, controlled clinical trials. Given the lack of evidence, no specific recommendations can be made."
So first they are saying that 'no treatment was demontrated to be effective'....but then they go on to say that certain treatments, "would be useful"
However, the following would be useful to advance the care of patients with persistent TMD pain and dysfunction. "
On what basis should we believe that the treatments they have listed "would be useful"...if there is no evidence to show that they are... ?lol
Also, when the report says that 'no treatment was demonstrated to be effective', do they mean that these treatments were not found to be effective at all...or just that they didn't substantially cure your Tmj condition ? Would this be suggesting that no scientific studies have been done to show that Tens has the ability to relax your muscles ? ( Dr. Barry Cooper has published research in scientific journals which clearly shows a decrease in muscle tension in jaw muscles after Tens use)
Furthermore, the article makes the statement that, " other treatments such as pharmacotherapeutics appear to have been underutilized"....
But how can they say that drug therapies should be used more often, when the report is also telling us that there is 'no treatment was shown to be effective' (presumably this would include drug treatments)?
Just a few thoughts. What are your thoughts guys ?
Have a great day !
John
Like Sarah said, I think the NIH article has generated some good discussion. I'm glad that she posted it :-) It is good to be exposed to what the 'experts' have to say, but then I think it's important to take a step back, and see if they have evidence to support their claims (especially since the NIH is stressing the need for dentists to have evidence to back up the methods they are using with patients)
As we know, experts, like the rest of us, can sometimes be wrong. For instance, here are two experts who have been wrong before, one of whom was one of the greatest minds of the past century :
"The bomb will never go off, and I speak as an expert in explosives." Adm. William Leahy referring to the atomic bomb
"There is not the slightest indication that nuclear energy will ever be obtainable. It would mean that the atom would have to be shattered at will." - Albert Einstein, 1932
Some of the statements made in the NIH report seem to be supported by facts, while others appear to be 'opinions'. Here are some statements made in the NIH report, which I find to be questionable :
"From the data provided, no single treatment or combination of procedures was demonstrated to be effective in randomized, controlled clinical trials. Given the lack of evidence, no specific recommendations can be made."
So first they are saying that 'no treatment was demontrated to be effective'....but then they go on to say that certain treatments, "would be useful"
However, the following would be useful to advance the care of patients with persistent TMD pain and dysfunction. "
On what basis should we believe that the treatments they have listed "would be useful"...if there is no evidence to show that they are... ?lol
Also, when the report says that 'no treatment was demonstrated to be effective', do they mean that these treatments were not found to be effective at all...or just that they didn't substantially cure your Tmj condition ? Would this be suggesting that no scientific studies have been done to show that Tens has the ability to relax your muscles ? ( Dr. Barry Cooper has published research in scientific journals which clearly shows a decrease in muscle tension in jaw muscles after Tens use)
Furthermore, the article makes the statement that, " other treatments such as pharmacotherapeutics appear to have been underutilized"....
But how can they say that drug therapies should be used more often, when the report is also telling us that there is 'no treatment was shown to be effective' (presumably this would include drug treatments)?
Just a few thoughts. What are your thoughts guys ?
Have a great day !
John
DianeTMJ
08-02-2003, 01:50 PM
Good morning John -
Well John, what I find so funny about this whole thing is that 2 months ago I was having every kind of symptom you could of in regard to TMJD, I am now symptom free, from a neuromuscular approach and splint, that the NIH says is ineffective in the treatment of TMJD. Hmmmmmm.
I think that each of us have to what works for us, I think that I am so lucky to have Dr B on my dream team. I think the NIH needs to have a more open mind about new approaches to TMJD treatment.
I am so happy that my neuromusuclar dentist has proved the NIH wrong!
have a good day John!
DIane
Well John, what I find so funny about this whole thing is that 2 months ago I was having every kind of symptom you could of in regard to TMJD, I am now symptom free, from a neuromuscular approach and splint, that the NIH says is ineffective in the treatment of TMJD. Hmmmmmm.
I think that each of us have to what works for us, I think that I am so lucky to have Dr B on my dream team. I think the NIH needs to have a more open mind about new approaches to TMJD treatment.
I am so happy that my neuromusuclar dentist has proved the NIH wrong!
have a good day John!
DIane
J-man
08-02-2003, 04:48 PM
Hey Diane,
That's so awesome to hear that you've been helped so much through your treatments !!! I hope the same for everyone on this board. I too have been greatly helped by my dentist, who incorporates principles of 'neuromuscular dentistry' into his practice. I am tremendously grateful for what he's done for me.
Looking forward to more good news updates from you in the future, as you continue your journey on the path to healing and recovery.
May God richly bless ya !
John
That's so awesome to hear that you've been helped so much through your treatments !!! I hope the same for everyone on this board. I too have been greatly helped by my dentist, who incorporates principles of 'neuromuscular dentistry' into his practice. I am tremendously grateful for what he's done for me.
Looking forward to more good news updates from you in the future, as you continue your journey on the path to healing and recovery.
May God richly bless ya !
John
DianeTMJ
08-02-2003, 05:19 PM
Hello John -
Thank you John. I so appreciate it.
You know it is my prayer that each and every person on this board and any other that is silently dealing with the effects of TMJD find that dedicated, caring Dentist/Dr that will see them through and them to the otherside, symptom free. My Dr B utilizes several techniques as well. John, I think they are rare birds, going against the grain, not listening to "norm" for education and training in regard to TMJD.
I am ever thankful for finding Dr B and neuromuscular dentistry.
I think God has already so blessed us! :0)
Take care John,
Diane
Thank you John. I so appreciate it.
You know it is my prayer that each and every person on this board and any other that is silently dealing with the effects of TMJD find that dedicated, caring Dentist/Dr that will see them through and them to the otherside, symptom free. My Dr B utilizes several techniques as well. John, I think they are rare birds, going against the grain, not listening to "norm" for education and training in regard to TMJD.
I am ever thankful for finding Dr B and neuromuscular dentistry.
I think God has already so blessed us! :0)
Take care John,
Diane
jafc
08-03-2003, 12:25 AM
Hi Saaraah and everyone,
I haven't been posting much lately, but wanted to add that I'm into month 3 with my neuromuscular splint and my TM joint *does not hurt* after 14 years of grinding and clenching all night, every night. I'm still grinding and clenching, quite a bit in fact, but the splint/tens/chiro seems to be preventing this behavior from hurting me.
------------------
Judy
I haven't been posting much lately, but wanted to add that I'm into month 3 with my neuromuscular splint and my TM joint *does not hurt* after 14 years of grinding and clenching all night, every night. I'm still grinding and clenching, quite a bit in fact, but the splint/tens/chiro seems to be preventing this behavior from hurting me.
------------------
Judy
crystalll
08-03-2003, 01:53 AM
Hi Saaraah,
In answer to your question, Dr. Rondeau refers to my splint as a "diagnostic splint". It's likely a cross between a repositioning splint and a stabilizing splint. It's built up quite high so that my teeth don't touch, and it creates room in my joint for healing, but it has also brought my jaw forward. If I were to remove my splint, my jaw would return to its original position. And my occlusion hasn't changed at all.
Again, a repositioning splint on its own is not permanent. If it doesn't ease your symptoms, it can be removed to allow your jaw to return to its original state. If it does ease your symptoms, then yes, some work may be required to "alter" your bite and bring it into harmony with your jaw position. That is considered permanent.
Take care.
Crystal
In answer to your question, Dr. Rondeau refers to my splint as a "diagnostic splint". It's likely a cross between a repositioning splint and a stabilizing splint. It's built up quite high so that my teeth don't touch, and it creates room in my joint for healing, but it has also brought my jaw forward. If I were to remove my splint, my jaw would return to its original position. And my occlusion hasn't changed at all.
Again, a repositioning splint on its own is not permanent. If it doesn't ease your symptoms, it can be removed to allow your jaw to return to its original state. If it does ease your symptoms, then yes, some work may be required to "alter" your bite and bring it into harmony with your jaw position. That is considered permanent.
Take care.
Crystal
QA11
08-03-2003, 09:08 AM
Hello all,
My 2 cents on NIH is this, they are a scientific body that researches medical issues. Their basic conclusion has been that there is not one single effective method of treating all TMD patients. They are trying to sort out the different paths of treatment but have found a wide assortment of components. To my knowledge, NIH has not said that the "neuro" group is not effective, but has said that not all patients respond to that particular set of treatments with success. They have also said that about that with splint therapy. They have not said that those treatments don't help anyone, they have said those treatments don't help everyone, all of the time. Like it or not, Dentistry is still very dependent upon the skill of the provider.
Also the Journal of Prosthetics is a separate group than NIH. They have been heavily influenced by the Pankey-Dawson Philosophy in the past. That is the functional, "centric occlusion", build up the bite style of treatment.
There are two resaons for splints, but the primary one is to try to find a point of "rest" for the jaw and to "quiet" the stress factors, to slow down the muscle spasms etc....
Lastly, there are irreversible proceedures in Dentitstry and you should be aware of them. Obviously surgery is one, ortho, and a large amount of crown and bridge work are others. Consider "build ups" with composite material instead, these can be be removed easily. If restoring your bite truly helps, then do the permanent crowns etc...
Something to remember here is that all of these groups and philosophies have developed to help patients with their care, and while it sometimes feels otherwise, most Drs. would like to help their patients, especially those in pain. Unfortuntely not all Drs. have the breadth of knowledge to help. And some may be very skilled in treating certain variations of TMD and not others.
QA11
My 2 cents on NIH is this, they are a scientific body that researches medical issues. Their basic conclusion has been that there is not one single effective method of treating all TMD patients. They are trying to sort out the different paths of treatment but have found a wide assortment of components. To my knowledge, NIH has not said that the "neuro" group is not effective, but has said that not all patients respond to that particular set of treatments with success. They have also said that about that with splint therapy. They have not said that those treatments don't help anyone, they have said those treatments don't help everyone, all of the time. Like it or not, Dentistry is still very dependent upon the skill of the provider.
Also the Journal of Prosthetics is a separate group than NIH. They have been heavily influenced by the Pankey-Dawson Philosophy in the past. That is the functional, "centric occlusion", build up the bite style of treatment.
There are two resaons for splints, but the primary one is to try to find a point of "rest" for the jaw and to "quiet" the stress factors, to slow down the muscle spasms etc....
Lastly, there are irreversible proceedures in Dentitstry and you should be aware of them. Obviously surgery is one, ortho, and a large amount of crown and bridge work are others. Consider "build ups" with composite material instead, these can be be removed easily. If restoring your bite truly helps, then do the permanent crowns etc...
Something to remember here is that all of these groups and philosophies have developed to help patients with their care, and while it sometimes feels otherwise, most Drs. would like to help their patients, especially those in pain. Unfortuntely not all Drs. have the breadth of knowledge to help. And some may be very skilled in treating certain variations of TMD and not others.
QA11
Cymy Sue
08-03-2003, 11:48 AM
The NIH was given it's first grant to research TMJ in 1969. They were to give this disease/disorder a common name to be used by all. A commonality in symtoms and a set standard of treatment protocol.
Since this topic was posted, due to my own curiosity, I decided to see if I could find out through research "WHAT" has been done in the last 34 years.
There are thousands of pages of minutes from meetings, many attempts for more funding to study TMJD, many other organizations involved in searching for answers, at least 20 years of trying to put together a "National Registry for TMJ Patients", so that we can tell the world of our plight, and mostly a lot of Professionals patting each other on the back for getting together at these meetings and "PLANNING" on what to do.
So far, there is no common name, no specific list of symtoms, no designation of disease/disorder, Dental or Medical????? and no Standard Protocol for treatment, non-invasive, invasive, reversible, irreversible ,surgical..................
I am happy that we have a National Health Inst. but as with many government agencies, politics and bureaucracy stand in the way of any real progress for the common people.
The NIH early on (I could not find a date) established a seperate agency called the NIDCR, "National Institute of Dental and Cranofacial Research."
Objective the same. Same results so far. 0
In about 1982, the JJAMD, "Jaw joints and Allied Muscleskeletal Disorders Foundation" was organized. I believe this was a combined effort by several TMJ Advocacy Groups to be able to approach the NIDCR and Washington as one group in their search for help. I think they are trying, but yet to make any real advances. You can read what they feel they accomplished in 2002 @ www.tmjoints.org/news/retro02.htm (http://www.tmjoints.org/news/retro02.htm)
In 1996 the NIDRC established a seperate agency to really get down to business. It's called the TMJDIWG,
"TMJD Interagency Working Group" You can read the minutes of their last meeting, I believe it was April 02 @ www.nidrc.nih.gov/tmdiwg/minutes.asp (http://www.nidrc.nih.gov/tmdiwg/minutes.asp)
I didn't see a whole lot of anything that resembled
any immediate help for TMJD patients.
In reading all of this "stuff" I got a terrible headache and didn't find any recommendations or warnings for any type of treatment other than they think TMJD in most cases will resolve on it's on without treatment. This statement was a real surprise. I did see occasionally, surgery is needed in only a small percentage of cases, of which I do agree with.
(I did of course see the "Implant Problem" discussed)
So, I, like many others could not find the paper Saaraah was speaking of, but I'm sure I missed many.
I assume these meetings, reports and papers are good intensions by these groups and hope it won't take another 34 years for them to get started with something that will actually be helpful for those who suffer.
Saaraah,
Most Professionals have their beliefs in what works and what doesn't. My former Surgeon of 10 years, very well-known and respected kept me out of any kind of Splint Therapy (the past 10 years), because he doesn't believe they work.
The fact that I had almost immediate relief from symtoms I've had for 25 years with Splint Therapy, proves that he is totally ignorant in regard to Splint Therapy and I suffered many years needlessly due to his ignorance.
QA11,
I have seen you mention the old Pankey-Dawson Centric Relation theory several times and there are most likely some Dentists who would still use this theory, however the Pankey Institute does not base their theories in Splint Design on this old theory anymore.
Studies of Centic relation may still be included in their curriculum, but the built up bite is no longer the standard. I got interested in this the first time I saw it mentioned here and unless I have the wrong Dr. Pankey & Dr. Dawson, their names have not been seen together for a long time.
I do see that the neuromuscular dentists have a problem with the Dentists who continue to use the Dawson Theories of centric relation as their only guide to Splint Design and occlusal therapy.
There are also Dawson Style Splints and Pankey Style Splints.
I brought this up due to this topic of a certain type of Splints not working????? and because my Dentist has attended the Pankey Inst. for the last 10 years for Continuing Education for TMJD treatment and Splint Design. He has designed a splint for me based on the Pankey Theories, but it is unique and individualized for my particular condition. It is 1mm thick and the only therapy that has ever helped me. I have very few symtoms now after 25 years of TMJD treatments and surgeries.
Your post is a very good one in regard to this topic, I have just been confused everytime someone mentions the Pankey-Dawson Philosophy. I have made posts regarding (MY) Pankey Trained Dentist and I just wanted everyone to know that the old philosophy does not appear to be taught there as a guide to treatment.
Anyway, my last opinion on treatment is, if you find a Doctor who you feel has your health and best interest at heart and is treating you with an individual therapy that is designed for your condition, that is the best you can do for yourself.
There are as many different theories and ideas on what works as there are Doctors. We have to make our on decisions on what's best for each of us. Our Government agencies are not yet advised, prepared nor have enough knowledge to do it for us. Maybe someday..
Cymy Sue
[This message has been edited by Cymy Sue (edited 09-05-2003).]
Since this topic was posted, due to my own curiosity, I decided to see if I could find out through research "WHAT" has been done in the last 34 years.
There are thousands of pages of minutes from meetings, many attempts for more funding to study TMJD, many other organizations involved in searching for answers, at least 20 years of trying to put together a "National Registry for TMJ Patients", so that we can tell the world of our plight, and mostly a lot of Professionals patting each other on the back for getting together at these meetings and "PLANNING" on what to do.
So far, there is no common name, no specific list of symtoms, no designation of disease/disorder, Dental or Medical????? and no Standard Protocol for treatment, non-invasive, invasive, reversible, irreversible ,surgical..................
I am happy that we have a National Health Inst. but as with many government agencies, politics and bureaucracy stand in the way of any real progress for the common people.
The NIH early on (I could not find a date) established a seperate agency called the NIDCR, "National Institute of Dental and Cranofacial Research."
Objective the same. Same results so far. 0
In about 1982, the JJAMD, "Jaw joints and Allied Muscleskeletal Disorders Foundation" was organized. I believe this was a combined effort by several TMJ Advocacy Groups to be able to approach the NIDCR and Washington as one group in their search for help. I think they are trying, but yet to make any real advances. You can read what they feel they accomplished in 2002 @ www.tmjoints.org/news/retro02.htm (http://www.tmjoints.org/news/retro02.htm)
In 1996 the NIDRC established a seperate agency to really get down to business. It's called the TMJDIWG,
"TMJD Interagency Working Group" You can read the minutes of their last meeting, I believe it was April 02 @ www.nidrc.nih.gov/tmdiwg/minutes.asp (http://www.nidrc.nih.gov/tmdiwg/minutes.asp)
I didn't see a whole lot of anything that resembled
any immediate help for TMJD patients.
In reading all of this "stuff" I got a terrible headache and didn't find any recommendations or warnings for any type of treatment other than they think TMJD in most cases will resolve on it's on without treatment. This statement was a real surprise. I did see occasionally, surgery is needed in only a small percentage of cases, of which I do agree with.
(I did of course see the "Implant Problem" discussed)
So, I, like many others could not find the paper Saaraah was speaking of, but I'm sure I missed many.
I assume these meetings, reports and papers are good intensions by these groups and hope it won't take another 34 years for them to get started with something that will actually be helpful for those who suffer.
Saaraah,
Most Professionals have their beliefs in what works and what doesn't. My former Surgeon of 10 years, very well-known and respected kept me out of any kind of Splint Therapy (the past 10 years), because he doesn't believe they work.
The fact that I had almost immediate relief from symtoms I've had for 25 years with Splint Therapy, proves that he is totally ignorant in regard to Splint Therapy and I suffered many years needlessly due to his ignorance.
QA11,
I have seen you mention the old Pankey-Dawson Centric Relation theory several times and there are most likely some Dentists who would still use this theory, however the Pankey Institute does not base their theories in Splint Design on this old theory anymore.
Studies of Centic relation may still be included in their curriculum, but the built up bite is no longer the standard. I got interested in this the first time I saw it mentioned here and unless I have the wrong Dr. Pankey & Dr. Dawson, their names have not been seen together for a long time.
I do see that the neuromuscular dentists have a problem with the Dentists who continue to use the Dawson Theories of centric relation as their only guide to Splint Design and occlusal therapy.
There are also Dawson Style Splints and Pankey Style Splints.
I brought this up due to this topic of a certain type of Splints not working????? and because my Dentist has attended the Pankey Inst. for the last 10 years for Continuing Education for TMJD treatment and Splint Design. He has designed a splint for me based on the Pankey Theories, but it is unique and individualized for my particular condition. It is 1mm thick and the only therapy that has ever helped me. I have very few symtoms now after 25 years of TMJD treatments and surgeries.
Your post is a very good one in regard to this topic, I have just been confused everytime someone mentions the Pankey-Dawson Philosophy. I have made posts regarding (MY) Pankey Trained Dentist and I just wanted everyone to know that the old philosophy does not appear to be taught there as a guide to treatment.
Anyway, my last opinion on treatment is, if you find a Doctor who you feel has your health and best interest at heart and is treating you with an individual therapy that is designed for your condition, that is the best you can do for yourself.
There are as many different theories and ideas on what works as there are Doctors. We have to make our on decisions on what's best for each of us. Our Government agencies are not yet advised, prepared nor have enough knowledge to do it for us. Maybe someday..
Cymy Sue
[This message has been edited by Cymy Sue (edited 09-05-2003).]
Arleen
08-03-2003, 02:15 PM
Hi Cymy Sue:
How are you doing these days? Thank you for another informative post. I've been on and off following this thread. My brain doesn't absorb much these days, so I haven't checked out the links. I'm wondering if you could give me an idea of what the Pankey-Dawson Centric Relation perspective/treatment is.
Also, there has been a lot of discussion here on how neuromuscular impressions and splints are created. I'm curious about the process you went through for your splint. How many hours/day do you wear it? Will you be using it forever, or is it something you dentist expects you'll wean off of. If you'll be using it only for a while, what is the next step in your treatment.
Cymy Sue, it makes me feel sick everytime I read about the length of time you've suffered and all you've been through. I just can't imagine. I really feel for you, and am so glad that you've finally got relief. :)
Hugs, and take care,
Arleen
How are you doing these days? Thank you for another informative post. I've been on and off following this thread. My brain doesn't absorb much these days, so I haven't checked out the links. I'm wondering if you could give me an idea of what the Pankey-Dawson Centric Relation perspective/treatment is.
Also, there has been a lot of discussion here on how neuromuscular impressions and splints are created. I'm curious about the process you went through for your splint. How many hours/day do you wear it? Will you be using it forever, or is it something you dentist expects you'll wean off of. If you'll be using it only for a while, what is the next step in your treatment.
Cymy Sue, it makes me feel sick everytime I read about the length of time you've suffered and all you've been through. I just can't imagine. I really feel for you, and am so glad that you've finally got relief. :)
Hugs, and take care,
Arleen
Cymy Sue
08-03-2003, 06:32 PM
Arleen,
Thank you for your concern. I am doing very well now with very few TMJD symtoms (to be a multi-surgical throw away :D ). I am forever grateful to the members of this board who made posts of successes with splint therapy.
When I was told almost a year ago, that nothing else could be done for me, I went to my Dentist and ask him if he knew of anything, anywhere that was being done to help people with the condition I was in. He said he believed that a relatively new concept in splints designed for people with joints damaged by osteo & rheumatoid arthritis might work for surgically damaged joints. He then told me about his continued studies at the Pankey Inst. and that he consulted with a couple of other groups on difficult cases. Once they "all" decided that this might work for me and that it would not cause any further problems with my joints, I had impresssions and the splint was made. That was the whole deal. It's made to support my joints and passively let the muscles go back to their normal or natural position. It seems that at this point, my major problem was muscles that had been in spasm for years, they had shortened on one side and enlarged on the other and I had all kinds of damage from surgeries. The splint is very thin with a flat plane that my teeth rest on. It's barely visible and I've had no discomfort wearing it. Since I was one of the first multi-surgicals with no disc that my Dentist had tried this with, we're kind of playing it by ear on how long. I wore it all day & night for about 2 weeks and then just at night. It inhibits clenching (for me) and has, in a few short months pretty much done what it was supposed to do. I have found, if I forget it at night, I wake up a with some muscle tightness. I may have to wear it forever at night to keep the muscles from going back to their clenched and spasmed state. This will not be a problem for me. My opening has increased over twice what it had been for years. My face is straight. No daily headaches. No joint pain. "Almost" no nerve pain. Tinnitus going away. I could go on & on, but you know all the problems. The majority of them have gone or are going away.
There is no next step. This is it. This is what it was designed to do. It will not move any teeth or bone. However, as the muscles relax, my jaw has dropped and come forward a little. This is where it should be. Where it had been for years, was abnormal and caused pain and all the other symtoms. I think this is one of the things a lot of members are not clear about on some of the repositional splints.
I really don't know much about the Pankey-Dawson Philosophy and Centric relation. It's been mentioned on the board a few times by QA11 and I believe GenDen. They may understand the theory. I think it at one time was considered by many to be one of the best theories in splint design and occlusal treatment. All I can find out about it, is that most believe it to be wrong and outdated, but some Dentists still use it. I understand what they're saying in regard to the theory, but I'm not sure how it would apply to each individual's condition. It sounds a little like assembly line treatment.
As I posted earlier, I became curious when I saw some posts about it and my Dentist has completed all the courses at the Pankey Inst. He doesn't use this theory, so I tried to find out when it was used and if the Pankey Inst. still included it in their curriculum. I really didn't find out much about it. The next time I see my Dentist, I'm going to ask him.
I'm sorry you're feeling so bad and hope you will find help soon.
Cymy Sue
Thank you for your concern. I am doing very well now with very few TMJD symtoms (to be a multi-surgical throw away :D ). I am forever grateful to the members of this board who made posts of successes with splint therapy.
When I was told almost a year ago, that nothing else could be done for me, I went to my Dentist and ask him if he knew of anything, anywhere that was being done to help people with the condition I was in. He said he believed that a relatively new concept in splints designed for people with joints damaged by osteo & rheumatoid arthritis might work for surgically damaged joints. He then told me about his continued studies at the Pankey Inst. and that he consulted with a couple of other groups on difficult cases. Once they "all" decided that this might work for me and that it would not cause any further problems with my joints, I had impresssions and the splint was made. That was the whole deal. It's made to support my joints and passively let the muscles go back to their normal or natural position. It seems that at this point, my major problem was muscles that had been in spasm for years, they had shortened on one side and enlarged on the other and I had all kinds of damage from surgeries. The splint is very thin with a flat plane that my teeth rest on. It's barely visible and I've had no discomfort wearing it. Since I was one of the first multi-surgicals with no disc that my Dentist had tried this with, we're kind of playing it by ear on how long. I wore it all day & night for about 2 weeks and then just at night. It inhibits clenching (for me) and has, in a few short months pretty much done what it was supposed to do. I have found, if I forget it at night, I wake up a with some muscle tightness. I may have to wear it forever at night to keep the muscles from going back to their clenched and spasmed state. This will not be a problem for me. My opening has increased over twice what it had been for years. My face is straight. No daily headaches. No joint pain. "Almost" no nerve pain. Tinnitus going away. I could go on & on, but you know all the problems. The majority of them have gone or are going away.
There is no next step. This is it. This is what it was designed to do. It will not move any teeth or bone. However, as the muscles relax, my jaw has dropped and come forward a little. This is where it should be. Where it had been for years, was abnormal and caused pain and all the other symtoms. I think this is one of the things a lot of members are not clear about on some of the repositional splints.
I really don't know much about the Pankey-Dawson Philosophy and Centric relation. It's been mentioned on the board a few times by QA11 and I believe GenDen. They may understand the theory. I think it at one time was considered by many to be one of the best theories in splint design and occlusal treatment. All I can find out about it, is that most believe it to be wrong and outdated, but some Dentists still use it. I understand what they're saying in regard to the theory, but I'm not sure how it would apply to each individual's condition. It sounds a little like assembly line treatment.
As I posted earlier, I became curious when I saw some posts about it and my Dentist has completed all the courses at the Pankey Inst. He doesn't use this theory, so I tried to find out when it was used and if the Pankey Inst. still included it in their curriculum. I really didn't find out much about it. The next time I see my Dentist, I'm going to ask him.
I'm sorry you're feeling so bad and hope you will find help soon.
Cymy Sue
Arleen
08-03-2003, 07:54 PM
Hi Cymy Sue:
Thanks for the information. I go for a complete exam on Friday, with a neuro dentist, so I'm starting to get a bit nervous.
I'd be quite happy to wear a splint forever if it fixes my problems. I've had enough bad things done to my bite and am not looking to add caps or braces to the mix. If a splint can even out my completely off bite, I'd be thrilled. I'd be thrilled if I could go through a day where I didn't have to think about my teeth. That doesn't happen, because my bite has no place it fits, so I feel that all the time. Oh well, my time will come. I'm hanging in :)
Take care,
Arleen
Thanks for the information. I go for a complete exam on Friday, with a neuro dentist, so I'm starting to get a bit nervous.
I'd be quite happy to wear a splint forever if it fixes my problems. I've had enough bad things done to my bite and am not looking to add caps or braces to the mix. If a splint can even out my completely off bite, I'd be thrilled. I'd be thrilled if I could go through a day where I didn't have to think about my teeth. That doesn't happen, because my bite has no place it fits, so I feel that all the time. Oh well, my time will come. I'm hanging in :)
Take care,
Arleen
navy2
08-03-2003, 10:17 PM
Cymy Sue,
The dentist that messed up my crown and fillings is a Pankey Institute grad. He still goes there for training. I've had 18 months of misery since he did my work and I now have a displaced disc which I didn't before he did his Pankey Institute stuff on me. They are into full mouth reconstruction, equilabration and bite studies. When you have your first appointment, he shows you every tooth in your mouth on a television screen. The only way he said he could fix the dental work was to do a $500 bite study to see if I was a candidate for equilabration. I'm not thrilled with Pankey Institute anything. Navy
The dentist that messed up my crown and fillings is a Pankey Institute grad. He still goes there for training. I've had 18 months of misery since he did my work and I now have a displaced disc which I didn't before he did his Pankey Institute stuff on me. They are into full mouth reconstruction, equilabration and bite studies. When you have your first appointment, he shows you every tooth in your mouth on a television screen. The only way he said he could fix the dental work was to do a $500 bite study to see if I was a candidate for equilabration. I'm not thrilled with Pankey Institute anything. Navy
QA11
08-04-2003, 12:27 AM
CymySue and Navy2,
I think I agree that "Pankey" has tried to incorporate more of the "current" info than Dawson. In general they both have many of the same beliefs, that is that a centric point can be found and occlusion reconstructed. Bottom line is the Dentist, one with hands, common sense and knowledge can often help. The importance of these two is that for many years they were "the experts" in the "60s" and "70's". This is especially true in the South. Both groups have made a ton of money as teaching institutions for continuing education. As with all professions there are "good" and "bad" practitioners. Check out Dr. David Miller's site, he's a Dentist that suffers from TMD, primarily caused by dental treatment. There are going to be Dentists that have been taught by all schools and philosophies that are more successful in treatng TMD than others. Personally I have seen many "successful" splint therapies. For most, if caught early on, splint therapy can alleviate many symptoms and perhaps head serious treatment off before total breakdown and or chronic states occur. Surgeons as a group don't see splints as helpful as general Dentists, but then they also see more patients needing surgery where splints can be less effective. CmySue I am really glad that the splint therapy has worked for you and that your Dentist is successful for you. NAvy2, it is hard to find a practitioner that truly understands TMD completely, sorry you had one that wasn't successful. I have talked with a bunch of Dentists and most really do want to help and they try what they know.
QA11
I think I agree that "Pankey" has tried to incorporate more of the "current" info than Dawson. In general they both have many of the same beliefs, that is that a centric point can be found and occlusion reconstructed. Bottom line is the Dentist, one with hands, common sense and knowledge can often help. The importance of these two is that for many years they were "the experts" in the "60s" and "70's". This is especially true in the South. Both groups have made a ton of money as teaching institutions for continuing education. As with all professions there are "good" and "bad" practitioners. Check out Dr. David Miller's site, he's a Dentist that suffers from TMD, primarily caused by dental treatment. There are going to be Dentists that have been taught by all schools and philosophies that are more successful in treatng TMD than others. Personally I have seen many "successful" splint therapies. For most, if caught early on, splint therapy can alleviate many symptoms and perhaps head serious treatment off before total breakdown and or chronic states occur. Surgeons as a group don't see splints as helpful as general Dentists, but then they also see more patients needing surgery where splints can be less effective. CmySue I am really glad that the splint therapy has worked for you and that your Dentist is successful for you. NAvy2, it is hard to find a practitioner that truly understands TMD completely, sorry you had one that wasn't successful. I have talked with a bunch of Dentists and most really do want to help and they try what they know.
QA11
Cymy Sue
08-04-2003, 05:59 AM
QA11,
Thanks for the explanation. You're absolutely right about Dentist and all in the "Profession". How they use what they have learned is the key to patients being treated appropriately and being helped.
I have been with this Dentist 25 years. He's always been very dedicated and a good Dentist. It appears he has used the training he received at Pankey very wisely and is helping many people. He also stays current with everything that is being researched and attends conferences and seminars all over the country to "learn" from different sources how people are being helped.
Navy,
When I made the first post several months back regarding the Pankey Inst. Training, I was thrilled with the theories my Dentist was explaining to me and how it could help me. I was also happy to know that there were Institues for extending one's knowledge and keeping up with new techniques and research. It occured to me anyone being treated by a Doctor or Dentist, particularly for TMJD, who was still using the skills he learned 20-30 years ago, might not be getting the best of treatment.
I also stated that all who received this training were most likely not "CREATED EQUAL" and I couldn't vouch for anyone other than mine. Although, I have heard of other people having great success with these Dentists.
My Dentist's practice is General Dentistry. He does not advertise as a TMJD Specialist and is not looking to make a fortune treating TMJD.
I'm terribly sorry that you had a bad experience with this Dentist. My experience has been there are more bad ones than good, regardless of their training. I have no knowledge of mine doing television screen bite studies and he seems to take the shortest and simplest route for each patient's successful treatment.
My Dentist continued to stress an individualized approach to each person's condition as we discussed my treatment and absolutely was against any pre-determined regiment of treatment. I guess different people use this training and apply these theories in their own way.
If we're going to dump all of the Pankey Trained Dentist into a common bucket, it appears you got a bad apple and I, a very good one.
I am sorry that you and others are hurt or made worse by someone we go to for help. I've been "there" also.
I still do have to believe that this Institute (as well as others) has something good to offer in continuing education for the Dental Profession. It is a terrible injustice to the Patients and the Care Providers who continue their training at these facilities to be the best they can be and then a select few have their own agenda and due to bad treatment, corrupt our opinions of all who have this training or use these theories in treatment.
I also have to believe that Dr. L.D. Pankey did have "something" to offer over the years in his theories and work in the Dental Field. I read that one of his philosophies was "Knowledge is ever changing and we must change with it."
He did make a lasting impression with his work, as he was inducted in 1999 to the "Pierre Fauchard International Hall of Fame of Dentistry", for contributions and achievements recognized by the Dental Profession world wide. There are very few who receive this Honor.
Cymy Sue
[This message has been edited by Cymy Sue (edited 08-04-2003).]
Thanks for the explanation. You're absolutely right about Dentist and all in the "Profession". How they use what they have learned is the key to patients being treated appropriately and being helped.
I have been with this Dentist 25 years. He's always been very dedicated and a good Dentist. It appears he has used the training he received at Pankey very wisely and is helping many people. He also stays current with everything that is being researched and attends conferences and seminars all over the country to "learn" from different sources how people are being helped.
Navy,
When I made the first post several months back regarding the Pankey Inst. Training, I was thrilled with the theories my Dentist was explaining to me and how it could help me. I was also happy to know that there were Institues for extending one's knowledge and keeping up with new techniques and research. It occured to me anyone being treated by a Doctor or Dentist, particularly for TMJD, who was still using the skills he learned 20-30 years ago, might not be getting the best of treatment.
I also stated that all who received this training were most likely not "CREATED EQUAL" and I couldn't vouch for anyone other than mine. Although, I have heard of other people having great success with these Dentists.
My Dentist's practice is General Dentistry. He does not advertise as a TMJD Specialist and is not looking to make a fortune treating TMJD.
I'm terribly sorry that you had a bad experience with this Dentist. My experience has been there are more bad ones than good, regardless of their training. I have no knowledge of mine doing television screen bite studies and he seems to take the shortest and simplest route for each patient's successful treatment.
My Dentist continued to stress an individualized approach to each person's condition as we discussed my treatment and absolutely was against any pre-determined regiment of treatment. I guess different people use this training and apply these theories in their own way.
If we're going to dump all of the Pankey Trained Dentist into a common bucket, it appears you got a bad apple and I, a very good one.
I am sorry that you and others are hurt or made worse by someone we go to for help. I've been "there" also.
I still do have to believe that this Institute (as well as others) has something good to offer in continuing education for the Dental Profession. It is a terrible injustice to the Patients and the Care Providers who continue their training at these facilities to be the best they can be and then a select few have their own agenda and due to bad treatment, corrupt our opinions of all who have this training or use these theories in treatment.
I also have to believe that Dr. L.D. Pankey did have "something" to offer over the years in his theories and work in the Dental Field. I read that one of his philosophies was "Knowledge is ever changing and we must change with it."
He did make a lasting impression with his work, as he was inducted in 1999 to the "Pierre Fauchard International Hall of Fame of Dentistry", for contributions and achievements recognized by the Dental Profession world wide. There are very few who receive this Honor.
Cymy Sue
[This message has been edited by Cymy Sue (edited 08-04-2003).]
QA11
08-04-2003, 06:32 PM
CymySue,
In my experience, the practitioners that are the most "certain" about treatment often don't have all the info. If I can offer anything here it is that treatment for TMD is a process and not always a straight line. That makes it hard because so few truly understand the scope for those that suffer with it, especially those in intense pain are left not knowing what to believe. Also it is expensive and often takes a set of Drs. to treat appropriately.
There are so many components that can go into it. The main thing for folks on this board to know is- there are different treatments and those treatments are most successful in treating specific parts of TMD. The sufferor has to sort out what makes things worse and what gives any relief at all. Most sufferors have some sort of stress factor, some are depressed as well and there is a psychological component that is hard to measure. You can take the nicest person and place them under stress, add a physical ailment and mix in TMD and voila- a person desparate for relief. Make that person hurt for a long time with chronic pain and the picture isn't always pretty. Early intervention is a good thing, splints and reversable treatments are a good thing, the right medications at the right time for the right reasons are a good thing. And patience is a good thing but the danger of chronic pain at 18-24 months is dangerous.
I only hope that the Dental/Medical community continues to make headway in sorting alot of this out and continues to filter in the mainstream. It's also imortant to have boards lie this one to help people sort out what works and applies to them. Cymy, you've done a lot of homework, hope you continue to post here because the historical context is important.
QA11
In my experience, the practitioners that are the most "certain" about treatment often don't have all the info. If I can offer anything here it is that treatment for TMD is a process and not always a straight line. That makes it hard because so few truly understand the scope for those that suffer with it, especially those in intense pain are left not knowing what to believe. Also it is expensive and often takes a set of Drs. to treat appropriately.
There are so many components that can go into it. The main thing for folks on this board to know is- there are different treatments and those treatments are most successful in treating specific parts of TMD. The sufferor has to sort out what makes things worse and what gives any relief at all. Most sufferors have some sort of stress factor, some are depressed as well and there is a psychological component that is hard to measure. You can take the nicest person and place them under stress, add a physical ailment and mix in TMD and voila- a person desparate for relief. Make that person hurt for a long time with chronic pain and the picture isn't always pretty. Early intervention is a good thing, splints and reversable treatments are a good thing, the right medications at the right time for the right reasons are a good thing. And patience is a good thing but the danger of chronic pain at 18-24 months is dangerous.
I only hope that the Dental/Medical community continues to make headway in sorting alot of this out and continues to filter in the mainstream. It's also imortant to have boards lie this one to help people sort out what works and applies to them. Cymy, you've done a lot of homework, hope you continue to post here because the historical context is important.
QA11
Cymy Sue
09-04-2003, 01:36 PM
Bump