TMJ Treatment: Across Illinois, Wisconsin and the Midwest

Dr. Shapira Blog 4 Comments

Why do patients travel long distances for TMJ treatment.
What I find is patients have had pain for years and think there is nothing else that can be done and then severity increases and they desperately look for an answer.

They want a comprehensive approach to diagnosis and treatment but most of all they want to QUICKLY IMPROVE THEIR QUALITY OF LIFE.

They come across a world of treatment different than what was ever discussed with their general dentist.

It turns out most dentists know very little about treating TMJ disorders beyond simple splints.

A small group of dentists become obsessed with knowing more and more about the condition and become more and more expert about very arcane little details.

The vast majority of patients get a night guard and simple habit changes and the TMJ problems are fixed. The difficult patients either learn to live with pain or end up seeking speciatly care.

There is no specialty in TMJ treatment so usually patients seeking specialty care first go to the oral surgeons (OS) office. This is appropriate for TMJ surgery but is the last place to go for occlusal therapy for TMJ problems because most OS never look at fine tuning occlusion. OS making splints that don’t work often look for surgical answers. The one rule in TMJ treatment is avoid TMJ surgery whenever possible.

So who are the TMJ Specialists? There is a group who want to create a specialty of Oral Facial Pain and have been denied specialty status by the ADA or American Dental Association so the are creating their own specialty board and declaring themselves specialists in oral facial pain a dangerous precedent but also rather pointless becaust they want to use the medical model of treating everything with drugs.

The real specialists are dentists who come together to study the intricacies of TMJ disorders. I often call them a small group of old doctors who learn more and more about less and less eventually knowing everything about nothing. Joking aside they delve very deeply into the most minute details.

I am currently the Chair of the Alliance of TMD Organizations and there are several groups who focus on different methods of treating the disorders.

I am a Fellow of the International College of CranioMandibular Orthopedics the Physiologic Group most dedicated to the underlying science involved in treatment utilizing physiologic dentistry protocols taught by the father of physiologic dentistry, Dr Barney Jankelson.

I am also a life member of the American Equilibration Society which is the oldest and largest TMJ treatment organization. They approach the disorder from a more mechanistic approach.

I always go to their annual meeting because I learn new aspects from doctors who approach treatment from a completely different approach. This group is also very focused on intricate details of treatment.

Both of these groups treat the same condition coming from a different direction. Doctors in both groups are successful.

The is another group the Academy of Craniofacial Pain (formerly academy of head neck and facial pain)who are very diverse in their approach. I would describe it as knowing less and less about more and more until they know nothing about everything (in jest) I am also a member of this group and I find they bring into the picture a wider scope of treatment possibilities.

Still another group is the American Academy of Physiological Esthetics (formerly American Academy of Comprehensive Esthetics) They are also a Physiologic Group affiliated with the Las Vegas Institute. They are very focused on physiologic Dentistry as approach to esthetic and full mouth reconstruction. LVI teaches a watered down approach to physiologic dentistry and the science but aree excellent (probably best) at hands on teaching of technique. They take a cookbook approach to Physiologic Dentistry and almost all of their work is based on scientific foundation of ICCMO and Barney Jankelson. I learned Physiologic Dentistry at ICCMO and from Barney Jankelson, Jim Garry, Barry Cooper, Dayton Krajiec and others at ICCMO but I learned to efficiently utilize it for Full Mouth reconstruction at LVIn for magnificent rehabilitations.

There are also orthodontic approaches to TMJ disorders as practised byInternational Association of Orthodontics, another excellent group primarily focused on orthodontics and secondarily on TMJ disorders but consider TMJ in all of their cases. This group is actively preventing development of TMJ disorders during orthodontic treatment.

The Sacral Occpital Chiropractic group, The Nucca Chiropractors, the At;as Orthoganol chiropractors and the Cranio/ Chirodontics group all integrate with dentists to trat TMJ disorders as part of full body function.

The field of Epigenetic Orthodontics is very new and is not yet represented by a group but ist is changing the method of treatment . I utilize Epigenetic Orthodontics routinely to finish TMJ cases after pain is resolved.

The Academy of Dental Sleep Medicine does not consider itself a TMJ organization because they treat sleep apnea. As a Diplomate of the organization I will clearly state this is their biggest failing. The American Academy of Sleep Medicine recommends that dentists treating sleep apnea with oral appliances should have expertise in treating TMJ disorders.

The NHLBI (National Heart Lung and Blood Institute) of the NIH consider Sleep Apnea to be a TMJ disorder and wrote a paper “The Cardiovascular and Sleep Consequences of YTemporomandibular Disorders”

There are two other Organizations that, in my mind have lost their way to some extent in treatment philosophy, one is the American Academy of Pain Management of which I am a Diplomat and the other is the American Academy of OroFacial Pain. Both have moved into treating functional and structural problems with drugs rather than correcting the underlying physiological issues.

I am still a member of the American Academy of Pain Management but that group is no longer part of the TMD Alliance.

Comments 4

  1. Post
    Author

    James,
    I have an office dedicated to treatment of TMJ Disorders, Sleep Disorders and Chronic Pain in Highland Park, Illinois

    I have a General and Reconstructive practice in Gurnee where I also treat TMJ disorders.

  2. My daughter was in braces for seven years. It was determined that to fix her alignment would require upper and lower jaw surgery at Loyola. The operation appeared to work and she had six months of no pain after swelling decreased. She has since been dealing with pain on most days in the joints and muscular areas of both upper and lower jaw. The pain can extend down into the neck and upward to the head. She had been seeing a specialist at Loyola for an entire year seeking pain relief as she had previously. She has been on soft foods for six months, sleeps with a mouth guard, had splints, physical therapy, Botox injections into the muscle, and of course medicine. All of these have only given temporary relief and then the pain returns. The Loyola doctor finally ran out of options and sent her to Mayo Clinic to see a specialist there. The specialist at Mayo told us that she will need to learn to live with the pain and be content to having good days when she does. He told us that all the things the specialist was doing needed to be done sooner and now her body has gotten use to living with the pain. If father Botox was given just a couple of months or weeks after she first described the pain it would had given her the results of being pain free, but now it’s all too late. I drove home with a crying upset daughter who now is considering no going back to finish her schooling that would be her last year in college. She was in so much pain or high on pain meds that she withdrew from classes last year which would had been her last year of college. I am losing faith in the medical field that a young woman needs to learn to live with pain that was a result from surgery that was needed. So I am seeking advice on what next step to take.

  3. Post
    Author

    First, please tell your daughter there is always hope! I would love to see her in my Highland Park office. Mayo clinic is phenomenal for some problems but not ideal for chronic jaw pain and related issues.Botpx is not a good long term answer. I think they are telling you she has Central Sensitization, possibly hyperesthesia or allodynia as a result. If you can achieve temporary relief you should be able to attain longer term relief as well.
    It is not too late! Please have your daughter watch some of my patient’s videos:
    https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos
    Especially ones on Sphenopalatine Ganglon Blocks and Neuromuscular Dentistry.

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