“It is the author’s position that patients with TMJ are often most definitively treated with orthodontics. These patients frequently have an incompatibility between the ideal physiological position of the teeth, TM joints, and facial musculature.” adjusted articulator or extensive myo-monitor TENs machine therapy to establish the correct bite. And it is also likely that you will never see a long-term result. This vapid understanding of how to treat TMD patients is most evident in the University dental schools. Typically, their complete lack of understand-ing and clarity of how to treat these cases is camou-flaged in the fog that they are “evidence based in the TMJ literature.” This message is typically delivered from a professor wearing a name embroidered heavily starched lab coat with an advanced degree in “pain management.” The authors here have concluded it is pathetically sad that so many of these professors could devote so much of their lives to one subject (the TMJ), yet still know so little about how to treat the problem. In the meantime, as clinicians we have real patients that do suffer from TMD related problems. We want to help these people and it is possible. How often have you seen a patient truly cured from TMD after mounting models and doing an additive or reductive occlusal equilibration? This is what is offered as the solution in dental school and most occlusion courses. It doesn’t work. It is the author’s opinion this is a flawed model of reality. It is a great disservice to conscientious dentists paying big bucks to take these courses to learn how to help treat their patients. It is the author’s position that patients with TMJ are often most definitively treated with orthodontics. These patients frequently have an incompatibility between the ideal physiological position of the teeth, TM joints, and facial musculature. Dental school TMJ professors essentially never know anything about orthodontics. So how could the “experts” in TMJ diagnosis and treatment teach other dentists how to help TMJ patients if they don’t know anything about the treatment modality best suited to definitively treat TMJ patient? Occasionally they will say “some cases need to be referred for orthodontic treatment.” But how much confidence do you really have that any orthodontist you might refer a case to will understand TMD? If they did, why do so many patients previously treated with orthodontic treatment as kids later develop TMD symptoms? Most orthodontic specialists have practices focused on treating 12-year-old kids. Our experience is that few of these doctors have true clinical experience treating adults that begin to express TMJ symptoms. Orthodon-tics done properly can correct TMJ problems and greatly improve the dental lives of these patients. But orthodontics done improperly can definitely cause TMJ problems. This is a contradiction to widely held beliefs about orthodontic treatment and TMD. Perhaps ironically patients with TMJ problems most often are best treated by General Practitioner’s (Gp’s) that have Orthodontic training and knowledge. This is yet another reason why we must reach out to Gp’s and nudge them into pursuing Orthodontic training. They will become better dentists, they will yield even more reward from the profession, they will better be able to help their patient’s, and will be in a better position to potentially save them from many of the specialist’s treatment. REFERENCEs 1. Thilander, Birgit, and Krister Bjerklin. "Posterior crossbite and temporomandibular disorders (TMDs): need for orthodontic treat-ment?." European Journal of Orthodontics 34.6 (2011): 667-673. 2. McNamara Jr, James A., Donald A. Seligman, and Jeffrey P. Okeson. "Occlusion, orthodontic treatment, and temporo-mandibular disorders: a review." Journal of Orofacial Pain 9.1 (1995): 73-91. 3. Nicassio, Ralph, and Zavala, Maria. “Systematic Approach to Diag-nosis and Treatment of Interceptive Orthodontics Part 3: Identifi-cation and treatment of key issues.” Journal of the American Orthodontic Society. Fall 2016:14-22. 4. Baccetti, Tiziano, et al. "Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask ther-apy." American Journal of Orthodontics and Dentofacial Orthope-dics 113.3 (1998): 333-343. 5. Ingervall, Bengt, et al. "A clinical investigation of the correction of unilateral first molar crossbite with a transpalatal arch." American Journal of Orthodontics and Dentofacial Orthopedics 107.4 (1995): 418-425. 6. Adkins, Michael D., Ram S. Nanda, and G. Frans Currier. "Arch perimeter changes on rapid palatal expansion." American Jour-nal of Orthodontics and Dentofacial Orthopedics 97.3 (1990): 194-199. 7. Nerder, Paul Henrik, Merete Bakke, and Beni Solow. "The func-tional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study." European Journal of Orthodontics 21 (1999): 155-166. 8. Nicassio, Ralph, and Zavala, Maria. “Accurate Assessments: Differ-ential Diagnosis and Treatment of Unilateral Class II (or Class III) Cases.” Journal of the American Orthodontic Society. Fall 2016:14-22. 9. Excel Cement. www.relianceorthodontics.com, 1-800-323-4348. 10. Memikoglu, T. Ufuk Toygar, and Haluk I eri. "Effects of a bonded rapid maxillary expansion appliance during orthodontic treat-ment." The Angle Orthodontist 69.3 (1999): 251-256. 11. Sarver, David M., and Mark W. Johnston. "Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances." American Journal of Orthodontics and Dentofacial Orthopedics 95.6 (1989): 462-466. 26 Winter 2018 JAOS
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