Consequences of Temporomandibular Disorders
Article Title:
Guest Editorial: The National Heart, Lung, and Blood Institute Considers the Cardiac and Sleep Consequences of Temporomandibular Disorders
Article ID:C2A0C2A0480
Authors:
Ira Shapira, D.D.S.
Volume:C2A0C2A025C2A0C2A0Issue:C2A0C2A02
Journal Date:C2A0C2A0AprilC2A02007
Fragmentation of the groups treating TMJ disorders has20 been a continuous problem in dentistry, with consensus ever eluding us as we consider the occlusal aspects of our treatment. There have been personality cults often bordering on the religious. The orthodontic community now claim s that orthodontics has nothing to do with TMJ disorders, the AOP has adopte d a medical/ psychological model where the patients are crazy, occlusion the rapy is a myth or fraud upon the public, and the best treatment is an ever g rowing list of prescriptions. There are 20 plus definitions of centric relat ion which proponents say is valuable for repeatability, but they cannot even repeat the definition. Neuromuscular proponents are more interested in rest position and healthy muscles, while another group says occlusion is joint-b ased. The science of dots and the abolishing them is what many think temporo mandibular dysfunction (TMD) is all about. Passions become inflamed and vari ous groups seek specialty status in the ADA. The National Institute of Denta l and Craniofacial Research (NIDCR) believes any permanent changes should be avoided and that orthotics change the bite. The Future is Now. The National Heart, Lung, and Blood Institute (NHLBI) has declared that TMJ disorders ha ve sleep and cardiovascular consequences that need to have the pathophysiolo gy understood. It is time to evaluate airway, swallowing, and breathing as p art of the picture. We must embrace this as an opportunity to unite us in a20 medical model, not based primarily on drug treatment and behavioral therapy, but on the autonomic and postural effects of the stomatognathic system and20 how they relate to airway and sleep, as well as pain. We must re-examine wha t we do, not in terms of how the teeth meet, but how the entire system funct ions. This is not to say that how the teeth meet is not important. The artic les published by Shimshack, et al.1,2 published in CRANIO on 200-300% increa ses of medical spending across the entire spectrum of medical specialties in patients with temporomandibular disorders substantiate the importance of tr eating these disorders or, at the very least, understanding the pathophysiol ogy. The future of TMD research is not just the intricacies of the TM joints and musculature, but in epidemiological studies of the effects of these dis orders on medical costs, life expectancy, and quality of life. I challenge t he NIDCR to put aside its bias against clinicians and to reduce the politica l clout of certain groups that leads to inequitable distribution of research funds to the same groups repeatedly and to work with the NHLBI on more expa nsive research. There are large cohort studies that are already funded that20 could easily add limited TMD evaluation of signs and symptoms yielding impre ssive epidemiological data while conserving tax dollars. We must re-examine20 concepts of vertical dimension, centric relation, and bicuspid extractions f or their effect on airway and tongue posture. We need to go back and evaluat e the work of people like Jim Garry, Brian Palmer, and Edgil Harvold on the20 development of airway problems and the dental consequences, as well as the d eveloping work of Farrand Robson and his oral systemic balance. We need to i ntegrate treatment of sleep- disordered breathing into our practices and que stion whether to treat these problems only at night or to look for underlyin g structural discrepancies and treat these problems 24 hours a day. The Amer ican Academy of Dental Sleep Medicine has been the leading force in securing an enviable working relationship with the medical sleep community. Their me etings are a gathering place where TMD practitioners meet on common ground,20 leaving behind the petty squabbling that has plagued the TMD community. Reco gnizing sleep apnea as a temporomandibular disorder at night opens up a comm on basis to evaluate that same condition during the day. The TMD Alliance sh ould invite the Academy of Dental Sleep Medicine to join its ranks. The Sept ember 2006 legislative update of the NHLBI site states that the Senate bill20 encourages further TMJ disorder studies as part of an almost three billion d ollar budget. All dentists interested in treating patients with sleep disord ers or TMD should download the NHLBI paper which can be found at http://www. nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf or by typing NHLBI into Google and then entering E2809CTMJE2809D into the search section. This is vital information that all of us must read, understand, and share with our med ical and dental colleagues. We should also contact the ADA and demand that t hey act responsibly and re-examine the TMD issues and set up a conference th at looks at the physiologic aspects of TMJ disorders. The ADA must reclaim t he field for dentists and recognize the importance of TMD disorders. The ADA should publish the entire NHLBI paper in its journal and promote the oral-s ystemic connection of TMD, as it has promoted the connection between periodo ntal disease and health. I do not advocate specialty status for any TMD or s leep organization, even though more than one of the organizations to which I belong are pushing for specialty with the ADA.
Ira Shapira, D.D.S. Gurnee,20 Illinois References
1. Shimshak DG, Kent RL, DeFuria MC: Medical claims prof iles of subjects with temporomandibular joint disorders. J Craniomandib
2. Shimshak DB, DeFuria MC:
Health care utilization by patients with temporomandibular joint disorders.
