Correcting a Pathologic Joint Position using Mandibular Torque and a Fixed Orthosis
Neuromuscular dentists are often criticized as dentists who just open the bite. What happens when we open the bite and maybe things don’t go exactly as planned? The patient still may be suffering from symptoms, restorative treatment gets delayed and the patient begins losing confidence in the dentist to solve their problem. What happens when the patient is your father! (Slide 2).
My father, Roy Adler, who I treated for many years, had a severe traumatic painful episode in his left TMJ while eating an Italian ham sandwich on a French baguette (slide 3). I have to be specific because my father takes his food very seriously. I say this because even after he experienced a crunching gravely pain in his left joint, he was able to finish the sandwich… which by the way was delicious. You see… I know his eating habits well. (Slide 4) I also have a long dental history to fall back on, clues as to why this happened at this stage in his life. The clues that led directly to his episode helped me ultimately to determine the treatment that would relieve his pain… although the solution was not clear at first.
(Slide 5) My father was well aware of my neuromuscular dental practice. He called from New York and told me he could no longer bring his teeth together normally. The pain was more dull than sharp. He experienced pain while chewing on both sides or tearing with his front teeth. The pain was strongest when first clamping down on food, but then lessened with subsequent chewing. He kept getting a dull ache when he pushed the jaw on the right side of the face to the left. Upon opening and closing the mouth he could hear bone rubbing against bone in the left TMJ. When he opened his mouth as wide as possible he sometimes felt the left TMJ catch, occasionally the right also. There was no pain or discomfort in the right joint. Opening the mouth wide to bite on food produced an ache, but doing the same maneuver without food did not. Directly after the initial event, there was a change in his bite. Upon waking in the morning he could close his teeth on the right side so that they met. However, soon after he would not be able to close down on the right side without difficulty, he would only hit on the left. So chewing food on the right side became a problem.