THE READERS' CORNER
1. Do you treat TMJ patients in your practice? Do you treat patients with intracapsular problems (pops, clicks)? Do you treat patients with muscular-based problems?
Eighty-five percent of the clinicians responding reported that they treated TMJ patients. Virtually all of these treated both intracapsular and muscular-based problems, although a few confined themselves to muscular problems only.
What types of treatment do you use?
Centric relation splints were by far the most common treatment method, with more than 95% of the respondents using them. Anterior repositioning splints were utilized by more than 80% of the clinicians treating TMJ problems. A little more than half used muscle relaxants and/or pain medications, and about 20% each reported using spray-and-stretch and TENS therapy. Even fewer (10-15%) used physical therapy, biofeedback, the Myo-monitor, or steroids. Several respondents mentioned trigger-point injections, diet modification, equilibration, or acupuncture.
Which treatment modalities have you found the most effective?
There was no clear consensus on this question, but the use of splints figured in more than 75% of the responses. Flat-plate centric relation splints were the sole method of treatment for 35%, followed by splints used in combination with physical therapy, diet modification, and medication (26%). Anterior repositioning splints were thought to be effective in recapturing anteriorly displaced discs, but only as a short-term solution. More than half of the respondents listed some combination of splints, counseling, equilibration, and orthodontics as an effective treatment modality. Occasional mention was made of joint surgery, but only for a small percentage of difficult cases.
Please outline your typical treatment regime.
Responses to this question were extremely diverse. Several representative answers are listed below:
B. Splint therapy to relieve acute problems.
C. Equilibration and/or orthodontics to define the occlusion in harmony with both CR-CO-position condylar positions.
B. For muscular problems, place a splint for three to four months and evaluate the symptoms if necessary. Provide additional therapy (e.g., TENS, medications) or refer to a TMJ specialist.
B. Examine for a dentally related cause (i.e., wear, clenching, interferences).
C. Make a diagnostic splint with an anterior plane to be worn full-time for one week.
D. Equilibrate to satisfaction.
E. Use a centric relation splint for more difficult problems.
F. Determine the restorative procedures necessary.
B. Analysis of records and correlation with clinical findings.
C. Consultation with patient.
D. Delivery of appropriate splint, to be worn 24 hours per day for one month (except during oral hygiene).
E. If improvement noted, continue; if not, remake the splint and assure that there is good patient cooperation.
F. If still no improvement, refer for physical therapy and further studies.
What methods do you use to diagnose TMJ problems?
Most of the clinicians reported taking "full orthodontic records", including mounted study casts. Records included tomograms for 27% of the respondents and magnetic resonance imaging for 19%. Detailed histories and clinical examinations, including muscle palpation and evaluation of range of motion, were still felt to be the best diagnostic methods by most of the readers. Only occasional mention was made of transcranial x-rays, CAT scans, or the Myo-monitor.
Do you think you are correcting or alleviating TMJ problems?
About 40% of the respondents believed their treatment was producing significant long-term improvement in patients' TMJ problems, while the other 60% felt they were simply managing, but not resolving, the problems. Specific comments included:
2. What kinds of community activities are you involved in?
Most respondents appeared to be involved in three or four community activities, with religious (68%) and sports (65%) the most popular. School-based activities (55%) and general youth activities (45%) were also frequently mentioned. A variety of civic clubs accounted for part of 38% of the readers' activities, while both fraternal organizations and sponsorship of teams or organizations were mentioned by 20%. Political activities and public speaking were listed by only a few respondents.
Which activities have you found the most personally rewarding?
Religious activities and working with children were by far the most personally rewarding, each being listed by 70% of the orthodontists. Civic clubs were a distant third at 40%.
Which have you found the most rewarding in terms of referrals?
Virtually all of the respondents said they did not take part in community activities to gain referrals. In fact, many tried to separate their professional and community activities, and most of the clinicians felt they got very few referrals because of their community involvement.
JCO wishes to thank the following contributors to this month's column:
Dr. Joseph C. Ainsworth III, Irving, TX
Dr. Charles Conarck, Smithtown, NY
Dr. Joe H. Crain, Fort Worth, TX
Dr. Mark L. Dake, West Plains, MO
Dr. Michael Diamond, East Hills, NY
Dr. Benjamin E. Foster, Shreveport, LA
Dr. John R. Frick, Chapel Hill, NC
Dr. Timothy A. Gault, Valencia, CA
Dr. Myron S. Graff, New Port Richey, FL
Dr. John B. Harrison, St. Petersburg, FL
Dr. Stanley Y. Inouye, Carmichael, CA
Dr. John D. Jones, Tempe, AZ
Drs. Ron. L. Knight and Raymond R. Noble, San Angelo, TX
Dr. George W. Lundstedt, Lynnfield, MA
Drs. A.R. McWilliams and Michael L. Ward, Texarkana, TX
Dr. Charles M. Manning, Charlottesville, VA
Dr. S.C. Marwaha, Baden, PAD
rs. Gerald Nelson and Michael Meyer, Berkeley, CA
Dr. Casey O'Connor, North Ridgeville, OH
Dr. Gerald D. Pionek, Green Bay, WI
Dr. David H. Reiss, Dresher, PA
Dr. Paul H. Rigali, Wallingford, CT
Dr. Alton G. Sheffield, Daytona Beach, FL
Dr. H. Zack Smith, Fayetteville, NC
Dr. Kurt D. Spieske, Grand Haven, MI
Dr. William F. Tinsley, Lehighton, PA
Dr. J. Philip Wiygul, Memphis, TN
