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Synonym Temporomandibular Joint Disorders (TMJD)
Harry Cooperman DDS*
NOTE: The International Academy of Myodontics (IAM) have discarded the use of the terms TMJ/TMJD, and in the future will use MANDIBLE MALPOSTURE DISORDER (MMD) as the replacement.
PROGNOSIS
Although the art of prognosis is neglected in formal medical and dental teaching, it is a prime accomplishment of the physician and dentist whose reputations in their local community may depend, in large part, on their skills in predicting the likely outcome of the affliction under immediate consideration. For, unlike those whose primary concern in diagnosis, most patients and their next of kin are most interested in learning the relative gravity of the affliction, the chances for uneventful recovery, the expected span of incapacitation and the potential dangers of permanent damage and invalidism.
While many imponderable enter into any given equal, the prognosticators weigh the following factors of which they have some intimate knowledge: (1) nature and course of suspected or diagnosed disorder; (2) potential complications and common sequels; (3) efficacy of available therapeutic measures; (4) skills of available therapists; (5) attitude of patient toward presenting problems; (6) role of social and economic factors; and (7) significance of overall statistics.
PAIN
The production of pain sensation is the organism's most important means for directing attention to body disharmony. The patient's description of the location and the character of the pain is often of incalculable value in diagnosis. Alleviation of pain is often the therapist's most significant contribution to the patient's comfort although there are times when premature and over enthusiastic use of pain killing drugs has unfortunate consequences.
In general, painful stimuli are referred to anatomic sites (i.e. head and neck) and to a physiologic dysfunction. Circumstances permitting defer symptomatic treatment of pain, wherever located, until efforts can be made to identify basic cause and thereafter, to eliminate, correct or control the mechanism.
ORGANIC TOOTH WEAR--OVERLOOKED
Most anatomy texts depict gear-like apposition of adult upper and lower teeth. But this apposition does not occur in uncivilized man. On the contrary the widespread tooth attrition which occurs in primitive man is well established. This tooth crown wear not depicted in anatomy texts or correctly evaluated in medical and dental education is the natural protective accomplishment to preserve oral,pharyngeal, and respiratory physiology throughout life.
RATIONALE
How does one attempt to change erroneous concepts of supposedly normal healthy dentition in anatomy texts? The International Academy of Myodontics have requested that GRAY'S ANATOMY change their figure of interdigitating occlusion of teeth to one of natural attritional occlusion. As man removed grit, sand, and other abrasive food from his diet, he deprived himself of a natural aid; i.e. attritional wear of tooth cusps that protected the physiology of his mouth, swallowing and respiratory apparatus. Unworn tooth crowns, characteristic in civilized man, prevent the instinctive postural changes in man that normalize head and neck physiology. The International Academy of Myodontics (IAM) has concluded that the therapeutic head and neck physiology resulting from uncivilized man's attritional occlusion is the diagnostic missing link to the understanding and treatment of Mandible Malposture Disorders. The interest in patients, who suffered persistent or recurrent manifestations of mandible Malposture disorders was aroused by the finding of various degrees of irritation of the covering tissues of the dorsum of the tongue and uvula.
Suspecting that the underlying cause of these irritative phenomena might be postural, we demonstrated; first, that mandibular protrusion, as seen in stone age skulls, was a natural protective mechanism that functioned to preserve head, throat and neck physiology, occurring after cuspal erosion by attritional occlusion of the teeth; second, that mandibular retrusion, as observed in our patients, causes the dorsum of the tongue and the uvula to impinge on one another, thereby producing irritation in the manner of overlying toes or similar structures; third, that uvula tongue impingement appreciably narrows respiratory and alimentary pathways in the oropharynx; fourth, that these impingements may produce anatomic and physiologic disturbances of breathing and swallowing: fifth, that mandibular retrusion in itself, may disturb mandible malposture: sixth, that recognition of basic anatomy and physiology malalignment may permit the informed physician and dentist to correct these alalignments by mechanical measures with the intervention by MMS soft wedge therapy.
Illustrated on page 158... 2nd MYODONTICS text.
ORGANIC TOOTH WEAR OVERLOOKED
The lack of natural tooth crown wear in our MMS patients is the overlooked observation that provides the medical and dental professions with accurate diagnosis of mandible malposture disorders.
RESEARCH AND INVESTIGATIONS
Seventy-seven Hawaiian, Japanese, Chinese, Filipino, and Caucasian patients had received a differential diagnosis, of their MMD problems in an Otolaryngology Department of a Hawaiian Medical Center and Hospital by the senior author.(1980-1985).
At the same time Doctor Noboru Miura in Japan conducted an identical therapy treatment of MMD with wedges.. Wedges are removable, non-invasive, non-toxic, intra-oral devices They are primarily made of soft mouth guard material in an analogue dental computer or similar designed dental instrument. They are easily constructed in an omnivac or stavac machine by the general practitioner. Prior to insertion in patients mouths, over all the existing teeth and any fixed or removable bridges, the wedges should incorporate the principles of (a) zero degree dental occlusion; and, (b) embrace the hamular-incisive-papilla plane of occlusion (HIP) and, (c) be fabricated to infringe and obliterate the freeway space and, (d) be adapted in the mouth over all of patient's remaining teeth.
DISCUSSION
The clinical observations indicate that mandibular protrusion, resulting from organic tooth crown wear plays an important role in the anatomy and physiology of the masticatory, swallowing and alignment of the oral pathways. Postulated, along with others, that organic tooth crown erosion facilitates mandibular protrusion. Recognition that the non- erosion of tooth cusps within our refined present day diets and the resulting disturbances, as seen in mandible malposture syndrome, may permit physicians, and dentists to correct MMD problems employing MMD wedges. This new appreciation of primitive man's diet and consequent organic tooth wear is the missing link to the profession's diagnosis and remedy of numerous ailments.
MECHANICAL AIM OF MMD WEDGES
This new MMD approach is dissimilar and unlike any forerunner medical and dental technique. The primary intention of upper and lower MMD wedges in the oral cavity (a) is to immediately negate any existing `geared' dental occlusion. (b) instantly correct and convert the patient's occlusal to a zero degree stone age man's type occlusion, (c) eliminate noxious three dimensional cusp force disturbances on the dentition during mastication, (d) produce an equilibrium of mandible-skull relations as established in stone age skulls.
CONCLUSIONS
New diagnosis and understanding of mandible
malposture disorders is presented, New management of MMD is obtainable
from the author by request. The use of MMD wedge therapy should:
Introduce a new mechanical procedure for problems.
* Harry Cooperman DDS
777 Ferry Road (P-6)
Doylestown, Pennsylvania, 18901
Phone 215-345-1149
myodont@comcat.com