STOP THE PAINS
MANDIBLE MALPOSTURE
DISORDERS (MMD)
Formerly Temporomandibular Joint Disorders (TMJD)
Harry Cooperman
DDS*
Noboro Miura DDS**
The International Academy of Myodontics
At one time
or another in life, each individual suffers pain
and/or disability as a result of some functional disturbance
of the musculoskeletal system. If a disability, as in Mandible
Malposture Disorders, the affliction is due to faulty mandible
malposture. Unless circumstances are unusual physician and dentist
have the capacity for safe and successful management of painful
MMD.
Musculoskeletal disturbances may be subdivided arbitrarily into
those of organic and those of functional origin, despite the
fact that the former are inevitably complicated by postural strains
and the latter by demonstrable lesions of misused muscles, joints
and bones.
Most organic lesions of the musculoskeletal system, such as MANDIBLE MALPOSTURE DISORDERS prove to be local manifestations of some fundamental developmental disorder. However, immediate reference to the orthopedic specialist is mandatory for an MD judgment. Our research indicates that, the lack of attritional crown tooth wear is the offender and the missing factor in MMD diagnosis.
ORGANIC TOOTH CROWN WEAR MISSING
As stone age man removed grit, sand and other abrasives from his diet, he deprived himself of natural anatomic and physiologic aid; i.e., attritional wear of crown tooth cusps, that protected the future of his head and neck well-being . Unworn tooth crowns, characteristic of present day man, inhibit instinctive postural corrections of civilized man.
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 is diagnosis, most patients and their next of kin are most interested in learning the relative gravity of the affliction, the chances for an uneventful recovery, the expected span of incapacitation and the potential dangers of permanent damage and invalidism.
While many imponderables enter into any given equal, the prognosticators weigh the following factors of which they may have some intimate knowledge: (a) nature and course of suspected or diagnosed disorder; (b) potential complications and common sequels; (c) efficacy of available therapeutic measures; (d) skills of the available therapists; (e) attitude of patient toward presenting problems; (f) role of social and economic factors; and (g) 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 and intra-oral
plastic or metal splints produce unfortunate consequences.
In general,
painful stimuli are referred to anatomic sites
(i.e. head and neck). Circumstances permitting defer symptomatic
treatment of pain, wherever located, until efforts can be made
to identify basic cause and thereafter, to eliminate, correct
and control the body physiology.
ORGANIC TOOTH CROWN WEAR--OVERLOOKED
Most anatomy texts depict gear-like apposition of adult upper and lower teeth (fig.1). However, this apposition does not usually occur in uncivilized man. On the contrary the widespread of tooth attrition which occurs in primitive man is well established (1.2.3). This tooth crown wear, that is not depicted in anatomy texts nor correctly evaluated in medical and dental education (fig.2), 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 attritional occlusion.
As stone age
man removed grit, sand and other abrasives from his diet, he
deprived himself of a natural aid; i.e. attritional wear of tooth
cusps that protected physiology of his mouth, swallowing and
respiratory functions (4). Unworn tooth crowns, characteristic
of civilized man, prevent instinctive postural changes to normalize
head, neck and throat physiology.
The International Academy of Myodontics (IAM) have concluded,
that, the therapeutic head and neck physiology resulting from
uncivilized man's attritional occlusion is the diagnostic missing
link in understanding and treatment of MANDIBLE MALPOSTURE.
Our interest in patients, who suffered persistent or recurrent manifestations such as temporomandibular joint 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 the natural
protective mechanism that functioned to preserve head, throat
and neck physiology, occurring after tooth cusp erosion by the
attritional occlusion; 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 oro-pharynx; fourth, that these
impingements may produce anatomic and physiologic disturbances
of breathing, swallowing or drainage of the accessory sinuses,
eustachian tube dysfunction etc.; fifth, that mandibular retrusion
in itself, may disturb temporomandibular joint relationships
as described by Costen (TMJD); and sixth, that recognition of
the
basic anatomy and physiology mal-alignment of the mandible to
the skull may permit the informed physician and dentist to correct
the mal-alignment; by mechanical measures with the intervention
of MMD wedge therapy for patients with painful or non painful
MMD.
We conclude that the lack of natural tooth crown wear in our MMD patients is the an overlooked observation that provides the medical and dental professions with accurate diagnosis of MMD. We also conclude that the lack of attritional occlusion is the key to the diagnosis and subsequent treatment of MMD.
MECHANICAL AIM OF WEDGE TECHNIC
This new approach for the physician-dentist team approach is dissimilar and unlike any forerunner strategy in the care of painful MMD. The primary intentions of upper and lower wedges which are positioned over the remaining teeth are; (a) to instantly negate the existing `geared' dental occlusion; (b) immediately correct and convert patient's occlusion to a zero degree type stone age man's dentition; (c) instantly eliminate three dimensional forces on the dentition; (d) abolish and terminate muscle and soft tissue postural stresses in the head and neck; and (e) produce the equilibrium of mandible-skull relations as found in stone age man.
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