A Jetset interview with Nancy Adachi on the controversial side of TMJ.
Get more info on her class coming next month - HERE.
Q: What is scalloping of the tongue and why is this significant for Rehab specialists?
Nancy Adachi: Scalloping indicates soft tissue changes on the tongue creating ridging marks along the sides of the tongue or front. Normally the tongue is smooth along the sides and rests on the the palate. If there are ridges, it may be caused by pushing the tongue against the teeth.
Q: What is the Occlusion Theory and what are your thoughts on this?
Who is often using this theory to treat and what is an example of a patient case where this theory was misused?
NA: Some dentists believe that the best treatment for TMD problems is a stable occlusion (bite). Thus braces or grinding the teeth or building up the teeth by crowns will alleviate the pain problems.
My belief as well as UCLA's is that the body tends to accommodate to imperfections and unless it is a gross or unstable or rapid change of the bite such as a car accident or injury to jaw and the bite is off, do not use non reversible methods to change the bite. An example PTs can use is leg shorter than another, we do not give everyone a heel lift. It would depend on the circumstances.
Q: What is bruxism and how do you address this?
What are some of the causes and consequences of bruxism?
NA: Bruxism is grinding or clenching of the teeth at night or during the day. We cannot control nighttime bruxism but during the day, we can give exercises and reminders of posture just like we do for low back pain or any other musculoskeletal pain problem.
Causes: are unknown but it is often exacerbated by stress and habit
Consequences for jaw pain patients: places extra load on the TMJ muscles and joints. The disc may be pushed more anteriorly causing potential pain, clicking and locking. Masseters, pytergoids, temporalis are on continuously rather than resting when not eating or opening, closing and swallowing.
Q: When do you recommend splints?
When have you seen the use of splints make the patient's TMD more severe?
NA: Usually hard acrylic full coverage splints are recommended for patients who have tried PT and exercises for myofascial pain and joint pain but still wake up in the AM with jaw pain. Also for the severe arthritic joints the splint can stabilize the bite and rest the jaw somewhat. Splints should not be worn 24-7 as it can change the bite permanently.
Splints that are not full coverage can cause teeth to erupt and bites to be anteriorly opened or closed.
Soft splints can cause pts to clench and grind more and usually disintegrate in a few months.
Q: There is talk among dentists on the internet that the next evolution of TMDs is the NTI brux splint. What are patients saying about this? What are your thoughts as a Physical Therapist on these?
NA: NTIs are similar to an anterior partial bite splint where the posterior teeth do not touch thus possibly decreasing clenching and grinding. The problems are that it can create a posterior open bite which would require reconstruction of the teeth and bite.
Indications are when a splint is needed ASAP as a stabilization splint takes 2 weeks to produce.
Q: What are some of the typical surgeries that you see in the jaw area?
NA: Arthroscopic surgery to release adhesions and clean the joint for anterior disc displacements that are non-reducible. Goal is to increase range of motion to functional range and symmetrical opening and ability to chew food and open.
Q: When have you seen the need to make money override the well being of the patient?
NA: Some surgeries and treatments that have no evidence based studies such as braces, total joint surgeries, using TENS to find the correct bite, cranio-sacral release.
Q: Where can you find a reputable dentist who treats TMDs without trying to sell them non indicated splints or who would be open to collaborating with Physical Therapists.
NA: Reputable dental schools such as UCLA or USC, they can refer you to community dentists that teach at the school, members of American Academy of Orofacial pain.