One of the greatly overlooked aspects in treatment planning, and the downfall of many cases.
I really don’t understand why such little time is given to managing these issues when we are learning as undergraduates. What is it, something like a total of 2 days over a 5 year period? Not only that but it’s taught incredibly poorly too using outdated, misguided science.
We need to understand the TMJ and it’s anatomy and how that relates to potential problems. Despite what we see in textbooks, the TMJ is not a ball and socket type joint, it’s actually pyramidal in nature.
On a basic level, and again this is discussed in much more detail in my seminars, we need to understand the approximate health of the joint. It’s impossible to understand it fully and studies have suggested that the justification for radiology is quite low given the fact it tends not to alter treatment planning too much.
From a restorative point of view, we need to understand where in the cycle and clicks are (early/mid/late), whether there has been any history of ear pain or previous TMJ based problems and whether any deviations occur on opening or closing
Of there is any history or current level of TMJ based pain then this MUST be addressed prior to any restorative work
Another point is to stop labelling jaw joint problems as TMD. It’s a very non descriptive term and really not appropriate as it doesn’t hold any diagnostic value. A recent article stated how the use of this term was confusing dentists as it was unclear what the pathological cause is. Can you imagine a knee surgeon starting any kind of treatment because a patient has ‘knee pain’?
My advice here is to learn from Barry Glassman. Whilst his science is away from the mainstream, he has taught all philosophies including NM, CR, Gelb and everything in between. He truly understand the science and literature. Just be warned it’s not what is dogmatically taught at university! You’ll need to unlearn what you have learned before benefiting. There are many philosophies out there, many of them have been disproved