If we have a symptomatic TMD patient and are trying to figure out, can we make this patient better or comfortable? How can we stabilize the joints?
Go back to the complete examination.
What does the examination tell you and what do we think is going on? Ask yourself:
- What is the joint diagnosis?
- Do we have healthy joints and it is a muscle issue thing?
- Do we have intracapsular problems whether it is a lateral pull or a medial pull?
- Do we have degenerative joint disease and the occlusion is unstable?
So when we look at it from this way what we are really trying to figure out is if it's a dental problem related to the oral facial pain or the symptoms of this patient? And can we solve it?
We want to try to do this in a reversible means.
So here is the one important thing: we do no irreversible dentistry until we can get a patient comfortable. We are going to use reversible means to try to get there. We are going to use splints. We are going to pick our splints based on the potential diagnosis, the joint diagnosis, and we are going to go from there. We are going to monitor the splint, for what we are going to say comfort and stability. So can we eliminate the symptoms of the patient? Can we make them feel better? Can we stabilize the occlusion and if we can is it possible to do that over a period of time?
Once the joints are stable, go through normal treatment protocol
If we get there and we get to that stability, now we can go through our normal treatment planning channels and figure out ideal treatment. Another thing in here is just to go back to that examination now because we know also that you have got to check or airway. So any symptomatic patient, it may solely a dental occlusal problem, but we have to make sure that airway is not part of it as well because that is going to affect where we are going to go with our treatment.