Bridging the gap between dentistry, physical therapy, and the TMJ

The intricacy of the temporomandibular joint (TMJ) and its relationship as to how it affects the harmony of the oral environment warrants analysis and understanding from an angle that many dentists are unaware of—physical therapy. What concepts are behind skilled TMJ therapy and what can this do for you, your patients, and your practice? This article will address the gap that exists between dentistry and therapy, and hopefully open the door to a service from which many patients and dentists can benefit.

Mar 3rd, 2015
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The intricacy of the temporomandibular joint (TMJ) and its relationship as to how it affects the harmony of the oral environment warrants analysis and understanding from an angle that many dentists are unaware of—physical therapy. What concepts are behind skilled TMJ therapy and what can this do for you, your patients, and your practice? This article will address the gap that exists between dentistry and therapy, and hopefully open the door to a service from which many patients and dentists can benefit.

ADDITIONAL READING |What dental professionals need to know about TMJ: An infographic

Several years ago, I began studying under Dr. Racabado, a world-renowned physical therapist from Chile, who specializes in TMJ and temporomandibular disorders (TMD). The results of a skilled, specialized physical therapist who works in conjunction with a dentist has yielded remarkable results for the patient who suffers from TMD, limited opening, or injuries from accidents. On average, there is an 85% success rate for patients who report relief and improvement with their jaw issues. With such a high favorable outcome from treatment, it is a surprise that the relationship between dentists and skilled physical therapists is not more utilized and recognized. This gap is preventing a paradigm shift that needs to occur in which dentists work with a skilled TMJ therapist much like an orthopedic surgeon works hand in hand with a physical therapist.

Several reasons for this gap lie in the culture of the therapy world. For one, there are very few therapists who specialize in TMJ. For example, to the best of my knowledge, I am the only certified CFS therapist in the state of Montana. Most physical therapy (PT) schools spend a lab, a half to a full day on TMJ. This means that most therapists know very little about TMJ and the relationship it has with the oral environment. Case in point: Most do not know what centric relation or parafunction means and probably have never heard of these terms before.

ADDITIONAL READING |The restful jaw: helping take the fear out of dental appointments for TMJ/TMD patients

Complicating the issue, therapists are a referral-driven industry: no referral=no patient. As a result, therapists have a hard time saying “no” to a referral, so if a dentist refers a patient, that patient will be seen. The drawback in this situation is that the therapist you just sent your patient to will, in all likelihood, be lacking the proper training. The therapist will perform a shotgun approach, and you will form an opinion of utilizing therapy. Depending on the success of treatment and your (and your patient’s) experience, your opinion and inclination for future referrals could be biased. If you want to work with a therapist, I would suggest taking the time to find one with the proper training. Call the clinics in your area and ask if they have anyone with specialized training in TMJ; if not, see if they know of anyone who does.

The therapy world as a whole knows little about TMJ. And what little they do know, they are biased in thinking that the patients who suffer from chronic or acute TMJ disorders are patients with a lot of emotional issues … so they either do not want to see them, or—as previously mentioned—they treat them with a shotgun approach. Those few of us out there who specialize in this area could not disagree more. We find the success rate to be very high and rewarding. We need to encourage our colleagues to get on board, but everything becomes complicated with those who specialize. They have found a niche, and it is hard for them to let their competitors in on this niche. If the therapy world knew of the success of TMJ treatments, then more and more therapists would specialize in it, thus increasing availability of services to dentists, which would shrink the gap between the PT and dental world. Dr. Racabado stated that after 30 years in the field, he is surprised that this discipline of PTs and dentists working in conjunction to treat TMJ/TMD patients has not taken off … because it works, and it works well.

Adding to this gap is the lack of knowledge in the dental community regarding the benefits of skilled therapy. I have found that this is primarily due to dentists being unaware that this treatment even exists and what it consists of. To successfully treat TMD, there must be a cohesive relationship between the inframandibular (teeth, occlusion, etc.) and supramandibular (neck, axis, and associated joints) areas. Oftentimes, only one of these areas is treated or the relationship is not recognized. Many dentists feel that by referring their patients to PTs, it will sever or reduce the patient/doctor relationship. PTs are not dentists, so it is important to realize that the highest success rates come from dentists and PTs working as a team for the best interests of the patient.

Another reason for the gap between the dental and PT world is the idea that therapists are used solely for the relaxation of the muscles surrounding the joint. Yes, we do provide a means of relaxing these muscles and decreasing their activity levels; however, a skilled TMJ therapist provides so much more. The specialized therapist will focus not just on the treatment of muscles but also the joint, joint movements (arthrokinematics), soft tissues in the joint (i.e., the joint capsule), the influence of the upper cervical spine on the position of the TMJ and centric relation, posture, and so much more. Yes, we are joint specialists, but providing a comprehensive approach allows for a more long-term successful result. As awareness increases of what the specialized therapist brings to the table in the treatment of TMJ, then the gap that exists will become smaller, resulting in a healthier working relationship between dentists and therapists.

In upcoming articles, I will talk more specifically about how we treat TMJ disorders and the influence the upper cervical spine, posture, and the joint itself have on the condition of TMD.

Jeff Humphrey DPT, MTC, CFS, graduated from the University of Utah in 1998 with a bachelor’s of science. He then went on to the University of St. Augustine and received his doctorate in physical therapy. In 2001, he became a Manual Certified Therapist and in 2012, he became a certified Cranial Facial Specialist. He lives in Corvallis, Montana, with his five kids and amazing wife.

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