tmj and orthodontics

I was reading an email on my Gmail account the other day and one of the corner ads got my attention. A fellow colleague was advertising as a “Holistic Dentist”.  Though I had heard it before, I have never put much thought into what it really means.

I suppose that the most basic tenets of “holistic dentistry” should be to do no harm and for the dentist to look at the mouth , teeth, gums and the jaws as an integral part of a larger, whole body system.  Interestingly, in most countries around the world, medical students recite an oath equivalent to “the oath of Hippocrates”, sadly though no student of our profession undertakes such oath upon graduation. I do however believe that we are implicitly bound to honor the trust placed in us as “medical professionals”.

Considering the above we all should be holistic dentists. The reality is different though. Case point is the orthodontic profession in that it has veered away from being a health science, and has become more pre-occupied with being purely cosmetic at the expense of our health.  Our orthodontic colleagues have been perfectly positioned to be at the forefront of TMJ/TMD treatments. However, not only there has been a total void of leadership on their part, there have been well orchestrated attempts to stop the progress of science.

An example of this is the prevalence of premolar (bicuspid) extractions in private practice. Data is not clear on this but it is estimated that as much as 25-85% our children get their healthy teeth removed in the name orthodontics.

The rational behind this methodology goes back to a 1954 paper by P.R. Begg, which has been proven wrong soundly many times since. Subsequent studies have shown that these cases have less than 10% stability over a 10 year period. This alone should suffice to explain, never mind that we are encroaching on the tongue space and therefore compromising the patient’s airway, creating persons with great susceptibility to sleep breathing disorders. Talk about “do no harm”.

Here we are in 2011 and biomedical instrumentation is available to dentistry. Rather than subjectively guess the position of jaw and move teeth, we can now objectively and scientifically find the position of the jaw and move the teeth according to the patient’s physiology.  Everything we do in the mouth must reflect a healthy echo to the rest of the body.

Many patients often ask what has caused their particular malocclusion (their incorrect bite), on this matter literature supports muscle function and posture. Regretfully, though there are no active teaching programs connecting the two together. (Mainly due to politics, another sad testament to our profession).

If dentistry aspires to be taken seriously as a medical profession, then it must put aside its antiquated ways of the past and re-orient itself towards more objective and scientific ways that are health oriented and less subjective.

Hamid Nassery, DMD

Reprinted from MedHelp.org

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