Dental School: University of Tennessee, class of 1969
Years in Practice: 45
What causes temporomandibular joint disorder (TMD), and how is it corrected?
The causes are “multi-factorial,” similar to low back pain and other musculoskeletal disorders, and could be anything from direct trauma to the jaw, to stress, to rheumatoid arthritis. Consequently, there are also a variety of treatments, from oral splints and muscle relaxers on one end of the spectrum to surgery on the other.
What prompted you to limit your practice to orofacial pain? Have you experienced it yourself?
I don’t have TMJ problems or orofacial pain. I decided to limit my practice to this field after I was fortunate enough to have studied with the top experts in the field and then be invited to be a professor in the first two-year residency in TMD and orofacial pain, at UCLA in 1990.
This is the first year we’ve recognized TMJ/Orofacial. Would you call it an emerging field?
It is definitely... Although not yet an ADA-recognized specialty, the ADA Commission on Dental Accreditation (CODA) has officially accredited 12 two-year post-graduate programs. I’m on faculty in two of these programs and am one of the site visitors for the ADA.
Are there any orofacial “mystery cases” you’re still working on?
Patients often have toothaches that are actually unrelated to their teeth, and have had many root canals and extractions before we see them. It is particularly satisfying to help these patients resolve their pain and prevent further root canals and loss of teeth. A recent case involved a patient with tooth pain that we actually diagnosed to be due to menstrual migraine, and resolved after we treated the migraine. An astute dentist referred the patient to us before starting endodontic treatment.
How can people minimize their risk factors for TMD?
Avoid harmful habits like biting cheeks, lips and fingernails, and try to avoid clenching and grinding of the teeth. Also try to keep the jaw relaxed and slightly open during the day.
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