by Gordon J. Christensen, DDS, MSD, PhD
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensen, please send an email to firstname.lastname@example.org.
I have avoided treating temporomandibular dysfunction (TMD) because of the apparent complexity of the treatment and the unpredictability of the results. Is there a simple treatment concept I could use?
Answer from Dr. Christensen ...
Fortunately, in my experience, most of the patients who present with pain and dysfunction in and around the temporomandibular joints do not have breakdown in the joint itself. As a result, simple repositioning of the mandible by disclusion of the teeth can often rapidly reduce pain and dysfunction. It's imperative to determine which TMD patients to treat, and which you should refer. I suggest that you learn to treat the muscular cases and refer the patients with apparent joint breakdown and degeneration. How do you know if the condition is muscular or not? It is impossible to tell with certainty; however, some simple conditions usually are indicative of muscular involvement. The muscular patient usually complains of pain in the temporalis, masseter, internal pterygoid, and neck and shoulder muscles. There is usually little or no pain in the joints, and when listening with a stethoscope as the joints move, you do not hear clicking or popping. The pain has usually been present only a short time — up to a few weeks. Treatment is usually easy, and relief is relatively rapid. What type of treatment is best? After trying most of the older and current modalities of treatment, I prefer to place an occlusal splint into the patient's mouth. Either maxillary or mandibular splints that have an occlusal contact on every opposing arch tooth, as well as a canine rise and an incisal guidance are effective in reducing or eliminating muscle pain within a few days. A simple occlusal equilibration, accomplished after the muscle pain has subsided, assists in reducing the chance that the pain will return.
Another simple device has been very successful in recent years. The NTI-TSS (Nociceptive Trigeminal Inhibition Tension Suppression System) is a simple anterior segmental bite splint that discludes the teeth, reduces pain, and reduces or eliminates bruxism and clenching. Other devices similar to the NTI-TSS are on the market, but the NTI-TSS has a proven track record over many years. Either type of splint therapy allows you to treat simple TMD patients effectively. The addition of this type of therapy to your practice will add interesting and stimulating variety into your practice.
Several popular PCC videos show the techniques described above: V3114 Occlusal Equilibration, V3127 Occlusal Splints, C500A Occlusal Disease Therapy Simplified (NTI-TSS), and V3146 Temporomandibular Disorders. For more information, call PCC at (800) 223-6569 or visit us online at www.pccdental.com.
I have been out of dental school for about 10 years. I was taught to use gold alloy as the crown material of choice, if it did not show significantly when the patient spoke or smiled. Is this concept still viable, or am I behind the times?
Answer from Dr. Christensen ...
There are some speakers on the dental lecture circuit who would consider you to be living in the dark ages. However, I am not one of them. Recently, I had one of my sons, who is also a prosthodontist, place gold alloy full crowns on two of my second molars. In a recent survey I conducted on the members and guests of the American Academy of Esthetic Dentistry, I found that in this very esthetically-oriented group, about 60 percent wanted gold alloy crowns on their own second molars, and about 50 percent wanted gold alloy on their own lower first molars. Yet, the public demands tooth-colored restorations. It appears that dentists believe one thing and that they treat their patients in a different manner with tooth-colored crowns. What is the most correct material to use for the restoration of teeth? As you know, this is a very personal decision. If the patient wants longevity, gold alloy is by far the best. Many gold alloy crowns survive in the mouth for 40 or more years, while the aesthetic longevity of porcelain-fused-to-metal (PFM) crowns is not much more than 10 years. Of course, PFM crowns will function longer than that, but they lose their superficial color and their initial excellent esthetic appearance due to dissolution of the surface ceramic caused by the presence of acids in the mouth.
I feel that patients should be given a choice of what material they prefer to have as their crowns. Many prefer longevity to esthetics, while others would not consider cast gold alloys in 2003. Complete informed consent is necessary for two important reasons — patient education and legal protection for you.
Two PCC videos show techniques to produce the best result in both types of restorations: V19-90 Multiple Unit Fixed Prosthodontics (2nd Edition) (for PFM restorations), and V3532 Cast Gold Restorations. For more information, call (800) 223-6569 or visit us online at www.pccdental.com
Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates, which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.
Dr. Christensen's views do not necessarily reflect the opinions of the editorial staff at Dental Economics.