Reddit mentions of Functional Occlusion: From TMJ to Smile Design

Thank you so much for your response! Yes, death can indeed be a comforting thought, with the right attitude.

What I’ve been wearing is a “true anterior positioning appliance” that pushes my jaw forward. I don’t actually know for sure how the doc diagnosed whether or not I had an anteriorly displaced disc – there was one time after the clicking and popping had been getting worse that my jaw eventually “dislocated” (doc’s term, not sure on specifics). I was spooked by the cost of an MRI and after my hesitation, he never insisted on one. Though with Ibuprofen and time things seemed to be getting better, he had this (expensive, of course) nighttime appliance made for me that I’ve been wearing ever since, along with a daytime appliance that I don’t wear anymore (can’t remember how long I wore it for- months? Over a year?). I’ve never actually been diagnosed with sleep apnea. Except for a sleepy energy drop in the late afternoon, I don’t exhibit potential symptoms of it. Anatomically there are warning signs (small jaw with oversized tongue, scalloped tongue, more) but again I’ve never been diagnosed. This so-called TMJ specialist had me do a home sleep test seven months after I started wearing the orthotics, and I think I was wearing the orthotic at the time. An “interested party” has since told me that there were problems with the test – for instance, no sleep physician examined the results, only a tech – but in any case, this potentially problematic sleep test did not suggest sleep apnea (though I was wearing the orthotic…). And yet I’ve been wearing this anterior repositioning orthotic for five years. Is this all sketchy? Because it seems sketchy to me. (I also don’t trust my current doc very much because of two rounds of prolotherapy, but that’s another story.)

I see that LVI advocates “physiologic dentistry,” which is often a synonym for neuromuscular dentistry, right? I was looking at Dawson’s recent textbook (on Amazon preview), which suggests that these technologies can be useful if people know what they’re doing and make the right scientific assumptions, which seems sane. But then how does the patient know that the dentist knows what he’s doing with these K-7s and TENS and whatnot?

I’m particularly concerned with the neuromuscular approach because there’s another “TMJ specialist” in my area who apparently trained with Dawson for a few years and specialized in oral surgery for about 20-25 years before shifting towards a neuromuscular approach and treating patients for TMD and sleep apnea for the past 5ish years. The past experience would give me hope that he might know what he’s doing more than the average neuromuscular doc, though your perspective is making me hesitant to go down this path. I don’t mind the thought of wearing a gelb splint for 4-6 weeks – seems less manipulative than this orthotic I’ve been wearing. Perhaps it would reset things to a better place after five years of my jaw jutting forward at night and taking hours for the bite to readjust each day? Have you found gelb splints to be beneficial in the short or long term- and does my reasoning hold any water at all? It’s the thought of phase II, getting my bite adjusted with filing and additions, that freaks me out, even though I’m told it would be minimal. Maybe it creates a perfect bite now, but what about after I’ve aged for another 20 years? I guess it’s like you say- the promise of finding a perfect solution, instead of realizing that TMD is the sort of thing that has to be managed.

Yikes, this is long, and I fully acknowledge that just because I’ve spent hours of my life attempting to research this stuff doesn’t mean I actually understand anything. I’ll look further for people with the Spear affiliation. Thanks for reading.