Dr. Steven Schluentz had been a dentist since 2012. He helps doctors and dentists learn more about TMJ and how we can help patients better their lives.
TMJ WHat to look for
What patients should know about TMJ, what to look for, and symptoms that they might be having.
Great question and pretty early out of dental school I was seeing a lot of patients even in my own office that I would think, wouldn’t have the symptoms they had, and they would go see chiropractors they would see natural paths they’d see all these different alternative medicines, medicine sources, and they still were dealing with certain issues, and I started looking for some answers. I would see a lot of teeth where I’d see a lot of issues, recurring cavities, and breathing issues and sometimes they were diagnosed with sleep apnea and I started to look at is there a link between all of the stuff. And that kind of led me on a path and my aha moment was when I started to learn how to treat TMJ the way that I do it, which is all about stabilizing systems and then restoring back to health.
I had one patient that had chronic shoulder pain for 10 years didn’t tell me about it. We actually went through this process together, and within a week this chronic shoulder pain she had for 10 years completely gone. That’s when I really started to get interested not just in my own practice how to help patients with TMJ and TMD issues, but how to help other dentists do this in their practice as well. And, you know, we just see so many things in our office that if we aren’t aware of it, we just kind of ignore it.
Patients out there are suffering from TMJ and TMD like symptoms headaches, neck pain, shoulder pain, facial pain, tightness. And, you know, I’m not saying that TMJ and TMD temporomandibular joint disorder is the only reason they have those things but sometimes it can be an underlying reason we typically don’t think about it, but it is important.
I think that’s the message that we definitely want to bring awareness to. There are a lot of things that are happening with our young adults with our older adults, they start in the mouth there and we’re not making that connection.
I’d love to say that the majority of my patients that I treat are young, but typically that’s not what ends up happening. Things that we thought were not significant when we were 10, we kind of just ignore it, when it goes away. It doesn’t completely go away though and those signs that we had, turn into symptoms and then the symptoms turn into some really severe debilitating problems, and then by the time that I usually get involved as a dentist, the cost of treatment has gone up dramatically to get them back to the state of health. So, I see a lot of patients in their 40s and 50s for treatment that if we were aware of some of these, you know issues early on we could have avoided a lot of problems. One of my missions is helping dentists become better educated and aware of what they’re seeing for their patients. So that ultimately they can give their patients better choices, in terms of how they want to potentially avoid a lot of dental problems that we see, I mean we see teeth breaking, teeth cracking and now you need root canals now you need crowns.
Typically tooth wear and teeth breaking and cracking are usually a sign of a breakdown in the whole system. It’s not just that the tooth decided to break one day, it was that there was a pressure source or something that was causing a mal alignment, and all of a sudden that tooth, just breaks, and now we need extensive dental work on just one tooth. And you’re still not actually creating a solution, you’re just solving a problem at that one point in time. and then all of a sudden six months a year ago, a year goes by and now we have another problem, and then another tooth break and then another tooth breaks and we’re always reacting to disease as a dentist. There is another way that ultimately benefits patients because now they know they’re working towards something rather than just treating symptoms of an underlying cause it’s undiagnosed right and a lot of times the alignment of the teeth isn’t just about straight teeth. It’s about aligning for function because of how they’re hitting and when your teeth are not aligned, it can also cause some of the gum disease and recession and things like that that you’re having correct. Absolutely I always tell patients. It’s pretty simple.
You have kind of three things that are either working with each other or not and it’s your muscles, your joints, and your teeth. And if we can bring your muscles to join some teeth in alignment, you’ll probably have pretty good success going and seeing the dentist over your lifetime. If those three things aren’t in alignment. Sometimes you luck out, and you still have very minimal issues. But if you’re prone to having issues, and those three things are not in alignment, you’re going to see recession gum and bone loss, and fractions, which is basically nothing of the teeth. You’ll be more prone to getting decay, you’ll have more symptoms in terms of headaches and neck pain, and the issue is sometimes we don’t typically think as patients I know when I started learning about this, it wasn’t the first assumption that a shoulder pain could be related to how my jaw joint is centered in the socket. but to learn that these things are all connected. And the more you know, the more we understand this, this, you know the connection between all of these pieces, the healthier we’re going to be. And so it first is just the awareness of asking the right questions for your dentist and your hygienist hey I’m, I’m experiencing these symptoms Could this be related to the way my bite works or the way that my mouth is working. I can’t tell you how many countless patients have headaches that until I see starts with signs in the mouth, and I asked them questions about potential headaches they have that they finally said, I never would have thought that my headaches were related to my mouth.
I’ve been going to chiropractors or I’m going to a neurologist and they’re giving me these really heavy dose medications that aren’t solving the problem. And so I’m continually dealing with this. The symptoms on an ongoing basis. I’m not saying again that there are some other things that can cause headaches but oftentimes dentists are way down on the totem pole in terms of when patients get to the dentist. And even if you do get to a dentist sometimes they just aren’t trained and educated in temporomandibular joint disorder.
I get a lot of dentists that send me patients because they don’t do that and they don’t want to do that and that’s okay, but now I am actually able to help some of these patients.
What about people that are on C pap machines?
I think that there’s a good majority of people that have sleep apnea, that could benefit from looking at how pivotal the airway is related to the mouth and vice versa. And again, I would love patients who do not have to wear a C pap machine. There are some modalities of treatment out there that could replace c-pap I think we as providers are getting more and more aware, of how you know prevalent sleep apnea is the different types of sleep apnea and how to best treat that. I mean, we see a lot of patients that are wearing c caps, because of underlying ventilation. Now we also see patients that don’t wear their c pap so they’re really not benefiting them, and, you know, we want to be able to provide solutions to those types of patients as well. We see a lot of these patients that are not getting diagnosed until they’re in their 40s 50s 60s 70s.
And a lot of patients that I see that have sleep apnea, are not the traditional patient that you would think has sleep apnea, we as dentists typically think 50 and 60 year old male obese. Big neck, those are the things that we learn as providers, those are what we want to look for. But I see a lot of 30s and 40-year-old females that are completely healthy they’re not obese, and they have severe sleep apnea. And those are the ones that typically go under the radar. And then they start to have headaches and pain and they can’t sleep at night, and you know they’re listening to their husband snore because he also has sleep apnea. There are some things that we should be identifying a little bit earlier and you can actually see a lot of those patients, very early on, you know, one, two and three years old they’re just not breathing they’re not developing properly, and the earlier you intercept the problem, the better the long term solution will be for you know the patient.
So your tongue is restricted and it gets pushed back and it actually closes the airway so you are having a difficult time physically breathing. And so you think about it, if you lay back then the tongue falls back even further, and you stop and you gasping for air, and that also contributes to clenching grinding teeth breaking. One of the things we see as dentists and what you’re, you know, listeners can tune into is look at your teeth, you know, usually, the teeth are a signal for something, if they’re cracking they’re breaking, you’re wearing your teeth down they’re chipping, by and large, those are usually symptoms of sleep apnea. And so when we see patients in their 30s and they have wear on their teeth that make them look like an 80 or 90-year-old, we know something’s going on in the system that’s not normal.
So it’s a simple thing you can ask your dentist. How much tooth wear do you have, because as patients we don’t see it. It’s like watching paint dry. So we’re not going to see every time we come in that our teeth are getting smaller and smaller and smaller, but if you take five years of snapshots you’ll see the progression of tooth wear. And that’s almost always a symptom of sleep apnea. So, again, there are other things that can cause tooth wear, but that’s one of the most common things that we can see as dentists, that signal there might be something going on as is, you know, severe tooth wear teeth that are breaking teeth that are cracking especially in the front. Maybe you’ve done crowns or fillings in the past, they just don’t last they break. Those are usually signs and symptoms of something else that could be happening as well.
The first thing you should ask yourself, again, seeing TMJ and knowing that there are solutions out there. If you’ve been suffering from headaches and neck pain, and jaw pain, and you haven’t been able to get solutions through traditional measures. Maybe you have seen neurologists. Maybe you’ve seen chiropractors, there are reasons you go see chiropractors and neurologists but if you’re not getting relief, start to ask yourself, could it be a dental problem. If it is a dental problem simply ask your dentist.
I am having neck pain could this be related to my bite? I think the biggest thing for patients to understand is, every dentist is a little different, and we all have our own unique skill set, because simply. Sometimes, a dentist may recommend an eye guard for you. A night guard might not help your problem. And that’s the biggest thing that I probably combat in my office is, I tried an over the counter night guard I didn’t wear, it didn’t fit. It didn’t feel good and I couldn’t sleep in it, or my dentist had tried this in the past and it didn’t work.
Nightguards are very similar to me if you’re thinking of a painter, and you gave me a tooth, or a paintbrush and a blank canvas and told me to paint something, and then you told Picasso to do the same thing. The painting you’re going to get from Picasso is totally different from the painting you’re going to get from me so every dentist is trained a little bit differently. With regards to TMJ and TMD. I strongly believe that every dentist should be able to diagnose it at some level, and then also be able to get you to the right person. I wouldn’t try to do, you know, a heart replacement for you and send you to a cardiologist, and that’s the same thing in dentistry, not at all like ours are created, not all appliances are created equal. And so you have to be able to ask the questions, and then also be receptive to doing some of your own research and getting answers, and you know I have honestly patients have called me from Los Angeles and I’m in Philadelphia just to see, is this something that’s related to my bike, and I’m always happy to help them I, I can do a virtual console and just say okay this is where you’re at this is where you could potentially go. And the cool thing about being a coach is I actually now know a lot of dentists that do this type of work. So I have my own little network and referral system that I can get to know patients if I can’t treat them to the right person in their area. That’s awesome.
Orthodontists we’re seeing a lot of things happening because patients are trying to do it themselves and it’s actually ended up being more costly because they are doing it themselves. Well, I don’t want to be sued by a smile direct club so I will say this, there are cases that probably could be handled with DIY, and the issue is, you don’t know if you’re a case that actually can be handled because there are a lot of. There’s not a lot of direct involvement with a dentist in any situation like that.
And so be very careful when you decide to move forward without. I always tell patients, if you broke your arm or your leg, and you wanted to go to a physician. That said, we can straighten that for you and fix it. You just take a photo, and a mold of your broken arm, and we’ll send you a cast, and you’ll be good to go. You just put the cast on, you probably wouldn’t do that. And in dentistry is the same way so you must be very. Ask yourself, would I do this, if this was any other medical treatment would I do this, I can’t make you do it or not do it, but just be aware because we do see patients that do have issues as a result of that, but we also have patients that don’t have issues and so if you look at smile directs website, they’re going to say that, which is. We can’t guarantee results.
Use it at your own risk. And that’s the best piece of advice I could give you is just, just think about it before you do it. There are cases that work out really well but then there are other cases that absolutely should not be done directly without any type of dentist or orthodontist intervention. And those are the patients you’ll see come back and it’s just it’s really to me it’s sad, because now them trying to be proactive and get straight teeth and get what they want, have created a multitude of problems that will not be able to be fixed by doing new ortho they’re gonna need a lot more work. You could have bone loss, you could have gum loss, you could have repairable damage you can’t simply just put the teeth back where they were.
That’s not possible sometimes so you just need to be aware of some of the risks before you decide to do it. That’s what I’m seeing with TMJ can definitely get affected by the alignment of the teeth because again what we talked about the alignment of your teeth your muscles and your joints, all factor into TMJ so if you get that alignment off and you didn’t know that you had an alignment problem, to begin with, you will have a lot of problems that are not going to be solved by putting the teeth back where they were. It’s, it’s Pandora’s box to open that thing up. It’s hard to put everything back in there.
Dr. Steve has a TMJ channel that I’m starting on YouTube so that’s still in development, but you can go to www.sleepstudio.com is the best way to get in touch with me, or you can send me an email directly to Steve@Mountain sky coaching.com If you are a patient that’s wondering about some of these things that we talked about and you need additional help, feel free to reach out to me, I’d love to help any way that I possibly can.
Listen to the full episode on “The Healthy Mouth Movement Podcast: May 18th, 2020