Moving toward a unified approach to TMD, airway, and full body posture

Abstract

The CRANIO Journal is a dear old friend of mine. I suffered from TMJ disorders for years without a real understanding of what they were until, in my junior year of dental school, I identified with descriptions of symptoms and became a professional patient. CRANIO did not yet exist! There were a multitude of continuing education courses for dentists, and although I was just a student, I went to several. I then became the patient at many of these courses and was put into centric relation (CR) position by the “experts.” I had mounted models, and learned I had worn through the enamel on the cusp tips of all my posterior teeth. During my senior year, I had 16 gold onlays on my posterior teeth and an ill-fated attempt at adding a cuspid rise to my group function occlusion with gold lingual pin-ledge restorations on 6 and 11; both teeth had 2+ mobility within 2 weeks, and the restorations were removed. An attempt to add cuspid rise was aborted due to severe mobility, but I continued being treated with equilibration on my gold onlays. Upon graduating in 1977, I started going to the American Equilibration Society and Academy of Head, Neck and Facial Pain meetings. I am not sure if I started reading CRANIO with issue one, but the first time I saw it, I was hooked! I am forever grateful to Riley Lunn for filling the desperate need with the CRANIO Journal. I now humbly assume Riley’s role as Editor-in-Chief of CRANIO. I have been a reviewer for many years and, more recently, the Craniofacial Pain Editor. I have written several Guest Editorials, including “TMJ, The Great Imposter has a Co-conspirator: Poor Sleep” for the issue announcing CRANIO adding sleep to become “The Journal of Craniomandibular and SLEEP Practice.” We are currently in the era of Evidenced-Based Medicine (EBM), but there are costs as well as benefits to EBM. Frequently, the big picture is left behind as we focus on studies with only a couple of variables and ignore whole body evaluations. Drug studies and psychological studies are perfectly suited for EBM, but often, in terms of clinical pain treatment, “better than placebo” is a very low bar. A statistically significant difference does not necessarily have clinical significance in a patient’s quality of life. Most studies do not examine attempts to correct or even address problems in their entirety. This month’s Guest Editorial is written by Dr. Jennifer Hobson and Bill Esser, PT, both physical therapists. Dr. Hobson is also an Oral Myofunctional Therapist and runs a breathing clinic. She is Rocabadotrained and lectures with Mariano Rocabado. I have utilized this Aqualizer® technique and have lectured on it for well over 10 years, but it has never been objectively evaluated by EBM protocols. The approach discussed avoided contaminating issues by evaluating patients on their very first visit for changes (correction) in hip height, per physical therapist protocols. A major issue of private practice clinical studies is that it would be unethical to deny care that the practitioner knows or expects is effective. Case studies and testimonials are not considered evidence but often yield results not matched by EBM. Dr. Hobson’s pilot study should lead to far more extensive studies to connect craniomandibular function to whole body posture and reduction in medical expenses. Currently, correction of jaw function and position is ignored by most medical doctors. The 1997 and 1998 papers by Shimshak et al. [1,2] showed a 200– 300% increase in medical expenses in patients carrying a TMD diagnosis. These articles, published in CRANIO, may be two of the most important articles on TMD disorders ever published. I hope future articles will address widespread important clinical issues utilizing EBM. Aqualizers® utilize Pascal’s Third Law of Hydraulics [3] to instantly quickly aid in the evaluation and differentiation of Ascending from Descending disorders relative to Sherrington’s Righting Reflex [4]. Patients’ hip heights are evaluated when standing with their feet together at the iliac crest. Patients then walk or ideally, climb stairs, and are then rechecked. In my experience, the vast majority of patients have rapid correction of uneven iliac crest heights from Aqualizer® use during walking and stair climbing. Dr. Hobson’s study is designed to be easy to duplicate and build on in multiple settings worldwide. It did not examine the airway or correction of forward head posture, nor did it include radiographs to determine the hyoid position. There are currently dentists in the US,