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Is the problem in the training of radiologists? if medical doctors can be held responsible for misdiagnosing patients or not investigating symptoms of serious illnesses, shouldn’t radiologists be held to similar standards? or does the burden shift to the dentists or surgeons to review the films or images regardless of the radiologists written report?
Here is the problem… most medical doctors/radiologist and dentist do not evaluate their patients from a truly healthy physiologic standard of functional and dynamic health. Most evaluate the masticatory system from a static position, but their standard of normal may in fact be unhealthy (example: as long as you have your arms and legs they say you are normal, but don’t realize maybe you have a limp in your walk or back pain or jaw pains, but you have your jaw and joints and teeth so what could be possibly wrong with you?).
That means everything they look at and evaluate (teeth, muscles and joints) are looked at individually not based on how dynamically they work together in a dynamic manner. MRI’s may show joints and disc position, but they miss the dynamic movements of how both TM Joints, left and right sides. One side of the jaw doesn’t by itself, but rather it moves as a whole unit. They either move in a healthy manner as a complete unit or else different individual parts don’t function well (impaired) leading to a one side (asymmetries) creating ill health while the other side may work but is actually influenced by the impaired body part. Impairing of the the complete (whole) systems health only requires one individual entity not not function properly.
MRI of a 22 year old female who has seen 52 previous health care professional for aberrant neck and facial spasms (mild dystonia and twitching) after previous functional appliance therapy and orthodontics. What does “Normal” mean when patient still has masticatory problems. Patient shows no limited mouth opening (3 fingers wide).
As professionals we do not always consider how the ill functioning muscles (tender in pain and straining, headaches, etc.) are actually impacting how the disc and whole body movements are not working to their optimal levels. The teeth, to the novice doctors, all appear in the mouth (lined up), but not once do they consider how they are actually not working well when the muscles and joints are not optimally functioning. So in reality the teeth are not occluding or acting normally. The medical and dental profession do not think that way in general. Since most clinicians don’t measure and quantify what optimal muscle health (EMGs and CMS data looks like) they don’t know if their patients are impaired or not,(accept by what the patient says), they really don’t focus on the muscles, but rather on what they have been trained to focus on (JOINTS – MRIs) and TEETH (radiographs), because that is all they can physically see, thus they miss the major problems of TMD. TMD is not about what you can see on MRI’s and radiographs, but on what these documents don’t show. So they conclude wrongly and on occasion get a few things right. (Some successes that they are happy with, somewhat random success, but they think they are accurate and precise). But when things do not go according to what they thought (according to their understanding and training), they give up and cash the case out as some other psychological whiner and complainer or else they say its a surgical case to unload the problem to the oral surgeons who don’t deal with occlusion. They assume it is not part of their discipline (DENTISTRY) since dentistry is really treating teeth and joints in their understanding.
They say “muscles” to sound inclusive in their approach, but the reality as you all know all too well, their clinical practice and understanding of the masticatory system does not fit the understanding you know all the better. It is in fact their limitations of these understandings to have been proven on these forums in spite of all the various opinions, philosophies and view points presented. You all are smart, intelligent and have all figured it out already in your hearts! You all are just trying to find some reassurances to confirm you all are not going crazy. YOU ARE NOT! You are on track. The medical and dental profession needs to catch up and get it all together from a functional healthy perspective and not assume just because a patient has the body part it is Normal. Ain’t always so.
Clayton A. Chan, DDS – Dentistry in Las Vegas, NV