Many folks have asked the following:
1) How many TMD patients you have treated cumulatively?
2) What share of these have been complex cases?
3) What is your outcome statistics in complex cases?
- a) % of full recovery / outstanding result
- b) 30% improvement of clinical / actual significance on a day-to-day basis
- c) no improvement, or no functionally significant improvement
- d) became worse
- e) complete disaster
4) What is the average cost incurred throughout a treatment period?
Here is some thoughts regarding the above:
1) I have been practicing dentistry for many years so I have seen many TMD cases. It keeps me on the edge of wanting to learn more.
2) Over the years the TMD case I see and treat seems to be more complex in nature now more so then before. Many are referred by other health care professionals to me. As you know TMD comes in all forms from simple, moderate, complex to very complicated. Not all TMD problems are the same.
3) Right now 100% of my cases are complex and challenging. Most of my patients come from out of state or out of country. These patients who come have seen multiple health care providers, tried many forms of therapies, modalities and had many forms of diagnostics prior to coming to my office for treatment. So, I focus only on one patient and never do I see multiple patients on the same day. I might end up spending 2-3 days (depending on the need) on the patient’s problem and no one else on those particular days (it is very focused on the patient). Me and the patient for those days, no one else booked in another room waiting for me.
4) My patients vary having restorative reconstruction problems to have orthodontic problems and or a combination of issues. Almost all my patients come from out of state or out of the country. Both lay folks as well as dentists are my TMD patients.
5) All of the cases I have treated and have completed treatments with have acquired an excellent result that they are happy with the outcome. But these results didn’t come over night or in just a few visits. Many of these cases involve both a Phase I stabilization for a period of time (usually) more than 1.5-2 years time (it may require a number of visits). Then they proceeded to a Phase 2 level of treatment (when they are ready..they tell me…I don’t tell them…) which involves either orthodontic/orthopedics (no surgery), restorative rehabilitation or a combination of both. I do have some patients who are in a phase 1 level of GNM orthotic treatment who are happy staying in their orthotics for various reasons and they are very pleased with that level of success.
6) Generally the TMD patients who come respond to our treatment rather quickly. There are a few who respond slower, but most see great results of pain elimination depending on their problems. As I have posted and discussed numerous times on various TMD forums) these patients have problems in the masticatory regions, joints problems and pains relating to TMD with cervical dysfunctions, TMJ as a primary problem, Class II division 2 TMD problems as well as anterior open bite TM/TMD problems. These cases may also have psychological and emotional issues along with these structural issues from long term traumas at various levels. In general we see positive results compared to previous methods. That is why keep doing what I do. (By the way, dentists from all over North America and some from Europe, Southeast Asia and Russia recognize the results we are getting with our patients using GNM approach. They come to discover the results are real and valid so they come to OCCLUSION CONNECTIONS to learn the principles of what we do. Dentists want to know how we do it and what we teach and practice, so we teach them. They then realize TMD and occlusion is very involved and not so simple as some may think. That should tell you something more about what we do and why we do what we do. Please read the OC website:www.occlusionconnections.com.
7) I have had a few failure cases that I can count on 1 hand over the course of these many years I have been practicing and treating TMD and occlusal problems. Cases that have been on extensive narcotic medications and are fearful of not weaning off of them I find them to be harder to get resolution. I have learned from these problems and understand why. I learned: 1) that some cases are beyond my level of expertise and abilities, 2) some patients were too anxious and had unrealistic expectations about their problems. I could not meet their time frame within the few visits they allotted me and themselves to be treated. I feel very sad for these individuals. But I know I did my best with what I was able to do and understood. I also learned, impatience can be an enemy to the resolution and be less anxious makes things much easier. There is hope for everyone if they only stay calm and not be so anxious and fearful.
8) Most of my patients definitely get better, not worse.
9) I don’t have any disaster cases as far as I know except those few I admit were failures to me. Again, I feel sad and hope they found an answer to their TMD problems. I know I did not cause more TMJ harm to them when they came to me for those 1, 2 or 3 visits.
10) Fees are commensurate based on time involved, effort, experience, judgment, knowledge, training and skills of the clinician. Some cases take a lot more time than others, no case is the same. Some require more visits and others less. Some require longer office visits and other require short shorter office visits.
Some TMD patients ask a lot of in depth questions and want detailed answers (requiring lot more time to discuss and explain), while others understand the process and don’t require as much time to explain things in the office. Over all the cases I see are typically very complicated in nature and require a lot of time and focus to address their issues.
In phase 2 treatment some realize they need some ortho, others realize they require more complex ortho+orthopedics to transition their bites (GNM orthotic) to the final optimized position, while others may require restorative/prosthetics because of previous full mouth rehab failures. Other cases may need a combination of all the above. I am able to do ortho, orthopedics and reconstructive restorative procedures myself without referring my cases out to other specialist. This way, I can better control the bites, the problems as well as treatment outcomes specifically and accurately to get the results we are looking for. Remember, I am not a specialist. I am a general dentist who focuses on treating my patients comprehensively when they need such.
Some TMD patients have all their 28 units of teeth, while others have missing teeth, or crowded crooked teeth, others have had previous joint surgeries, others with various forms of joint derangement problems, others with locked joints, disc problems that have not recaptured, others can open their mouth but with dyskinetic movements. Some have come with all kinds of medications (maybe require detox management), making their problems much more complicated than those who are not on medications. Some patients are clenchers and others are not, maybe with grinding problems. Lower back problems, pelvis and shoulder problems, etc. Clenchers are more complicated and take more time. The K7 data and tests we use helps us discern and understand underlying CNS issues as it relates to the TMD patients structural and autonomic/parasympathetic system. Some folks are wide goal posted (not as detailed occlusally) while others are narrow goal posted (supper occlusally detailed). These are the kinds of patients we see…not the easy cases. Again, no case is the same.
But the gnatho-neuro-muscular principles (GNM) we apply and practice are what we use along with our K7 and TENS protocols following our GNM OC Optimizing the Bite protocols. THAT IS WHAT I DO. 1 CASE AT A TIME.
Please understand I am not God. I can’t cure everyone. Only our Heavenly Father can do that. All I can do is do my best. If every TMD forum member would recognize, “THERE IS HOPE FROM HEAVEN FOR YOU”. Remember, God is the great provider. Not the dentist. NO matter how great they are. God is the one who treats. He is the REAL HEALER.
(I was a former trained laboratory technician who later in life went to Dental School and studied dentistry). Today, I am passionate about this area of TMD and occlusal dentistry. I believe I have found better answers that have satisfies my analytical curiosity to better help my patients.
LIfe is a journey….we learn and meet many along the way.
– Clayton A. Chan, D.D.S. – Las Vegas, NV