JAMISON SPENCER
do anything else—BUT I NEED
YOU TO USE YOUR MORNING
REPOSITIONER EVERY DAY,
AND IMMEDIATELY NOTIFY
ME IF YOU FIND YOU’RE HAV-
ING A HARD TIME GETTING
YOUR BACK TEETH TO TOUCH.
OK?”
Here is a video of me doing
this, using the “TMJ Tutor”
from Great Lakes Orthodon-
tics, which I think is a great
tool for patient education:
The Bottom Line
First, we must understand
what is going on in the nor-
mal TMJ and with internal
derangements. I have only
gone over 1 issue here—re-
ducing disc displacements—
but that’s just the beginning
(granted, it is a very import-
ant beginning).
Second, we must be able to
understand what is going
on with our patients so we
can educate them, as well as
provide informed consent.
People with reducing disc
displacements are FAR more
likely to develop a posteri-
or open bite, BECAUSE THAT
IS WHERE THEIR JAW IS NOT
DISLOCATED!
Third, we need to reinforce
this with the patient at every
follow up.
Fourth, we need to know
what to do with the patient
who tells you that they are
no longer comfortable taking
their jaw back to where their
teeth used to touch—i.e. they
don’t want to dislocate their
jaw anymore (usually this is
due to an increase of pain,
dysfunction, headaches, etc.
if they do). I would recom-
mend you present a possible
game plan PRIOR TO THERA-
PY, and then reassure the pa-
tient that usually additional
treatment is NOT required…
but could be in their case.
Educate, consent, educate,
consent. This doesn’t end.
These things are not usually
intuitively obvious (particu-
larly to your patients). Your
colleagues may not under-
stand what is going on at all
with the posterior open bite.
They may say that the front
teeth supra erupted due to
oral appliance therapy. They
may think that the posterior
teeth were intruded due to
oral appliance therapy. But
if you discussed this phe-
nomenon with the patient
PRE-TREATMENT, and rein-
forced it at follow up with
proper questions and evalua-
tion, they will understand.
All this stuff wasn’t covered
in that 1 hour class in dental
school. So it’s up to us to learn
it now. And your patients will
be the better for it (and you’ll
be A LOT more comfortable
treating them).
Now to put you more at ease,
in my experience, even pa-
tients with a reducing disc
displacement do NOT typical-
ly have a posterior open bite
occur, IF
use an effective
. They
morning
repositioner
(by the way, all morning
repositioners are NOT
created equal),
check their occlu-
. They
sion EVERY night be-
fore bed,
immediately in-
. They
form you if they notice
any changes.
DR. JAMISON SPENCER
DMD, MS
JAMISON R. SPENCER IS THE DIRECTOR OF THE
CENTER FOR SLEEP APNEA AND TMJ IN BOISE,
IDAHO. HE IS ADJUNCT FACULTY AT UOP AND UNC.
FOR QUESTIONS OR COMMENTS PLEASE
REACH HIM AT
[email protected]