Hi Friends! I’m Priya Mistry the TMJ doc and today I’m going to talk to you about Phase 1 vs. Phase 2
Treatment in terms of TMJ Disorders. As you can imagine, I get a lot of questions about treatment for TMJ Disorders - what it
consists of, what order it’s done in, how long it all takes, and more! I truly hope this video helps
answer some of your questions, my friends! That being said, if you’re looking for more information
on TMJ Disorders for yourself or for a loved one, then this is the YouTube channel for you. Be sure to hit that
Subscribe button as I post a new informational video every Friday specifically for people who are suffering from TMJD!
For those of you who don’t know me, I’m a general dentist with a practice in Portland, Oregon where we are dedicated
to taking care of patients with TMJ disorders. I work here with my wonderful
mentor, Dr. Arthur L Parker. Please be sure to check out the links in the description box below if you want to hang out with
me on other social media platforms, especially Instagram! I post lots of useful information
about TMJ disorders, tips, trivia, muscle releases you can do yourself at home, and more, so if you like to nerd out on TMJ stuff like I do, be sure to check out those links!
So let’s get right into it! At my TMJD-only practice, patients present with a wide variety
of symptoms - ranging from mild jaw pain and infrequent clicking or popping to severe headaches,
jaw pain, ear pain, constant clicking and popping with pain, locked jaw, and more. For our patients, we diagnose based upon perceived
degree of difficulty with 4 levels, 4 being the highest. For more information on this,
please watch my video called “The 4 Treatment Levels”. For all 4 of these treatment levels, we
treat with custom orthotics, myofascial release, and osteopathic manual jaw manipulation as needed.
For most patients, we make both a nighttime orthotic and a daytime orthotic with the goal of
tapering our patients off of the daytime orthotic within 12-16 weeks. I’ll circle back around to WHY
we taper our patients off of the daytime orthotic a little bit later in this video. The orthotics - daytime and
nighttime - the myofascial release, and the osteopathic manual jaw manipulation are all considered Phase 1
treatment and can take anywhere from 2 months to 6 months with weekly or biweekly appointments,
depending on the severity of the symptoms. Phase 1 is considered over when our patients are symptom-free.
No more headaches, neck pain, jaw pain, or ear-related concerns, no more joint noises, and
a good, healthy range of motion for the jaw. At this point, the muscles and joints are in a healthy and functional state.
Throughout Phase 1, patients may experience changes in their bite as their neuromuscular
system adapts to the new healthy position of the muscles and joints. This position is
determined by sophisticated software and is where the orthotics position the mandible when worn.
These changes in the bite can be non-existent, they can be subtle, or they can be drastic! That’s where Phase 2 comes into play.
I want to take a moment to pause and state that at our office, we ONLY do Phase 1
Treatment. We refer out if Phase 2 Treatment is needed or wanted by the patient.
Now let’s move on to talking about Phase 2 TMJD Treatment,
which we refer out to local practitioners who are skilled & experienced in Phase 2 TMJD Treatment. Phase 2
TMJD treatment consists of creating a bite that helps to support the healthy position of the muscles and joints. This
can be done with orthodontia - braces - OR Full Mouth Reconstruction, also called FMR. Orthodontia
consists of moving teeth with brackets and wires to the healthy position of the muscles and joints.
Again, this position is determined in Phase 1. FMR - Full Mouth Reconstruction - consists of placing caps or crowns on all of the
teeth to bring the bite back to that healthy position of the muscles and the joints. FMR is a good option for patients with SEVERELY worn
down teeth from decades of clenching and bruxing activity. If Phase 2 TMJD Treatment is wanted by
the patient or needed due to drastic changes in the bite, then it is VITAL to work with a skilled and experienced
practitioner who understands the relationship of the bite to the temporomandibular joints and to muscles that surround and support the jaw.
One question I frequently get asked is: “Is Phase 2 Treatment necessary?” And my answer to that is: “If Phase 1
Treatment results in a change in the bite, then Phase 2 Treatment is likely be a good option to explore, of course
with the patient's agreement and consent." At my office, we do our best NOT to change the bite
during Phase 1 Treatment, thereby making Phase Treatment 2 optional. The way we do this is we ask
our patients to take the daytime orthotic OUT when they're eating and drinking. This allows the bite to reset
during the day when the orthotic is taken out. We also do our best to taper our patients off of the
daytime orthotic within 12-16 weeks, thereby lowering the chance of the bite changing.
Other offices will tell patients from the start to expect minor or even
drastic bite changes and that Phase 2 Treatment will then restore the bite. Each TMJD office practices
differently and there’s no clear right or wrong way when it comes to treating TMJD.
Another question I frequently get asked is if braces, or moving the teeth, will “fix” TMJD - if it'll fix jaw joint noises
and/or pain. And my answer to this is that I don’t like the idea of starting TMJD treatment with braces or with moving teeth. The reason for this
is something we call the “Tripod Effect” at my office. Our two Temporomandibular
Joints - or TMJs - and the way our teeth fit together like cogs on a gear - this system works like a tripod.
What happens when you cut off one leg of a tripod? The whole system goes out of balance. For many
of my TMJD patients, their TMJS (their Temporomandibular Joints) are already unstable when they come to see me. So that means that already already
two legs of the tripod system are out of wack. To me, it doesn’t make sense
to then start moving teeth which affects the third leg of the tripod without first
addressing the unstable first two legs - the TMJs. Stabilizing the joints & bringing the
muscles to a healthy and functional state first is what I would recommend. Once that’s done,
Phase 2 can start if it's needed to due drastic bite changes OR if the patient desires it.
To review - Phase 1 is all about stabilizing the joints and bringing the muscles to a healthy and functional state, eliminating pain and jaw joint noises and episodes of the jaw locking.
We ONLY do Phase 1 Treatment at my office. If the bite changes in Phase 1 Treatment, Phase 2 is likely a good
option to explore. Phase 2 Treatment consists of Orthodontia (braces) or Full Mouth Reconstruction (FMR)
to build the bite to a position - a very specific position - that then supports the healthy muscles and the healthy joints.
Again, this Phase 2 Treatment must be done by a skilled and experienced practitioner who understands and
appreciates the relationship of bite to TMJs and the muscles that surround and support the jaw.
So that’s really it my friends. I hope this video helped explain the differences between Phase 1 Treatment
and Phase 2 Treatments when it comes to TMJ Disorders. If you like what you heard or learned something new,
be sure to click “Like” below, Subscribe to my channel, do all the things, my friends.
As always, questions and comments are welcome. And remember, you can never have TMI about TMJ! Thank you!