DDSWally

Articles

A New Look at an Old Bite Splint

A Passion for Healing

Healing Ministry of Dentistry

PDFs

The Bicuspid Buildup as an Alternative in Phase II Treatment of Craniomandibular Dysfunction

The Biscuspid Buildup: As a Diagnostic Aid in TMJ and Muscular Dysfunction—A Followup Study

A New Look at an Old Bite Splint

For Dentists

Occlusal Screening, Tests, and Bite Splint Adjustments

How a passion for treatment can turn into a healing ministry in   the practice of dentistry

By Walter W. Niemann, DDS

Many people have often asked what makes one interested in the practice of dentistry? In olden times dentistry was looked upon as a profession that drilled , filled, and billed. As a matter of fact dentistry was part originally of a barbers occupation as he had chair for it.

The answer I received when asking about dentistry as a profession was, if you want to be a dentist you better like people and be good with your hands. I think this is still a good criteria for being a dentist. The flipside of this discussion is that dentists appointments are way down the list of things people like to do. Patients even when they come are resistant, squirming, and noncompliance rooted in their innate pain and discomfort fear usually associated with being in the dental chair.

Why would you like to be in a profession where people resist or don't want anything done to them especially in the past when they had to pay for it. Insurance has somewhat abrogated that problem since most things are paid for. Under these daunting circumstances how does one develop a passion for dentistry?

After about 10 years in practice when one has a handle on what he is doing and the associated confidence of that experience changes in practice methods do occur. A study club colleague and I decided to dialogue or personally visit with our patients before ever looking into their mouths. This was demonstrated at a practice administration lecture and two usseemed a good thing to do. The simple fact is much can be learned by merely observing a patient at a conversational much more relaxed distance in a consultation room setting.

This dialogue lets the patient know we are interested in "them" as a person not just a mouthful of teeth. This opens the door to discussing other problems seemingly not related to their mouths. Their fears, anxieties, concerns about their appearance often surfaced with some leading questions. See photograph of a typical consultation and questions.

The fact is that many patient problems or melodies are related to dental conditions like clenching grinding and evidence of tooth wear and associated facial changes and this dysformation and dysfunction. These changes also are associated with anxiety and life's vexing problems. But usually these situations are rarely discussed because patients don't usually associate medical problems with their dentist as they don't seem relevant.

This is where the dentists interest in the patient as a whole comes in with the dentists deeper professional interest and subsequent patient bonding.

An example of deeper probing could be a patient's answer to a question "do you have headaches might be no. In the dialogue the dentist may ask if the patient takes prescription medications and in the patient says no. The dentist may then ask if the patient takes aspirin or Tylenol or ibuprofen and the patient often says yes. The dentist may then ask why do you take the medication? The the patient usually says for "my headache". The dentist then responds by saying you wrote down you didn't have any headaches. The patient usually says "oh you mean those headaches". if the patient's problem is solved because no complaints. But in the process of the aspirin bottle going down he may have problems with stomach instead with chronic drug intake. this brings up the point that patients who take prescribed medication for other conditions may also mask symptoms associated with their mouths, jaws or head and neck relationships. these chronic conditions may often be associated with dental activities like grinding and especially clenching of teeth there may also be chronic neck ache problems which are being treated by a chiropractor acupuncturist massage therapist physical therapists etc. and could be dental related. This puts up a red flag and is at least a reason for a more extensive screening routinely in hygiene appointments or during the initial exam and diagnostic phase of a new patient workup. The reality is that for some years many research studies have revealed a high as much as 80% comorbidity (association) of TMJ/D (Temporomandibular joint/dysfunction) and the following conditions. Gerd, fibromyalgia, chronic stress disorder, irritable bowel syndrome, traumatic stress disorder, pelvic pain etc. etc. this fact alone is a reason for recommending a more thorough TMJ and general physical assessment including posture, had position tilted head and shoulder height hit on even mess leg length discrepancy cant of the eyes, peer level are complaining mandibular plane etc. etc. this should include palpation of the head and neck muscles chewing muscles shoulder girdle for pain and discomfort, many patients have been treated for years a plethora of practitioners in addition to their own physician who prescribed physical therapists as I addressed but additionally patients also go to their own chiropractors acupuncturists massage therapist holistic practitioners yield the sessions and all forms of therapeutic regimes not to mention holistic medications many of these are on a continuing basis with little or no reduction of the symptoms completely but continued treatments for the pain and irritation.