About 10 million people in the world have TMD. So, why do dentists ignore this problem? We need to think better, and today’s guest helps do exactly that. Kirk Behrendt brings in Dr. Tiffany Lamberton from TMD Collective to help you understand everything joint-related, how to be fearless about treating these patients, and finding ways to connect with the right specialists. Identifying it early is the key! To learn more about this overlooked condition and what you can do to help, listen to Episode 571 of The Best Practices Show!
Links Mentioned in This Episode:
Dr. Lamberton’s educational platform or coaching/mentorship: www.tmdcollective.online
Specialty Imaging Temporomandibular Joint and Sleep-Disordered Breathing by Dania Tamimi: https://www.elsevier.com/books/specialty-imaging-temporomandibular-joint-and-sleep-disordered-breathing/tamimi/978-0-323-87748-0
Chicago Study Club: https://chicagostudyclub.com
Look beyond the teeth.
Slow down your diagnosis.
Know the signs of airway issues.
Pain isn’t the only symptom of TM issues.
Start collaborating with different specialists.
“There needs to be a way to bring the joints into the picture more because we always are just very focused on the teeth, and how they fit together, and the bite, and the occlusion. But I always think of like, if you’re building a house and you do these beautiful front doors, you’re building this entryway, you’ve spent $40,000 on these doors and the hinges are like $3.99 from the hardware store, you may run into problems. And so, I think that as dentists, we need to have a little bit bigger lens of looking at the jaw joints, looking at the muscles of the head and neck — myofunctional therapy is really big right now. (3:20—4:04)
“I think that there are a lot of myths as far as telling people, ‘Oh, you have clicking and popping. You’re fine,’ or like, ‘Oh, your joints look like they’re really degenerated, but you’re going to be fine with that.’ I give the analogy — I have an 11-year-old and he’s an incredible skier. We were just up at Whistler. He’s doing hits, and he’s in and off the runs. If he had a bad ski injury and injured his knee, let’s say his medial meniscus, ACL, some of the soft tissue of the knee, you wouldn’t even think twice about ordering an MRI to evaluate, ‘Are we going to do PT and a brace, or are we going to do arthroscopic surgery?’ And so, I get a little bit frustrated when I start hearing so much pushback about like, ‘Well, why do you need an MRI of the TM joints? Why would you do that on someone that doesn’t have any pain?’” (7:40—8:35)
“I think especially our young female patients where they may be a little bit hypermobile, or they may have more ligament laxity, or basically where you have a series of things, maybe they had a gymnastics injury, or they fell on their chin, or they fell off the rope swing, as a dentist, or especially as a mom, you’re like, ‘Are your teeth okay? Are you bleeding? Do you need stitches?’ But no one thinks about the jaw joints. And the issue is that even if you have a little bit of displacement of the disc, that’s going to affect the growth of the condyle early in life.” (10:18—11:00)
“When you’re thinking about craniofacial defects, and as we’re starting to see different bite presentations — we used to call it cheerleader syndrome. They used to say, ‘Well, there are all these young females with anterior open bites. Maybe they’re yelling too much.’ It turns out, from talking to Jim and Drew and those guys, as we’re starting to get better tools with our modern imaging and correlating that with our clinical exam, we’re realizing that not all TM joints are normal, or not all of them are healthy, and not all of them are reaching their full growth potential.” (11:01—11:39)
“What we’re seeing is rotations of atlas in these kiddos. Even though they may not have a lot of pain, they may be starting to have other sympathetic system symptoms that are manifesting as maybe headaches or postural changes. And so, I think that what I want to manifest is this crystal ball of — so, rather than having that 45-year-old patient in my chair that’s crying because she can only open two finger widths because her jaw is locked closed after she had her restorative work, what if we could go back in time, or now, as we’re moving forward, as we’re starting to look at interceptive ortho and these kids that are younger and younger, and we’re starting to see things like crossbites, or anterior open bites, or bite changes, and postural changes, muscle changes, that’s where I think the myofunctional therapists are really our advocates because they’re looking at them in different ways. (11:59—13:03)
“I think dentistry, with how we’re trained, we’re just very focused on the teeth. I think we need to have that bigger lens of looking at things as we’re learning more and more about how all these systems work together and function in our patients.” (13:47—14:03)
“We need to start training ourselves to utilize the tools that we have available to us. I’m friends with a lot of endodontists, and I say to them, ‘Would you ever want to do molar endo without your microscope, without your GentleWave, without your CBCT?’ And they’re like, ‘No! I could never go back!’ And so, I think that when you start seeing things like in the airway world, if you start seeing that kiddo that has the tonsils that are kissing on the midline, or you see the kiddo that can’t even lift their tongue from the floor of the mouth, or you see that mismatch between the maxilla and the mandible of the growth and development, once you start seeing those things and start to look through that bigger lens, I think you just can’t unsee it.” (14:21—15:11)
“Airway dentistry is really amazing. I think the paradigm is shifting where there are a lot of dentists that are getting excited about airway and realizing that the oropharyngeal airway space is really our jam, and we can impact that, especially in these young kiddos. But I want us to think more than just putting in a mandibular advancement device, because I do think that back when I was starting to delve into the sleep and TMD world, if you start to change the position of the jaw, you realize that you need to know what the condition of those joints are before you start doing that. Because if the patient ends up having maybe some subpar outcomes, maybe they have some bite changes. Maybe they start to have clicking and popping of their joints. Maybe they start to have pain. You want to know what your starting point is. And I think that that’s what I really want to emphasize . . . is really, in the beginning, let’s slow down to get the diagnosis.” (15:28—16:40)
“I think with dentistry, we’re so quick to jump to like, ‘Okay, this is a great case! I can really fix these things. I can change your bite.’ But you’ve got to know that those joints are stable. So, no matter what your treatment proposal is, whether it’s ortho, whether it’s a referral to an oral surgeon, whether it’s restorative dentistry or equilibration, my message would be, let’s slow down and let’s look at all those three points of the triangle.” (16:41—17:12)
“I don’t want us to forget about the joints. Because, like I said, those are the hinges. And if those break or aren’t functioning properly, you’re going to really start to see show it affects other parts of the system. You’re going to start to see how it affects the neck and the cervical spine. You’re going to start to see how, if you start looking at your patients, their sternocleidomastoid, or maybe they have a torticollis in their neck, or you start to look at how they’re holding their body or how they’re moving. And so, I think that we can’t leave those things out. As a general dentist, I think we’re perfectly positioned to be the leader of the team and to really be bringing all these different collaborators into our orbit. And so, I want to encourage — don’t be afraid of that.” (17:33—18:23)
“Our friends in the oral and maxillofacial radiology world, we’ve got to be talking to them. They’re taking those big, full-field of view CBCTs that look at airway and upper cervical and the TM joints. I always do an overread with my OMR. They’re an important part of my team. Even though I know a lot, I want to make sure that I’m not missing anything.” (18:53—19:18)
“Back in the day, we used to think that splint therapy was the only thing. I don’t know if you had a patient like this where you made an appliance, and they’re like, ‘Oh, it’s great! It’s wonderful!’ Then, they come back like six months later and like, ‘Augh, I’m having all this jaw pain again.’ And so, you adjust. Or maybe you have your assistant come in and adjust. And then, you’re like, ‘Oh, no! She’s back!’ She comes back six months later and, ‘It’s broken.’ And so, again, I think that whatever type of appliance you’re doing, just knowing what your starting point is really gives us that prognosis discussion, and it really lets us tell our patients like, ‘This is your anatomy.’ I tell my patients, ‘You want to own your anatomy.’ Because no matter what you do, if you didn’t tell them about it ahead of time, it’s your fault. Because you did that crown, or you did that splint, and all of a sudden, it changed everything.’ (19:47—20:49)
“I think myofunctional therapists have really jumped on that virtual model as well [during COVID-19]. And so, even if you don’t have someone right down the street from you, or you haven’t hired one, I would say, as a dentist, first of all, talk to your team. Who’s excited about this? Who wants to be certified? Or sponsor someone to get certified. One of my colleagues in the Chicago Study — actually, a couple of the female dentists there have paid for a person on their team member to become a myofunctional therapist. I’m like, ‘Yes!’ Or look into big networks. Social media has some incredible myofunctional therapy communities. The Breathe Institute is incredible. There are a lot of different ways to connect virtually as well. Find out, is there a myofunctional therapist that is an outstanding rockstar in their right that would take virtual appointments?” (22:34—23:40)
“The crushing debt of dental school, we’ve got to figure out a way to not let that be an anchor and limit how we think and how we practice.” (25:54—26:04)
“If you’re interested in doing this, do a fee-for-service model style of practice. And even if you have a restorative practice, Dr. McKee always says, ‘Just pick out three patients that you’re going to work up this way this month.’ Or maybe two. Do that slow process of gathering all your records, your photos, your digital scans, deciding after you’ve taken the clinical history, are there enough check marks that you’re thinking like, ‘I think that this person may have some issues’? whether it’s pain, or jaw deviation, maybe limited range of motion, maybe headaches. Or maybe in this young kiddo, you’re seeing these bite changes and you’re seeing growth patterns that, there’s that mismatch between the maxilla and the mandible, or you’re seeing some concerning things about how it’s not just about getting the teeth to fit together, it’s also how are they growing.” (27:08—28:13)
“The NIH tells us 10 million people, worldwide, have TMD. Females are twice as likely as men to have it. And my question is, why are we ignoring this? Or why are we waiting until they have pain or problems?” (29:05—29:21)
“As a dentist, we can’t be fantastic at everything. But we can bring people into our orbit that have that different lens. And then, that pushes us forward in our learning.” (29:45—29:56)
“When you start to understand modern imaging and how that correlates with our clinical exam, all of a sudden, it’s not scary anymore because you know exactly what’s going on, and you can tell the patient, ‘Hey, instead of this beautiful ice cream cone, your condyle looks like a high-heeled shoe because you have this really degenerative condition.’ And so, I think that really, with our young patients especially, if we’re starting to see changes with their growth that are concerning as far as that mismatch between the jaws and with the cervical spine, that’s when we can really make the most difference to these young kiddos.” (33:55—34:41)
“Do Pilates. I’m a huge proponent of Pilates. I think as dentists, you’re in these terrible postures all day. You’ve got to find a way to preserve your spinal mobility. I was listening to a couple other podcasts where they’re like, ‘You’ve got to be able to practice and take care of your body for the next 20, 30 years.’” (34:54—35:18)
“Stay humble, stay curious, find your people, and do Pilates.” (36:04—36:08)
1:31 Dr. Lamberton’s background.
6:49 What dentists get wrong.
14:05 Look through a bigger lens.
15:13 Don’t forget about the joints!
19:18 Know your starting point.
21:19 Connect virtually.
24:13 Slow down.
28:40 Why are we ignoring TMD?
30:01 Build a practice with what you enjoy.
31:42 More about TMD Collective.
34:49 Last thoughts.
Dr. Tiffany Lamberton Bio:
Dr. Tiffany Lamberton is a Washington native who has dual degrees in both Physical Therapy and Dentistry, both from Loma Linda University. When she graduated with her DDS degree, she was also inducted into the Omicron Kappa Upsilon National Honor Society and received awards in Oral Pathology and Leadership. She currently has focused her practice on evaluation and treatment of Temporomandibular Joint (TMJ) Disorders and is available for New Client appointments via her website www.tmdcollective.com. She will be a speaker for the Pacific Northwest Dental Convention and is delving into the educational world speaking about TMJ, Airway and Myofunctional Therapy. She is a member of the ADA, WSDA, and is a Pierce County Dental Society Board Member. She is also a member of AOMT and the Chicago Study Club. Dr. Tiffany considers herself a life-long learner! She lives in the North End of Tacoma with her husband and two children, and enjoys snowboarding, wake surfing, and Pilates.