Our practice focuses on the diagnosis and management of Temporomandibular Disorders (TMD), Facial Pain and Idiopathic Tooth Pain (which are principally Neurogenic Pain or Neuralgias) Sleep Apnea (OSA) and Snoring. Because of the higher incidence of TMD problems in the general population, these patients represent the majority of our practice. We average between 2 and 4 new TMD patients daily. We treat 2 to 4 OSA patients per week and because the neurogenic pains are much less common, we probable see 1 to 2 a month. The practice relies upon 3 guiding principles. The first is basing our diagnosis and treatment on scientifically validated concepts. The management of these problems (especially TMD), has historically been fraught with unscientific and quasi-scientific approaches, that mislead the public, wasting time and money and frequently resulting in unneeded treatment and at times, iatrogenic injury. We confine our procedures to those therapies that are cost-effective, eliminating excesses in diagnostic and treatment modalities that have no impact on patient outcome and only result in higher costs. For example, we do not use invalid diagnostic tools such as electromyography, kinesiology and sonography, which typically provide data that has no therapeutic value.
Our second treatment principle dovetails into the first and that is to be cost-effective. A major problem with health care in this country is the burdensome costs that accompany its admired competency. Recognizing that the chronic trend in health care coverage is for insurers to eliminate procedures that were once covered and to increase patients' out of pocket expenses for covered procedures, health care providers need to minimize their role in the insidious collapse of the industry. As fellow consumers, we are acutely aware of the desire to spend our discretionary dollars on competent and cost-effective measures, in both medical and non-medical endeavors. As an example, our practice sparingly utilizes sophisticated joint imaging (CTs and MRIs) because the information gained, though impressively detailed, rarely impacts therapy. Towards this end, this office confines diagnostic and treatment modalities to those most likely to effect a positive patient outcome. With respect to treating Snoring and mild to moderate Sleep Apnea, an oral appliance is more cost-effective and user friendly than CPAP and yields more predictable results than the eclectic assortment of surgical therapies. Although it is common for the public to be uncritically passionate about technological advances, the value and appropriate application of these modalities requires a judicious assessment of accuracy and effect on therapy. Most new technologies are very costly and this financial burden requires that the modality be frequently utilized in order to be cost effective. This places significant pressure on practitioners to over use the modality. Examples of this include digital imaging (3D C-Ts, MRIs), in-office dental crowns, etc. These situations are not unique to dentistry and exist in medicine and other fields. Newer is not always better.
The third and final practice principle involves our focus on conservative and reversible therapies. This approach is prudent because of the many recognized gaps in TMD understanding (for example, the cause of most TMD problems is unknown), the superior success of conservative treatments and the poorer success of invasive therapies such as splints that change one's bite, NTI splints, orthodontics, TMJ surgery and occlusal adjustments (equilibrations). Valid invasive therapies are utilized in our practice, (i.e. TMJ injections, arthrocentesis and TMJ surgery), but only after thorough attempts at conservative therapies have yielded an unsatisfactory outcome and the patient has a problem that is likely to benefit from more aggressive management.
TMJ, Facial Pain and Sleep Apnea Therapy and Research Center, Inc. All rights reserved.