The TMJ Iatroepidemic
Unintentional Confessions of a Profession

Webby & Chang

First Edition

BrierNet,  San Diego, California

This book is dedicated  

to

humanity

 to every person who has been or will be a patient

to the professional people

who seek the ways to ease suffering

for ... the quality of medicine depends upon

humility, compassion and knowledge

the good of humanity depends upon us all

dignity belongs to us all

and this book is for everyone

Table of Contents

Chapter One
  What are Iatroepidemics?
9

Chapter Two
  What is Netcanting?
17

Chapter Three
  Venturing into the Unknown of Usenet
33                                            

Chapter Four
  The Book of Numbers                                              53

Chapter Five
  Establishing Medical Truths
121

Chapter Six
  See No Evil, Hear No Evil, Speak No Evil
197

Chapter Seven
  Ugly but Important Discussions
227

Chapter Eight
  The TMJ Iatroepidemic and the Harm it Causes
325

Chapter Nine
  The  Nine-Hundred Pound Gorilla
365

Chapter Ten
  Hope Against Hope
369

Appendix

  List of Subjects and Netcantings
395

  Glossary
405

  Index
411

About the Authors and this Book

From:  Webby & Chang
RE:  About this book
To:  The public
Distribution:  Worldwide

As the authors of this book, we have reason to believe that the dental
profession and the US government are ignoring and thereby protecting
the existence of a serious iatroepidemic.  This public health concern
is reported to affect tens of millions of innocent Americans.  It
appears that this iatroepidemic has been designed to promote the
statistical growth of this patient population. The very suspicion of
such dispicable conduct, for reasons known only to those in control,
is unthinkable.  

This book tells a shocking and true story.  Questions must be asked.
Are the dental profession and the government choosing to ignore such a
possibility?  If this is the case, such atrocious conduct is nothing
less than criminal.  You, the reader, will see why the public must
demand investigations into this matter.  If you ever visit a dentist,
you are at risk of becoming one of the tens of millions of innocent
victims.  You may think of TMJ as a minor problem.  This book will
offer you the opportunity to see its many complex issues and your
opinion will probably change.  

The authors hold firm in their belief that a {*filter*}  to protect
the professionally sanctioned iatroepidemic exists.  You probably do
not know what an iatroepidemic is, but you will learn.  You may wonder
why the public should bother to care so much about a condition they
probably do not even have (yet). You will learn that too.

Public online discussion forums known as newsgroups in Usenet are
accessible to anyone with a computer and an online connection almost
anywhere in the world.  Most people do not have this sophisticated
type of equipment.  For those who do, this other dimension of OUR
world is a very real place.  As it was with telephones, televisions,
and automobiles, people will slowly add these new high-tech tools to
their lives.  If you listen to radio, watch tele-vision, or read the
newspapers, you have probably wondered if you are the only one left on
the planet who is not on the internet.  Rest assured, most people are
just like you.

This book represents our contribution; a new genre in nonfiction
literature which we call, Netcanting.  Genre means a category of
artistic composition, as in music or literature, marked by a
distinctive style, form, or content.  We developed Netcanting in order
to meet the needs of a public that may or may not know anything about
the internet, Usenet, or computers.  What is happening on the net or
in Usenet should not remain a mystery when the subject matter is of
public interest.

We, the authors, consider ourselves to be theorists, {*filter*}nauts, and
writers.  We are convinced that it is our duty to share the findings
of our expeditions into {*filter*}space just as the explorers did for
mankind in previous centuries and as our astronauts do today.  This
book documents our expeditions. Through Netcanting we have been able
to expose some of the reasons behind what is believed by many to be
TMJ patient-manufacturing an element of the unidentified TMJ
Iatroepidemic.  

As you read this book keep in mind that its purpose is to examine some
of the endless mal-effects of failed practices.  Our intention
through this work is to expose a sampling of those harmful effects as
an attempt to influence the speed of a process known as decay
(discussed in the pages ahead).  Once  these tragically harmful
outcomes are known to exist (because of this book) one can only ask
how long anyone can pretend they do not?

Warning-Disclaimer

The issue of  Usenet privacy has been discussed in many newsgroups
within the Usenet Hierarchy.  Usenet is a publishing venue, perhaps
one of the most powerful and versatile that the world has ever known.
Using Usenet, an individual with Internet access can make his or her
views known to millions of people worldwide almost instantaneously.
Usenet authors need not belong to any particular intellectual elite to
get their opinions across to a large number of people. The age-old
method of debate is very much the rule on Usenet.

The advice to those accessing Usenet has generally been lurk (read)
before you leap (post). When publishing something in Usenet, writers
must accept that their words can be seen by anyone.  We feel that
users of the Usenet system should seriously consider the
responsibilities of using their real-world names. The content of
Usenet is in the public domain. Information posted on the net can come
back to haunt you or the person you are writing about.

This book represents a new genre in literature which we call
Netcanting. No part of this book is intended to serve as medical
advice.

The authors of this book have intentionally not corrected grammatical
and punctuation errors because of the very nature of Usenet postings
and a simple rule of courtesy that says most of us are intelligent
enough to figure out what the other person was writing.  Great effort
was placed on maintaining the original writings while attempting to
keep the material as readable as possible.  Countless hours went into
the editing of this book.  Its our belief that you as the reader will
eventually read these writings just as easily as those involved in the
original discussion did.

As you read the various chapters in this book you might see some
material quoted from writer to writer within a particular subject.
This redundancy was neccessary to maintain the original record held in
the various archives on the internet should you the reader care to
research the original postings.  In a few instances there are
imperfections in the hyphenation process which result from text
complexities involving the internet.

*Taken in part from the DejaNews Archive Website www.dejanews.com

The decision to write this book, The TMJ Iatroepidemic, Unintentional
Confessions of a Profession,  was as agonizing as it was exciting.
About ten years ago, I was introduced to the work of  Eugene D. Robin,
M.D.,  Stanford University professor and physician.  His book titled
Matters of Life & Death:  Risks vs. Benefits of Medical Care, first
published in 1984, was initially written for doctors.   Because of its
favorable reception, Dr. Robin decided that his teachings might be
useful to nondoctors as well.  His committment to medicine is
unquestionable.  Dr. Robins position with regard to his book, Matters
of Life & Death,  was that people, as patients, can minimize the risks
of modern medicine if they are taught about the existence of certain
flaws that are presently a part of the system of medicine.  

What is an iatroepidemic?  So that there is no misunderstanding I
shall quote from Dr. Robin who wrote in his book:  Iatroepidemic is a
term I have coined to denote an epidemic, or plague, caused by
doctors.  Like iatrogenic it derives from the Greek (iatros=doctor,
epi=on, demos=people). Iatroepidemics develop because of systematic
errors incorporated into medical practice.  The application of these
errors to masses of patients results in harm or death to large
numbers.  Unlike iatrogenic episodes, which are random and accidental,
iatroepidemics are systematic and their causes are predictable and
therefore potentially preventable.

It was because of the value of his work that I was determined to
pursue the identification of the TMJ Iatroepidemic.  Although Dr.
Robin may not remember our conversation of so many years ago, I
promised him that someday I would find a way to identify the TMJ
Iatroepidemic.  I remember his reply as though he spoke the words to
me today.  He asked, Why is it I have no doubt you will?

I believed then, as I do now, that  the cause of a significant
percentage of the TMJ crisis is due to an iatroepidemic which has not
yet been recognized.  My committment was to find a way to spare some
57 million or 20% of our American people from becoming part of an
unnecessary patient population.

How could one woman manage this challenge?  It could not be done by
one woman.  Many of you might wonder if this iatroepidemic is simple
enough for a nondoctor to describe, why then havent the doctors
described it?  Thats a very good question and one that is

addressed through the discussions in this book.  For me to have reason
to believe that certain TMJ conditions were occurring as a result of
systematic errors applied to millions upon millions of people is not
good for much.  I had to find a way that would allow for the
profession to describe its role in the iatroepidemic. The ability to
enter into discussions with mainstream dentistry seemed impossible.
But it proved to be possible afterall.

Something miraculous happened in early 1994.  I began to read more and
more about the coming of the Information Superhighway.  Of course, I
had no idea what that even was, but it sounded fascinating.  I had an
immediate sense of encouragement that this new computer information
resource would lead me where I needed to go.  That was three years
ago.  Three years is not very long in real time.  But in {*filter*}space,
the clocks tick differently.  Three years is like an eternity.  Three
years ago is like stepping back an entire century.  {*filter*}time is our
new time.  And the impact of the internet upon the development of
medical knowledge proved to be the newest unknown.  {*filter*}space, the
internet, Usenet... what does this technology have to do with the
cause of iatroepidemics?

Although Dr. Robin was convinced that new technology used in medicine
would increase the risk of iatroepidemics, I dont think he could have
predicted this book.  In the 1980s, I doubt anyone could have
predicted the impact of the publics use of the internet, the
Information Superhighway,  upon society.  Could anyone have predicted
its impact upon the health of our society?  This book is about many
things. Above all, it is about the significance of the identification
of the TMJ Iatroepidemic and about shared responsibility in this age
of the information explosion.

Several specific characteristics are common to all the identified
iatroepidemics.  Those features, generally fall into five distinct
transitions. As such, they were applied to the potential
identification of the TMJ Iatroepidemic, and were explored in Usenets
newsgroup, sci.med.dentistry, over a period of more than two of the
three years devoted to this {*filter*}space expedition.  The topics you
will read about in this book represent a fraction of the thousands
which exist.  These subject lines and threads (discusssion) were
selected because the authors felt they best described the attitudes
behind the features characteristic of this serious public health
problem.

Those five points are listed here and accompanied by a short
explanation following the asteriks ( * ) from co-author, Sabra Broock
(Webby).  The comments serve to offer readers a glimpse into how she
so easily became a victim of this tragic iatroepidemic.  The balance
of the book is devoted to a more in-depth look at the catastophic harm
which can happen to anyone.  

Webby would not have become a victim if not for having trusted her
good friend and family dentist in 1981 who convinced her that a bad
bite would lead to the destruction of her healthy jaw joints.  This
tragedy never should have happened, but it did.  Because of that, she
has devoted her life to promoting awareness of the harm that can come
from a fundamentally unsound idea that was introduced into practice.

1.  A fundamentally unsound idea or one with poorly interpreted
experience is introduced into practice.

* The dentist convinced the healthy subject that dentistry knew the
cause for a terrible problem that deteriorated the jaw joints leaving
people to suffer a lifetime of terrible pain caused by a preventable
but otherwise untreatable condition.  

*  There was no known treatment for deteriorated jaw joints or jaw
joint pain.

* The cause of the disease was known by dentistry to be due to an
imperfect bite (occlusion) and dentistry had the means to prevent this
terrible condition from developing in people without symptoms.
Prevention was only an option for those without symptoms.  

* The subject (patient) trusted the dentists professional advice.

2.  The practice (diagnostic and treatment) took hold without adequate
study as to the safety or efficiency of the practice and then
developed a life of its own.  

* The practice of treatment based on preventing TMJ conditions began
with the unproven theory that occlusion (the way a persons teeth come
together) was a causative agent for disorders affecting the jaw
joints.  

*  Asymptomatic patients had the least to gain because they had no
problems and the most to lose.  The benefits of the treatment were
emphasized and the potential risks were minimized by the dentists
(dentist-orthodontist and maxillo{*filter*} surgeon) who promoted the
practice.

*  This practice was encouraged because of the widespread public
acceptance that preventive medicine was part of being a responsible
person.  Taking care of oneself is closely linked to the theory of
Doctors as God in the modern world.  If people do not take care of
their bodies, they are thought to be irresponsible and their future
suffering would then be due to their own irresponsibility.  A person
who failed to heed the dentists advice to prevent such suffering was
a foolish person and one who was disrepectful of the quality of life.

*  In the case of preventing jaw joint disease, the symptom-free
candidate patient would need to be convinced that prevention was not
only possible, but it was the patients responsibility to take care
of the potential problem before it developed.  The point of closing
the deal between the dentist and the person (soon to become a patient)
came in the form of applied guilt.  

3.  A group of experts supported  the practice which in turn
encouraged its continued application.

*  Two types of specialists in dentistry, the orthodontists and the
maxillo{*filter*} surgeons, supported the practice of preventing TMJ in
people without symptoms by making the bite correct through a
combination of orthodontic correction and jaw surgery.  The
orthodontists and maxillo{*filter*} surgeons encouraged this application
of treatment. (There are many other disputed causes and treatments
which apply to other areas of the dental profession.)

4.  The reputations or positions of the experts partially depended on
the practice they encouraged.  When the practice was challenged, they
leaped to its defense, which caused changes to come slowly.

*  The jaw surgery failed to prevent deterioration of the jaw joints.
In fact, the surgery caused massive destruction to the jaw joints,
{*filter*} muscles, and injury to the {*filter*} nerves but was not identified
at all for four{*filter*} months post operative.  

*  The surgeon denied any problems with the surgery that could have
caused such complications.  The orthodontist agreed.  They defended
the practice as being routine in their specialties.

*  Multiple surgical opinions over a course of four{*filter*} months all
agreed that there was nothing physically wrong with the patient and
that the treatment had been performed correctly simply because the ...

read more »

From:  Webby
RE:  Venturing out into Usenet 1994
To:  The public
Distribution:  Worldwide

My primary preparation for dealing with the Usenet environment came
from a resource book written in 1994 by Bryan Pfaffenberger titled,
Internet in Plain English. The most important things I learned in
the interest of personal survival on the internet (specifically,
Usenet) from Mr. Pfaffenberger should be shared with you, the reader.
Excerpts of his definition of Usenet are:  Usenet is best described
as an experiment in controlled anarchy; it has no central
administration, no governing body, and no formal sanctions to
administer in case of abuse. ... Usenet freely reflects the character
of the male dominated user communities from which it has grown --
meaning in short, that a Usenet user may encounter unfettered
controversy, expletive-ridden language, and male oriented {*filter*}a of
every possible kind.  Women who try to bring a different perspective
to Usenet discussions sometimes find themselves hound-
ed off the net by e-mail bombings, flames, and outright {*filter*}
harra-ssment, and prefer to do their networking in closed, all female
systems (such as the Houston-based Starfleet Ladies Auxillary and
Embroidery/Baking Society).

I realized that venturing into this unknown of Usenet would require
great patience and understanding of the {*filter*}place that had been
described.  First, a male-dominated environment rooted in the
computerworld.  Second, the need to establish a working dialogue in
the newsgroup named sci.med.dentistry was bound to be male-dominated
simply because it was rooted in the profession of dentistry.  And
third, the plan to take a fresh look at the TMJ crisis, absolutely,
involved the need to introduce a new perspective to the discussion!
Everything that was warned of happening to women, happened to me.
But, I knew that gender was not the whole of it.  TMJ, as an issue,
was far more the unwelcome guest than I as a woman.  It was more than
a gender issue and I went there very well prepared for that.  Mr.
Pfaffenbergers description could not have been more on target.

From:  Webby & Chang
RE:  Usenet Culture 1997
To:  The public
Distribution:  Worldwide

Although Usenet is a culture of its own, it is quite the reality that
specific newsgroups have their own cultures too. They are  the
subcultures of Usenet.  How all of this affects our societies on and
off line takes some time to ponder.  That is something which should be
done when there is little else to cloud your mind. Ponder it when you
are alone with your  thoughts ... when the lights are out... and you
have few distractions.  A great deal of thought goes into the content
of whatever we post (which includes the reasons for the potential
ramifications of our actions).  To function as a Usenet society,
social and technical skills are needed.  An example of a technical and
social skill combined might be the so-called killfile option.  It is a
technical tool used to delete what a reader does not wish to view but
for most people, its use requires a human decision somewhere along the
line.  So with a stretch of the imagination, one could almost
reasonably argue that it is also a social skill employed to avoid
unwanted interaction with others in Usenet.  

TMJ has a culture of its own too.  Webby & Chang study what others
teach us about that culture and they also teach others about that
culture through their contributions to Usenet and now through this
book.  Admittedly, our style sometimes resembles forced-feeding but,
because we believe in the value of what we are doing, the technique
serves a good purpose in our eyes.  A serious information famine has
plagued the people for too long.  Food for thought is the feast we
serve.  That further complicates the problem of taking cultures from
the real world into a culture such as Usenet and further into the
subcultures such as sci.med.dentistry.  Those who are quick to use
that killfile technique may miss out on learning how to survive the
online version of the TMJ culture as well as the one in the real world
(offline).  There is a civil war going on in Usenet and few realize
they have walked right into it until they are caught in the crossfire.
We have often encouraged people not to overlook or underestimate the
value of lurking ... because Webby & Chang have another net acronym on
their list:  YSHLL.  (You should have lurked longer.)  We are
well-known to have some mean junk yard {*filter*}-dogs which are best left
sleeping.  That has come to be part of the Webby & Chang culture and
as such, it is another subculture.

We are looking for ways to bring about changes so that the people of
the TMJ culture will not be in the line of fire as they have been for
so many years.  This place, sci.med.dentistry, is much more serious
than many expected on arrival. Suffice it to say that we have had good
reasons to do things differently there than what is done elsewhere on
Usenet.  The reasons may be too deeply hidden in the TMJ Culture for
some to grasp.  A study of that culture should reveal much about the
people.

Taking time to understand the culture and the subcultures of these
people on and off line is particularly key to recognizing some of the
dynamics of this iatroepidemic.

Something about the significance of Usenet writing styles

Usenet currently has about 28,000 separate newsgroups.  The name of
each approved and created newsgroup designates particulars related to
the type of discussions a person could anticipate in any particular
group.  If a user wishes to locate a newsgroup for discussions about
dentistry, there is only one such group (out of the 28,000 or more) on
the entire Usenet system.  The name of that group is
sci.med.dentistry and it is the resource for the focus of most of the
work in this book.

How does a person know what kind of writing style to use in any
particular newsgroup?  Whether or not most people posting articles
give any thought to their writing style is not the issue.  How we
interpret and respond (called a reply) to what others write becomes
the issue.  The technique used in Usenet for discussion development
has its own style.  A person will write something and submit it as a
post to a newsgroup.  Other people will be able to read this post and
each reader then decides if or how to reply.  If a newsgroup has
one-hundred current articles, readers will have much to read and many
opportunities to reply, or to contribute a new subject line
altogether.  Normally, a person who wishes to reply to a post will
save a portion or specific portions of the previous article which
serves to either refresh readers memories as to what was written or to
use for the purpose of direct reply to those selected comments.  The
process does not encourage others to think carefully about what was
written and as a result of such thinking to then submit a new essay
about the same idea from a different perspective.  It seems that a
study group like sci.med.dentistry would do well to consider  how they
use the forum for study.  (More on this subject follows in the section
below:

Something about Webbys style of writing)

Writing gives people an opportunity to express themselves through the
use of words and ideas.   Writing, as an opportunity for personal
expression,  can place the writer in a powerful position.  Usenet, is
probably the most versatile and powerful publishing venue the world
has ever known.  What is written by an author and posted to Usenet is
generally referred to as an article or a post.  Usenet newsgroups are
normally thought of as discussion groups but very often writers will
comment about what was said rather than what was written.  

This sometimes ambiguous use of net-terminology gives rise to various
issues concerning the interactions of users in the Usenet forum.  As
people are composing their thoughts for an original subject line post
or in reply to one, do they feel as though they are writing or
speaking?  Does this matter?  The written word has a lasting value
that unrecorded spoken words do not.  Most of the contributing authors
in sci.med.dentistry appear to reply to Webby and Chang as though
their words will be lost forever to the obscurity of Usenet.  As far
as we know, almost nothing posted to Usenet (net news) has ever really
been brought to the attention of the outside world.  This book is our
attempt to make Usenet useful in the real world through the process we
call netcanting.  

About netcanting

What do the authors of this book take into consideration about  the
term discussion as it applies to Usenet newsgroups?  Our understanding
of the term has passed through many stages over the past three years
because of our experiences, and because of our willingness to attempt
to interpret the meaning of the various discussions or the lack of
discussion.  This understanding came about mostly because we needed to
develop a valid sense of what we did and did not understand about the
meaning of discussion if we were to be able to achieve our work for
this book through netcanting.  By way of netcanting, we have defined a
new literary environment where additional essays can be written and
shared upon the reflection of what the writer found to be the final
focus of certain ideas.  These essays do not appear in Usenet; rather,
they are published in this book  to create netcanting.  At the
conclusion of each chapter, the section called Netcanting includes an
essay written by ...

read more »

Newsgroups: sci.med.dentistry
Subject:  TMJ needs clear definition
Date: 1995

Im thinking that for the purpose of discussing questions about
conditions called TMJ or TMD in this newsgroup, it might be
helpful for there to be guidelines up front so that we dont step all
over each other trying to raise issues only to find that we arent
even discussing the same point.  Has this been done?  If so, could
someone send me a copy?  If not, is there any interest in doing this?
Any interest in discussing the need for this even if no one wants to
actually come up with a clear guideline for reference?    

For instance, if we want to discuss some aspect of TMJ conditions,
wouldnt it be helpful for us to have clarification of which
condition?  TMJ conditions can range from the very insignificant to
the most debilitating.  We cant apply one set of rules to all the
conditions that affect jaw function.  That is what the health
insurance companies have tried to do (with quite good success).  TMJ
should not be used as a diagnosis.  More correctly, it is a general
heading for certain related disorders caused by a variety of related
and unrelated situations.  

I am hopeful that there can be some meaningful exhange of thought on
this subject.  Its an area that has caused a great deal of confusion
for patients, their access to health insurance, and in general it has
created an obstacle for people in their quest to make good decisions
about their health needs.  I would prefer to see this discussed in the
newsgroup, but of course replies may be emailed to me as well.

Regards.

Sabra
www.tmjfound.com    ( No replies followed )
_____________________________________

Newsgroups: sci.med.nutrition
Subject: Severely limited jaw function
Date:  1995

Are there any registered dieticians who would like to discuss the long
term dietary needs (physical, social, emotional) of individuals who
have lost nearly all normal jaw function due to temporomandibular
joint destruction and related conditions?

Please see our WWW site in case you might like to contribute to that
project as well as in this newsgroup.  Replies would be appreciated in
either forum.  Thank you.

Sabra
www.tmjfound.com    ( No replies followed )
_____________________________________

Newsgroups: sci.med.dentistry
Subject:  Difficult Airway Intubation and TMJ dysfunction
Date: 1995

The Medic Alert Foundation had planned to offer a special service to
people within the U.S. who are known to have difficult airway
problems.  It was initially thought that the affected population was
less than 3%.  They have reason to believe that the actual population
may be significantly less than predicted and because of that, they may
need to abandon the project which had been planned for completion
later this year.

The TMJ Foundation has worked in cooperation with the Medic Alert
Foundation in the past and is pleased to be of assistance in another
worthwhile cause.   We have offered to help in finding ways of
reaching the people who need this kind of remote access health
service. Our goal is to bring this situation to the attention of the
professionals and patients who know they have seriously compromised
airways due to  conditions of the temporomandibular joints and/or
supporting structures.

If there are any surgeons in this newsgroup with patients who have
very special airways problems, please contact Lisa Howard at the Medic
Alert Foundation:  1-800- 863-3424 for more information on their
Difficult Airway Project.

This life saving service is of great importance to the people who need
it.  

Thank you for your assistance.

Sabra
www.tmjfound.com    ( No replies followed )
_____________________________________

Newsgroups: sci.med.dentistry
Subject: FDA TMJ Implant Update for Consumers
Date:  1995

The TMJ Implant crisis continues to haunt the very people they
(implants) were intended to help.  The most recent FDA Consumer Update
regarding this situation is available on our Web site.  To go directly
there:   http://www.***.com/ ~sbroock/fda.html.

In truth, few dental practitioners will have had personal experience
with patients affected by this tragedy that has been described as a
national atrocity.   However, professionals claiming ignorance is of
little comfort to the patients left holding the bag.  The power to
heal and the duty to do no harm are yours.  Read this report and
remember the lesson.

There seemed to have been alot of people at various posts asleep on
the job for this disaster to have gotten so far out of hand.
Comments?

Sabra
www.tmjfound.com    ( No replies followed )
_____________________________________

Newsgroups: sci.med.nursing
Subject: Hospital nurses caring for TMJ/Jaw Surgery Patients
Date:  1995

Our organization would like to hear from nurses who have had  pre
and/or post op  experience with patients undergoing surgery on the
temporomandibular joint(s) or maxillo{*filter*}-orthognathic surgery.
Because these surgical procedures are not very common, patients
frequently encounter nurses who have trouble understanding their
special needs related to pain, communication, nutrition, as well as
various psychosocial considerations.

It would be nice to see some discussion regarding experience, or the
lack of it, in this newsgroup.  Of course, I welcome any email
directly to me.  We would like to help the people who will be there to
help us better understand our concerns from the patient perspective.
And it never hurts to have a two way street... what are your concerns?

Regards,

Sabra Broock
www.tmjfound.com    ( No replies followed )
_____________________________________

Newsgroups: sci.med.dentistry
Subject: TMD how do dentists recommend no further treatment
Date:  1995

There are so many people writing into this newsgroup with chronic TM
disorder symptoms.  At the TMJ Foundation we have received requests
over the years from people who desperately need to know how they can
know if they should simply live with their condition and stop
seeking solutions.

This is a complicated question for some fairly obvious reasons.  Some
that are not so obvious might relate to a general public attitude or
belief that modern medicine should be able to treat almost (and thats
where the problem lies) any health problem.  People want and need to
believe that to be true.  But, in this TMD arena, people have been
faced with an additional problem of self-professed TMJ experts...
always believing that another one, with more wisdom, will be better
qualified to diagnose and treat them.  Obviously, the ADA needs to do
something about the lack of a recognized subspecialty for the care of
these conditions to improve public confidence.  This lack of public
confidence is at the root of people on the merry-go-round that never
stops.  There must be a point where acceptance of a given condition
occurs without the patient feeling as though the doctor actually said
that there is nothing wrong.  That is quite different from there is
nothing more we can do.  

However, when people are faced with financial ruin from medical bills,
a lack of health insurance, the loss of jobs because theyre forced to
make medical visits the priority (or else?... or else they wont get
better) and the Americans with Disabilities Act doesnt recognize TMD
as a legitimate disability.... well, the list is long and growing.
There are many diseases that cause people to live with chronic pain...
and they do find that they can live with it.  Such is not easy, and it
is an unpopular goal, yet sometimes it is realistic and in the best
interest of the one suffering.  Compassion is required.

Would anyone care to comment on how the problem of approaching the
reality that sometimes nothing more can or should be done *to* a
patient.  I prefer discussion to be in the newsgroup, but you may
e-mail me if you wish.  

Regards,

Sabra Broock
www.tmjfound.com
_____________________________________

Newsgroups: sci.med.dentistry
Subject:  Re: TMD how do dentists recommend no further treatment
Date:  1995

Sabra,

Dentists should be prepared to tell patients HOW to deal with it.
This  means referrals to pain centers, psychotherapists, physical
therapists,  biofeedback (behavioral) therapists, substance abuse
centers, etc.   Patients must decide which is worse, the disease or
the cure.

Bil Donlon
(aka William C Donlon, DMD, MA)
Peninsula Maxillo{*filter*} Surgery
Diplomate, American Board of {*filter*}& Maxillo{*filter*} Surgery
Fellow, American Association of {*filter*}& Maxillo{*filter*} Surgeons
Fellow, American Society of Temporomandibular Joint Surgeons
Atherton, Burlingame, San Carlos, South San Francisco: San Mateo
County, California

http://www.***.com/

_____________________________________

Newsgroups: sci.med.dentistry
Subject: {*filter*}Health and Special Care Patients
Date:  1995

As a result of my second request for discussion on this subject line,
Ive been asked to re-post the original message.  Im pleased to
submit it with slight editing for clarification:

Historically, has there been any ...

read more »

NetCanting

This chapter, Establishing Medical Truths, attempts to draw attention
to the correlation between the development of medical knowledge and
the development of iatroepidemics.

In Chapter 1, What are Iatroepidemics, five characteristics of
iatroepidemics were listed.  Here is a review of those items:

1.  A fundamentally unsound idea or one with poorly interpreted
experience is introduced into practice.

2.   The practice, diagnostic and therapeutic, took hold without
adequate study as to the safey or efficacy of the practice and then
developed a life of its own.

3.  A group of experts supported the practice which in turn encouraged
its continued application.

4.   The reputations or positions of the experts partially depended
upon the practice they encouraged.  When the practice was challenged,
they leaped to its defense, which caused changes to come slowly.

5.  The fundamentally unsound idea was repeated time and again.  This
process fosters iatroepidemics and harms many patients.

The three phases of the development of medical knowledge are
translation, transcription, and decay.  Transcription is how a new
medical practice is introduced.  This introduction depends extensively
on the professional literature (the medical literature).  How such
literature becomes widely accepted may involve peer review as the
decision process for rejection or acceptance of the work, and
ultimately publication in the medical journals.  Items 3, 4, and 5
(above) give a look into the importance of the experts and the medical
literature. Translation is the phase when the clinicians will
interpret what the literature says and they will apply that
interpretation to their patients.   Should it be discovered that the
original investigator was in error after publication and after it had
been accepted as a truth, this becomes the role of the third phase,
decay.  Depending upon how rapid the decay process is, item 5 becomes
more and more meaningful to the harm that comes from systematic errors
incorporated into health care. The longer the decay process, the
greater the opportunity for harm.  

All of the subject lines in this book are evidence that the potentials
for harm are underemphasized by the profession.  What is the impact
upon establishing medical truths as it applies to the diagnosis and
care of TMJ conditions?  What does this tell us about the risks and
benefits of treating these conditions when there is such adament
denial of the known potential of harm?  What does this tell us about
the way in which harm becomes known?
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Not all readers see all posts
Date:  1996

This is an important comment.  

Ive submitted several posts over the past few days on topics
concerning the NIH conference on TMD Technology. There are a few posts
which I am able to see that reference posts of others which I can not
see. In case there appear to be gaps in the threads, we need to all
keep in mind that there are some technical quirks in Usenet News
propagation that often contribute to misunderstandings between
readers. An important quirk results in the risk that is much like
providing all of us with a copy of the same book, but each copy is
missing pages here and there, some dont even have a cover, ....  and
no one knows who, if anyone, has the benefit of a complete copy. Yet,
all are asked to participate as though they each have the full benefit
of a complete copy.

One author kindly provided me with a Cc of his reply to one of my
posts and I still havent seen the post. Others can, because others
have replied to it. So, please do not think that I am not tending my
threads just because I am not replying.  

This problem applies to all the threads in all news groups. Sometimes
we just need to be reminded that Usenet News is imperfect, just like
me.  ;-)

TMJ Foundation
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Not all readers see all posts
Date:  1996

My server is very sick and for some reason it thinks it needs to
be treating who it serves! As the saying goes, starve a cold feed a
fever... well, it seems to think that I must have a cold. I havent
been served any news since Saturday night (this is Tues morning) and
it hasnt allowed me to send any to you either. So I guess it
thinks you have a cold too.  Starve those colds and the server will
get better!  Too bad it didnt think we all have fevers!!!!  ;-)

So, you might want to keep in mind that its tough to have a cold for
more reasons than you might have realized.....

TMJ Foundation
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Not all readers see all posts
Date:  1996

Notice:  I am hereby unsubscribing from smd.  I wish everyone here the
best of luck.

Grant Ritchey
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Not all readers see all posts
Date:  1996

You cant leave, the list will go unstable there might even be a riot
resulting in TMD for everyone.
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Not all readers see all posts
Date:  1996

Tell me Dr. Kurtis Wirth, can you get TMJ in a riot too?

BC
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Silence is commendable
Date: 1996

15 years of orthodontic practice Never have seen a prosthetic TMJ
replacement Never have seen a failed prosthetic TMJ replacement Dont
know any colleagues that have seen failed hip and knee replacements
Never seen avascular necrosis of a condyle or fossae except on lecture
slides Never have seen a patient whose quality of life was so impaired
from TMD problems that I recommended a surgical consultation Never
treat TMD problems except to reccomend a soft diet and cessation of
any paranormal functions and then refer to the Dental School if
problems persist And yes, I see many patients and yes Im probably not
the only dentist with these experiences

However because I dont comment on every single endless TMJ/TMD post I
and all the other dentists in this group are evidently criminals

DANIEL HUERTER (please see top of page 214)
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Silence is commendable
Date:  1996

Dear Daniel: I agree completely...yet we are lambasted with the claim
that this is a *$100 BILLION* problem?

Regards,

Roger D Metcalf DDS (please see top of page 119)

_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Silence is commendable
Date: 1996

More tongue-in-cheek?

Webmaster
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Silence is commendable
Date: 1996

No, not at all, $100 BILLION just seems like a *lot* of money to
me.....

Regards,

Roger D Metcalf DDS

_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Silence is commendable
Date: 1996

Why do you think that?

Webmaster
_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Silence is commendable
Date: 1996

Well what would you consider to be a reasonable amount ? How much
money does it take to diagnose and treat 10 Million (their figures)
patients presenting with all the various disorders that can be in the
tmjs? Would 1 Billion cover it? would 10, 20, 30, 100, a trillion? To
even announce numbers like that was careless wasnt it? But they did
make the statement and now what do we do with it?

Regards,

bruce chang

_____________________________________

Newsgroups: sci.med.dentistry
Subject: Re: Silence is commendable
Date: 1996

Thats an interesting list.  Its a little bit like the three monkeys
who hear no evil, see no evil, speak no evil.  What, in your own
philosophy of life,  do you believe that is all about?  Their
attitudes could constitute unethical, immoral, or even  criminal
behavior? Could it not? Certainly, it depends upon what they ignored.
Some think they were simply so righteous that they needed to be able
to remain uninfluenced by the evil world but were they?  Its also a
little bit like the poor old ostrich that sticks its head into the
sand believing if he cant see anything there isnt anything to see.
But, theres a difference between the monkeys that made conscious
choices and the ostrich that doesnt know any better and only acts
instinctively.  I could go on, but Im sure you get the point.

No one expects you to be seeing these types of  tragic cases (your
list) in an orthodontic practice unless you work closely with surgeons
doing this type of work.  No one wants to be the tragic cases.  How
many of the tragic cases would not exist if not for the work of some
(I did not say all) dental professionals?  Its inconceivable for
anyone to begin to think that all practitioners treating people with
some kind of minor jaw dysfunction (real or imagined by the patient or
the practitioner) will have seen these kinds of cases since they
represent an extremely small (rare?) percentage of all TMD.

But, just because in your practice you havent seen a prosthetic TMJ
or a failed prosthetic TMJ or other forms of severe joint destruction
pre-treatment or post-treatment (I think you refer a total joint
prosthesis) doesnt mean that you shouldnt be concerned, as a dental
health care provider,  over such occurances and the impact upon the
patient population in general.   Its just a matter of keeping up with
whats going on, isnt it, doctor?  Would you dare say that you have
been treating TMD (by way of orthodontic management?) for 15 years but
youve never heard of the problems in the patient population caused by
Viteks Proplast? I would certainly hope not.  Would you dare say that
everything about TMJ care has been on the up and up and all patients
have always been put ahead of the almighty dollar to be made off their
suffering if only the dentists could convince them that they are or
will be suffering if something isnt done? Would you dare say that in
all your years of experience that this just doesnt and hasnt
happened?  Orthodontic treatment for TMD.  Thats a touchy issue.
Cant help but wonder how
much revenue TMD has provided your practice over the years.  Care to
comment on the Billion Dollar Bash?

The posts I offer are almost always related to issues that are
basically beyond the realm of commonplace.  No one else seems to take
on the subjects and somebody needs to.  They are offered to help
practitioners such as yourself see a point of view that is not
generally available. Once in awhile, it wouldnt hurt to show a little
appreciation for the efforts of your fellow posters.   Its a matter
of seeing more than what you might typically read in your journals or
hear in conferences.  Of course, you can take it or leave it.  You
dont need to comment on anything.  Every once in awhile you might
find something of interest. Isnt that why any of us read any of this
stuff?  And still, you may not have anything to contribute.

But, lets be fair here.  From time to time you have been discourteous
to authors who write about TMJ-TMD subjects.  You make fun of them for
what they write and this isnt constructive nor is it nice, but its
your choice.  I dont pay much attention because Ive been around you
long enough not to take too much of what ...

read more »

NetCanting

The TMJ Iatroepidemic and the Harm it Causes,  is a chapter devoted to
the devasting and most tragic consequences of this iatroepidemic.
What are some of the potential reasons that the dental profession
might have to continue to promote the business of treating TMJ or TMD
in light of all that has been presented in the previous chapters?

Could the following statement made by Dr. Eugene D. Robin in Matters
of Life and Death have anything to do with why the dental profession
continues to ignore the possibility of a TMJ Iatroepidemic?

A doctor does not have to be correct to be innocent of malpractice.
The required standard is that his medical practices conform to the
minimal levels of care as practiced in the community.  This
interesting principle implies that it is acceptable for a doctor to be
wrong as long as all other doctors in the community are wrong in the
same circumstance.  Doctors participating in iatroepidemics ... are
presumably protected because, at the time, most doctors were equally
quilty of the errors that caused the epidemic.  Collective malpractice
in medicine is usually not considered to be malpractice at all.  

So what does that tell us?  Actually, it leads us to think about many
things.  

First, dentists who provide nonsurgical care for these conditions will
be held to one conformity while those who provide surgical care are
held to another.  This is clearly expressed throughout the book.
Where they overlap is not the issue.  Second, we should consider why
it is encouraged in TODAYS FDA (ISSN 1048-5317) that dentists and
their staffs must know how to recognize, document and avoid any
possible aggravation or precipitation of TMJ disorder.  

Is there a link between the need to inflate the numbers (60 million
sufferers), the need to deflate the economic impact upon our society,
the need for all dentists to have equal opportunity and responsibility
in identifying  the TMJ disorders, the need for total denial of the
harm caused, and the subsequent ability of dentistry to be found
innocent of any wrongdoing to masses of people?

We think it does.

As the final touches were being made on this manuscript, I had reason
to send email to a friend of ours.  Our relationship with her
represents a rare kind of friendship developed through the internet.
All friendships are unique, but this one is rare for some unusual
reasons. One reason stands out among all the others.  The key to our
friendship appears to be rooted in mutual respect which was carefully
cultivated over {*filter*}-time and it is something that we have found to
be generally lacking in the Usenet environment.  Any kind of true
respect seems all but impossible to find in Usenet where we have been
on exploration for the past three years. Chang and I have no idea who
our friend is by real name, and as she knows, her identity never
mattered to us. She stood up to adversity with a determination to
bring attention to the harm that has been and continues to be
inflicted upon so many innocent people. We didn't always know that we
would come to be friends.  In fact, we got off to a very rocky start
because of the way it is out there on the net.  The inherent risks of
a faceless-nameless society are uniquely characteristic of Usenet and
the internet.  Those features contribute greatly to the known causes
for distrust to result more easily than trust when people interact in
the many {*filter*}-environments, and especially at-risk are those who bear
the deepest of wounds (in this case those wounds are caused by the TMJ
Iatroepidemic). To those familiar with the newsgroup environment
(sci.med.dentistry or alt.support.jaw-disorders), there is an obvious
rift between the "patients" who suffer from the iatroepidemic in the
faceless-nameless society . Who should they trust?  A long time ago,
our nameless-friend was hard hit by friendly fire in sci.med.dentistry
because none of us were able to determine friend from foe. She was a
swift warrior who fired many shots (fierce posts) in our direction
because she believed she was under attack by us. It was a terrible war
between people who did not know that they were on the same side.  It
was a sadly necessary risk of this necessary civil war.  I remember it
well.  We remember it well and the pain persists because it was just
one of the many psychological impacts suffered as a result of is
unidentified iatroepidemic. Friendly fire as part of the flamewar
probably occurred because of a loss of trust but it may never be
entirely revealed or known. Generally speaking, the patients who have
traveled "distances" far enough to have arrived in operating rooms on
multiple occasions, trust no one anymore. In the future, compassion
from the dentists and surgeons might temper this tragic emotional
scarring of the people, but I wonder what will come of all of us.

There is good reason that we, the patients, must try to learn how to
know when the risk of trust is worth taking again. Taking that chance
puts us at emotional risk... again.  Chang and I  took the chance on
our friend and we were able to develop a special kind of trust with
her over time in spite of our unfortunate beginnings.  Because this
trust could only be based in a blind form of reasoning Chang and I can
only explain it as a meeting of the hearts and minds. Perhaps that is
all that trust is ever about.  How much can we ever really know of
someone else's heart and mind?

Our friend's real identity remains anonymous to us.  We appreciate
that she was willing to take a chance with her heart on us when almost
no one else would.  This chapter has been written in appreciation of
her efforts. It is our special gift.  It is another reason to believe
that there is reason to have hope that the future will be better than
yesterday or today.

This person followed our work, as did many others, all the while
knowing that we were willing to endure attack from every imaginable
direction year after year after year.  She knew nothing of us in the
real world but must have sensed a reason to stick by us.  No one
trusted or encouraged us in the way she ultimately did. Bruce and I
believe it was because we had all discovered that there is true
potential for developing friendships online if you understand and
accept the accompanying risks.  Perhaps because we are especially
familiar with the issues of benefits versus risk, we might
have been more inclined to make the decision to accept the risks
involved. This friend of ours had never asked for anything.  But today
she asked me if her copy of this book could be signed to her.
(Actually, she put it a little differently than that!) But she could
not have known that we had a secret element of this select chapter.
(I wish she could have seen how I smiled upon reading her request.)
The truth is, she stood by us while so many others (who mostly
identified themselves as dentists) had "known" us over the years
participated again and again in the "stone throwings" at our fragile
glass houses (our hearts) attempting to shatter our abilities to
continue our efforts.  The dentists acted as if we, two fragile human
beings, were made of steel and their actions were harming nothing that
mattered.  Because we were so determined to stand up to their gorilla,
they apparently thought we were less than human.  They could not have
been more wrong.

How do people stand up to the nine-hundred pound gorillas of our
society?  The answer seems to always be the same:  most people just
cannot do it.  A few will try and ultimately fail, and a few will
ultimately take the gorilla down!  We believe the TMJ Iatroepidemic
population will take this Nine-Hundred Pound Gorilla all the way down!
The dentists online did not like it that we appeared to have a gorilla
bigger than theirs.  Our friend saw what was happening as she watched
those who seemed so comfortable looking the other way while their
"colleagues" attempted to destroy our integrity and our efforts.  To
date, no more than a fistful of  people online have been willing to
stand in defense of us for our willingness to tackle this terrible
crisis.  It is possible that the Language of Silence by some was
intended to be supportive, though we refuse to take much encouragement
from mere acts of omission. Time will tell what the silence was all
about. This image in {*filter*}space is just another reflection of the real
world.  For decades, only a few of the many who stood to gain
financially from the unidentified TMJ Iatroepidemic have also stood in
defense of the innocents who were harmed by the plagued caused by
organized dentistry and the plague that was allowed to exist by our
United States government.  They all know who they are, regardless of
which side of the line they are found to be standing. Fortunately,
some dentists-surgeons have switched sides over the years upon the
realization that they had errored in their initial selection of sides
for whatever reasons they had. It is never too late to make the change
for what is morally and ethically in the interest of humanity.  For
all of those on or off line who have supported me or us over the years
in this relentless pursuit of what is right... we thank you.  You know
who you are and you are the good people who do not require public
recognition in order to do the right thing.

The following was part of the email I sent to our friend today: ...
All I can say is this:  It's been an exhausting road to travel.  It is
impossible for me not to be humbled by the experiences of my life and
all that has touched me along the way.  And for that reason, I am
deeply grateful for this almost bizarre life which is mine, as painful
a thought as it may be.  I've known for a long time that the journey
over all these years was what allowed me to find the meaning of my
life and, for that reason, I am at peace with the life which is mine.

RE:       The Final Analysis
DATE:   October 1996
FROM:  Webby
TO:       Chang
Distribution:  Worldwide

The situation has grown steadily out of control.  It appears that
there is no willingness on the part of sci.med.dentistry participants
to conduct themselves responsibly.  The Anonymous Participation
Project, one of our final hopes for improving conditions, will
undoubtedly fail. The project depends upon trust. The
supposed-professionals in sci.med.dentistry possess an overwhelming
distrust of anyone with an interest in (the) TMJ.   Their greatest
need continues to be total avoidance of the truth as evidenced by
their unfaltering arrogance.  The internet is a double edged sword.
People come here to be helped without realizing the risk involved
because they have been lead to believe by the outside-media that there
is an abundance of high quality health related information available
for them if they would just get online. It is very clear to us that
sci.med.dentistry is not a place where high quality TMJ related
information can be found.  And so we will take our last ray of hope to
the newsgroup alt.support.jaw-disorders which was originally created
to shelter the TMJ people from the hostile attitudes which we have
personally endured.
_____________________________________

Newsgroups: sci.med.dentistry
Subject: The TMJ Iatroepidemic  (the product of our research)
Date: 1997

Dear sci.med.dentistry participants:

As you were advised on Feb. 23, 1997 in post: 1 of 7 Sabras story.
Has it been told?, a final detail would be coming soon.  We werent
quite ready to make this announcement, but because of mounting tension
regarding our research (Webby & Chang) as expressed by Steve Fawks in
a post, we feel that it would be in the interest of all concerned to
announce our work product at this time.

We have written a book titled The TMJ Iatroepidemic which is
in-tended to be used as a serious didactic work. We are hopeful that
it will be of interest to all of you.  In our efforts to accomplish
final manuscript details, it became necessary to deal with certain
realities of the internet.  

The finished manuscript will be handed off to the printer in the
morning, Wed., March 12, 1997.  It is not our intention to market our
book through this or any other newsgroup and our announcement is
offered to you as a courtesy only because we have developed online
relationships with many of you.

Sincerely yours,
Webby & Chang
_____________________________________

RE:       alt.support.jaw-disorders
DATE:   1997
FROM:  Webby & Chang
Distribution:  Worldwide

The publication of this book was delayed for two reasons.  The first
had to do with the letter to the Governor of Kansas concerning a
problem with his Dental Licensing Board member, Dr. Douglass.  We
hoped for a reply that would somehow clear up the matter   concerning
Dr. Douglass identity and the problems the governor seems to have
with his dental licensing board.  This issue heavily impacts the
public-confidence in health care. We decided to wait until May 1st for
a reply. There has been no reply.

The second reason involved the lines of communication between the
patient-public and the dentists online.  The newsgroup
alt.support.jaw-disorders has been experiencing growth pains; however,
it is apparent that a changing attitude between the public and the
professions representatives is developing.  We wanted to be able to
include an example of this development prior to going to press.
Improved communications represents a symbol of hope. Acknowledgement
of the communication crisis is one of the first steps toward the
identification of the TMJ Iatroepidemic.

The identification of the TMJ Iatroepidemic as a means to stop the
harm depends upon a change in attitude.
_____________________________________

Newsgroups: alt.support.jaw-disorders
Subject: What causes TMJ/TMD?
Date: 1997

What is it that causes most of the conditions called TMD?  
What causes most of the cases which become surgical?
What causes most of the bad surgical outcomes?
What HAS caused the majority of the surgical failures?
What do those causes have to do with tomorrows treatments?
What causes misdiagnosis?
What is the greatest risk facing people about TMJ care?
_____________________________________

Newsgroups: alt.support.jaw-disorders
Subject: Re: What causes TMJ/TMD?
Date:  1997

What is it that causes most of the conditions called TMD?

Muscle disorders that are attributed to the joint.  SITE of pain is
not
necessarily the SOURCE of pain it is  very important to know the
source in order to have correct treatment.

What causes most of the cases which become surgical?

Sometimes it only takes a patient to be seen by a surgeon for
evaluation and then it seems surgery soon follows...regardless of the
diagnosis (if there is one).  I dont mean to hit surgeons below the
belt, but so often it happens because of a paradigm and not
necessarily an unethical clinician (see below for a further
explanation).

What causes most of the bad surgical outcomes?

I dont know.

What HAS caused the majority of the surgical failures?

I dont know this either since there are so many different types of
surgery there are different reasons for failure.

What do those causes have to do with tomorrows treatments?

I sure hope that the profession is learning from the mistakes that
have been made in the past.  

What causes misdiagnosis?

Many times it is lack of education on the part of the clinician as to
how to actually determine the cause of an oro{*filter*} pain problem.
Other times can be attributed to the paradigm in which a clinician
works.  An example:  You have a headache.  Dentists look to the teeth,
joints, and muscles of the head and neck.  Neurologists look for brain
tumors.  Gynecologists tell you to quit taking birth control pills (if
applicable of course).  Im sure you catch my drift, many times the
health care provider will only look in the area that falls under their
specialty (as it should be) and it can be hard to accept that the
problem may not be related to their field.  The problem arises when
treatment begins anyway without a correct diagnosis instead of
referral to someone who might better help the patient. One case that I
know of involves a woman who had a constant headaches, she had a
history of cancer in the past and she called her oncologist.  The
response was I dont treat headaches, so she called her dentist.
The dentist fabricated a night guard right off the bat (no diagnosis I
assume, just trying to fix a headache) two weeks later, the headaches
remained, she went to her neurolgist who then found a large brain
tumor...one week later she died.  Obviously the tumor was very
advanced since she died so soon after diagnosis, and the dentist did
not speed her death (I dont think), but he did not have a diagnosis
that warranted placing a night guard.

What is the greatest risk facing people about TMJ care?

Having treatment initiated without an accurate and complete diagnosis
of their condition.

Dr. Dave

_____________________________________

Newsgroups: alt.support.jaw-disorders
Subject: Re: What causes TMJ/TMD?
Date: 1997

TMD is caused by chronic parafunctional muscle activity, most
significantly, during REM sleep. During REM sleep, ALL people
demonstrate some degree of jaw muscle contraction, primarily the
temporalis.  As the temporalis contracts, it approximates the jaws,
i.e., it clenches them together to some degree.

Whether the person developes TMD or not is dictated by the intensity
of the event, and whether or not other muscle groups participate in
the parafunctional contractions (particularly the lateral pterygoids
and masseters).

Everyone clenches their jaws during sleep, for a particular duration.
Countless studies have demonstrated varying degrees of duriation of
events (that is, how long and how many times the events occur), but
studies are lacking in how INTENSE the muscle contractions are
(particularly the temporalis) during the events.  Probably the best
way to describe the TMD diagnosis is: Intense muscle contraction with
frequency.  The intensity of the particular muscle(s) and the
frequencies of those particular muscular contractions dictates the
nature of the TMD.

For example, if only the temporalis were contacting with a high degree
of intensity during practically every dream, the patient would wake
with a severe headache (temporalis myofascial pain), but practically
no jaw (joint) soreness.  This patient is rarely diagnosed with a TMD.

If the massesters and lateral pterygoids were highly active during
intense temporalis contraction, significant strain is placed on the
TMJs, resulting in potential internal derangement of the joint,
depen-ding on the duration and intensity of the event.  However, if
temporalis contraction is only moderately intense, the patient would
simply have sore jaws from bruxing.

If an internal derangement does occur, it could require surgical
intervention.  If the surgeon is not aware of how the derangement was
caused, the outcome is in jepardy.  It would not be unusual for a
patient to continue with the identicle muscular events that damaged
the joint ...

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