THE QUESTION IS NOT WHAT IS THE "TMJ" APPLIANCE,
THE QUESTION SHOULD BE WHAT IS THE RIGHT TOOL FOR THE JOB
Upon graduation from dental school there were many voids in our knowledge base. At best, the four-year curriculum is packed with mostly pertinent knowledge on all the services a good dentist provides. Unfortunately, we find that we have to spend an inordinate amount of money and time increasing our abilities so we can provide expanded services. As you expand your services, you must develop knowledge and clinical skills to provide such expanded service. Great businessmen would advise us that we should expand our services in areas where the demand is greatest and then limit how far we go in that one service area.
One of the services that does need to be expanded in the basic dental practice is the use of appliances. There are a number of appliances available that can be used to treat parafunction at night, chewing system muscle pain, and partial disc displacements. The combination of 'which one' and 'for what' can present a quandary. My favorite quote for this situation is, "If you do not stand for something you will fall for anything". It sums up the confusion in appliances quite nicely.
Unfortunately, many standard dental offices expand their services in appliances by going to one "guru" driven or "market product" driven course and using one appliance for all problems or all patients. The appliance world has blossomed into a million dollar industry from the NTI, neuromuscular appliance, best bite discluder, soft-hard appliances (Impact, Comfort, Bite Guard), aqualizer, Kois deprogrammer, orthotic, suck down appliances, retainers, and store bought mouthguards.
In the real world of services, a doctor must know both his client and the pathology in order to provide the best service. As Dr. Parker Mahan said in his book on "Facial Pain": "Never treat a stranger in pain with irreversible therapies" (109). This statement applies not only to the knowledge of the service, but also the knowledge of the patient. Until one understands the purpose of each appliance and the science of the pathology you are treating, one should be careful when providing appliances. Each Appliance has a specific purpose and, like drugs, it is important to know them well.
