Molar Derby

For doctors, there's nothing like a pop medical malady to make the big bucks. Back in the Seventies, hypoglycemia, or low blood sugar, was the fad of the day. Ten years later, many a physician got that second Benz as yuppies everywhere fell prey (or thought they did) to Epstein-Barr virus. But in the Nineties, dentists are sinking their teeth into a cash cow of their own: The jaw-joint malady called TMJ, or temporomandibular-joint disorder. Depending on whom you talk to, from 28 percent to 86 percent of Americans have TMJ, which can cost up to $30,000 a mouth to treat.

That's good news for Arizona dentists, who, like their colleagues in other parts of the country, have been suffering a business slump because these days people have healthier teeth than ever before. "There are less cavities and more dentists and less treatments to do because teeth are healthier," admits Dr. Paul Daniels, a Phoenix dentist and former member of the Arizona Board of Dental Examiners, which watchdogs the state's dentists.

The outspoken Daniels served on the board in 1988, when it drew fire from some dentists because it was thought to be too strict in disciplining dentists. At the time, he said he felt the board should "represent the consumer." He still feels that way.

Daniels says dentists have been signing up for quickie postgraduate courses that teach how to treat TMJ. Such courses are sometimes flagrantly advertised in dental journals as a way to "revitalize faltering dental practices," the Washington Post reports.

Daniels explains: "There are these weekend courses given across the country that dentists can take on how to treat TMJ. Some people take these courses and are really not qualified to diagnose the problem adequately. Before they really know what's causing the TMJ, they do irreversible things, like putting caps or crowns on lots of teeth that might not be necessary."

Nobody knows that better than Mathew Wheeler, the executive director of the dental board, who tells New Times that patient complaints about TMJ treatment have risen sharply in the past few years. "It's a new field that more and more dentists are taking an interest in," he says. "Some even narrow their practice to TMJ."

According to Daniels, TMJ sometimes will go away on its own, without any treatment at all.

Daniels says TMJ is caused by an imbalance between the chewing muscle and a joint in the jaw. Symptoms include sandpapery grinding sounds or popping in the jaw, a locked or tender jaw, difficulty in chewing, headaches and earaches.

TMJ can be caused by stress, the habit of grinding one's teeth, a bad bite or a psychological problem, he says. Sometimes the malady goes away on its own; sometimes despite the best treatment possible, it can't be cured completely. Treatment for TMJ depends on what causes it. Daniels and other experts say the least invasive, least permanent methods of treatment should always be attempted first. Unfortunately, experts say, the more radical and expensive techniques may not always cure the problem and could have side effects a few years later.

Some patients say their TMJ is relieved simply with stress-reduction counseling and training in relaxation techniques and pain control. Others wear mouth-splints to bed--the devices make them look like Muppets, but patients swear the splints ease their malaise. A few patients may have to have their teeth filed down and capped, at about $500 per tooth, to correct a bad bite. And still others may opt for expensive microscopic joint surgery.

What really makes consumers gnash their teeth is that most insurance companies won't cover TMJ treatments. Daniels says the companies are reluctant "probably because there's been some abuse" by certain dentists. "Before some dentists really know what's causing the TMJ, they do irreversible things, like putting on caps or crowns."

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Terry Greene