Americans Are Not Going To The Dentist Enough

An estimated 5-10% of the U. S. population experiences a disorder with their TMJ, the joint that connects their jaw to their skull. The good news? Relief is possible. The secret? Go see your dentist. Today on the show, Emily talks with Justin Richer https://www.riversideoralsurgery.com/meet-us/meet-dr-richer/, an oral surgeon, about the diagnosis and treatment of TMJ disorders. Got a question about your teeth or dentistry? Email us at [email protected] mailto:[email protected]. Listen to every episode of Short Wave sponsor-free and support our work at NPR by signing up for Short Wave+ at plus.npr.org/shortwave http://plus.npr.org/shortwave. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 1:38Emily Kwong?

  Shortwavers, it's Emily Kwong, and I have a confession. Somehow, in the six years that we have been making this show, we've never had on a dentist.

• 1:49Speaker 02

  This is the very first. I'm so excited to be a part of the very first of anything.

• 1:54Emily Kwong?

  I was like, how is this possible? Like, I floss. I have no reason to avoid dentists, but it appears that we as a nation are not going to the dentist enough. Justin Richer tells me that has led to a delay in the detection of oral cancer across the US.

• 2:11Speaker 02

  Nobody wants to go to the dentist. Even like, most dentists don't want to go to the dentist. I don't love it either, I get it, but it's important. Do your routine care, do your hygiene. Like, you know, they're, hygienists are amazing.

• 2:24Emily Kwong?

  Justin, by the way, is technically an oral surgeon. He's based in northern New Jersey, went to dental school in Boston, and did his fellowship in Arkansas.

• 2:33Speaker 02

  Yeah, I've been all over. I've tried different areas of the country.

• 2:36Emily Kwong?

  You've seen so much of America's teeth.

• 2:38Speaker 02

  I, I have. And some areas of the country have more than others, but, um.

• 2:42Emily Kwong?

  More teeth?

• 2:43Speaker 02

  Yes. Some areas of the country have more teeth than others, and they have varying degrees of like dental problems.

• 2:49Emily Kwong?

  And one of the biggest problems out there is TMJ disorders, or TMD. That is a suite of disorders affecting the TMJ, or temporomandibular joint, which moves every time you chew, speak, or open your mouth. It's a joint that actually connects your jaw to your skull. And when that joint becomes strained or injured, it can cause stiffness, jaw dysfunction, and pain. And this is not some niche problem. Tens of millions of people in the US have some form of TMD. And Justin specializes in treating it.

• 3:19Speaker 02

  Really, what I do on a regular basis, like every day when we're seeing a new TMJ patient, is diagnosis assessment, figuring out what the problem is and then where it's coming from. And then, you know, that helps direct treatment from there.

• 3:34Emily Kwong?

  So today on the show, we sit our butts down in the dentist's chair to investigate one of the most pernicious problems of all: TMJ disorder. Why people get it, who's most susceptible to it, and how relief is possible. I'm Emily Kwong, and you're listening to Short Wave, the science podcast from NPR.

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• 5:25Emily Kwong?

  Okay, Justin, so I read that an estimated 5 to 10% of the US population has some form of TMJ disorder. That is a lot of people.

• 5:35Speaker 02

  Yes.

• 5:36Emily Kwong?

  Do we know what causes this? And who is most susceptible to developing it?

• 5:40Speaker 02

  Yes and no. It's so overwhelming majority of TMJ issues.

• 5:47Speaker 02

  Are related to a cartilage pad that sits on top of the bone in your jaw joint. And the position of that cartilage pad overwhelming majority of people popping, clicking, locking the jaw. Majority of those issues at some point are related to that cartilage pad not being in the proper position. Which affects the movement of the joint and you know, and then symptoms that are that are associated with that. Now, who's more susceptible? That's what we don't really know about.

• 6:16Emily Kwong?

  Oh.

• 6:16Speaker 02

  So sometimes like people who don't have teeth in the back of their jaw. That might lead to an unsupported jaw joint. You get put get strained on the ligaments that support that cartilage pad. And then you have a problem that that is associated with it.

• 6:32Emily Kwong?

  Got it. Okay. How do our teeth, which sit on the jaw, affect this joint? Which is all the way, the jaw joint is like all the way in the back, right? Like it's like right below our ear canal.

• 6:44Speaker 02

  Mm hmm.

• 6:44Emily Kwong?

  So like when we look at the architecture of the jaw, why do our teeth matter?

• 6:49Speaker 02

  Right, so you know, again, like the teeth ultimately are the support system to the joint. So like, let's just say like you don't have any teeth on half of your mouth. So you're going to chew on the left side of your mouth.

• 7:03Emily Kwong?

  Right.

• 7:03Speaker 02

  And you're going to probably develop a habit with the way that your jaw wants to rotate. And shift to be able to function, to talk, to be able to chew. You know, to be able to say how great your podcast is, your jaw joint is moving around. Every every time that, you know, we're speaking or eating or functioning. And so if you're unsupported on one side, you start to develop habits with the way that you move your jaw. To be able to function and then that can that can weaken the structure. So again, using like analogous to like an orthopedic issue, like a hip issue. If you had one leg that's shorter than the other.

• 7:42Speaker 02

  It's a really common reason for having misaligned, you know, pelvis and sore develop hip and back pain. And so really, it's the same type of thing at the end of the day.

• 7:52Emily Kwong?

  I never realized our teeth support our jaw. Without it, we would just have a gap mouth. I thought the teeth supported my appetite, you know, like emotionally speaking, the teeth.

• 8:06Speaker 02

  Yeah.

• 8:06Emily Kwong?

  But the teeth are like serving an architectural purpose in our head.

• 8:11Speaker 02

  Right.

• 8:11Emily Kwong?

  Oh my god.

• 8:12Speaker 02

  That's a, that's a structure.

• 8:13Emily Kwong?

  Oh no.

• 8:14Speaker 02

  It's an extension of the bone and it's, I mean, it's harder than bone in some cases, but

• 8:17Emily Kwong?

  Okay.

• 8:18Speaker 02

  I mean, they, they really do matter and they're supposed to be there.

• 8:21Emily Kwong?

  What are some of the signs that a person has TMD? And, and what are the signs that they don't? Like, how do you even go about diagnosing this?

• 8:29Speaker 02

  Well, my TMJ exam is longer, more detailed than anything else that I do. And most, including most surgeries that I do. And part of that reason is, is you really have to listen as a provider. And so like, you know, do they have locking of the jaw? Do they have dislocating of the jaw? Like, you know, maybe just one side of their jaw is having a problem and the other one's moving fine. Maybe their jaw deflects a little bit, you know, it doesn't, doesn't move so well on one side. But you start by listening and then, you know, you, you compare, you know, what they're saying to what you're seeing on an exam. And then we take an X-ray and we see if, you know, there's changes in the bone. You can get MRIs of the jaw joint, just the same way you get MRIs in a knee. And so like, you know, those are, those are forms of assessment.

• 9:13Emily Kwong?

  How do you say like, aha, it is temporomandibular joint disorder? It's TMD for sure. What are you looking for?

• 9:20Speaker 02

  MRI.

• 9:20Emily Kwong?

  MRI?

• 9:21Speaker 02

  MRI proves it. You look at an image and you're like, well, cartilage is supposed to be here, but it's actually there. And you can't, MRI doesn't lie. So, you know, once you see it, you know it. I look at the health of the bone and, and the position of the bones. And so if there's not a lot of space in there, normal space for the cartilage to be sitting in, then the cartilage probably isn't sitting in the right spot. You can also see the health of the bone. And so inside the cartilage pad, there's synovial cells. And synovial cells produce a fluid that acts like a lubrication, but also nourishment, you know, to the bone. And so like, again, while you're functioning, you're talking, you're chewing, you're breathing,

• 10:02Speaker 02

  moving your jaw, jaw around to do those things, you have to be able to heal from normal function. And so when that cartilage pad is not sitting in the right area, synovial fluid is not in the right area either.

• 10:13Emily Kwong?

  Yeah.

• 10:14Speaker 02

  You have a diminished capacity to be able to heal. And you start to develop bone changes that you can see on an X-ray in a lot of cases.

• 10:22Emily Kwong?

  Okay.

• 10:22Speaker 02

  And so it's all, you know, it's all related.

• 10:26Emily Kwong?

  Okay.

• 10:26Speaker 02

  At the end of the day.

• 10:27Emily Kwong?

  Yeah. So, once you make a diagnosis, or you have a pretty good sense that yes, someone has TMD, what treatments are you pursuing? Like what? What do you think people should be doing to get help for this?

• 10:41Speaker 02

  Treatment ranges from things as simple as occlusal appliances. So like a thick Invisalign retainer.

• 10:48Emily Kwong?

  Wow.

• 10:48Speaker 02

  That sits on the teeth and just takes some of the pressure off the joints. Kind of like a knee brace.

• 10:54Emily Kwong?

  Okay.

• 10:54Speaker 02

  You know, would be on like a knee injury.

• 10:55Emily Kwong?

  Yep.

• 10:55Speaker 02

  But you also have like minimally invasive like procedures, like this procedure called arthrocentesis, which really is just using some needle holes to inject water through the jaw joint, get rid of inflammation.

• 11:11Emily Kwong?

  Whoa.

• 11:11Speaker 02

  Get rid of some byproducts that are in there. And sometimes we inject things into the joint like PRP, which is essentially like a stem cell, you know, inject, we harvest some blood and concentrate growth factors from the blood and, you know, inject that in and around the joint to help reduce inflammation.

• 11:29Emily Kwong?

  Yeah.

• 11:31Speaker 02

  People are injecting things like fillers, like that they use for like lip off-label, obviously, but like inject that in the jaw joint.

• 11:39Emily Kwong?

  So these are all of the more minimally invasive treatments. What about more invasive procedures like open joint surgery? What do you think of that?

• 11:46Speaker 02

  Right. I think majority of TMJ issues probably don't even need surgery at all.

• 11:50Emily Kwong?

  Yeah.

• 11:51Speaker 02

  But open joint surgery, you know, can fall into a couple of different brackets. If it's a cartilage issue and the cartilage is in the wrong position.

• 12:00Emily Kwong?

  Yeah.

• 12:00Speaker 02

  You can reposition it and essentially hold it in place with a permanent stitch. But sometimes you have to remove the cartilage. Those are all day procedures.

• 12:10Emily Kwong?

  Like if you're worried about TMD, who should you see?

• 12:14Speaker 02

  Always you start with your dentist.

• 12:15Emily Kwong?

  They're like your primary care doctor for your mouth.

• 12:17Speaker 02

  Exactly. Exactly.

• 12:19Emily Kwong?

  Right. What can people do to manage jaw pain of any kind at home?

• 12:25Speaker 02

  Go see a dentist.

• 12:29Emily Kwong?

  You can't worm your way out of this.

• 12:31Speaker 02

  No, yeah, sorry. If you go on Amazon, you can find appliances that you can make at home. Those create more issues.

• 12:39Emily Kwong?

  Oh.

• 12:40Speaker 02

  Way more issues than they ever solve.

• 12:42Emily Kwong?

  Oh, no. So don't be buying occlusal, that's what they're called, occlusal appliances?

• 12:47Speaker 02

  occlusal.

• 12:47Emily Kwong?

  Don't go buying those on the internet.

• 12:50Speaker 02

  It doesn't work.

• 12:51Emily Kwong?

  Oh.

• 12:52Speaker 02

  It just, it's, it's, keeps me in business.

• 12:56Emily Kwong?

  When you think about like the next generation, how do you want TMJ to be incorporated into like education and how people in your field are thinking about it?

• 13:07Speaker 02

  Yeah, so what we got to do is we got to standardize our TMJ education across dental education. And then everybody is just getting into the same foundation when they're coming out of school. And they're knowing they have the same tools at their disposal, same information, knowledge. That's, I mean, that's the biggest thing. And we're starting to do that, which is amazing. That's the most exciting thing. If as a dental community, if we all can get on the same page on what the problem is and how to go about treating it, wow.

• 13:41Emily Kwong?

  Wow.

• 13:42Speaker 02

  Sky's the limit.

• 13:43Emily Kwong?

  Justin, thank you so much for talking to me. It was fantastic. And as someone who loves my dentist, shout out to my dentist. It's great to have you on the show.

• 13:52Speaker 02

  Thank you so much, Emily. Really appreciate your time.

• 13:57Emily Kwong?

  And Short Rivers, just so you know, this will not be the last episode we do about the dentist. Justice for our teeth. So if you have a question, email us at [email protected]. This episode was produced by Burleigh McCoy. It was edited by Rebecca Ramirez. Tyler Jones checked the facts. Jimmy Keely was the audio engineer. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Short Wave, the science podcast from NPR.