Sometimes you just have to come up with an analogy to make a person understand what is going on. And sometimes you have to come up with more than one analogy to REALLY get them to understand. In my little world of treating TMJ disorders, I make it a point to try and get our patients to understand why they have a problem long before I explain how to treat it. Recently, I revamped my MRI order with the radiologist to include measuring condylar angulation relative to the central axis. What that means in English is that I am having the radiologist measure how ‘in line’ the jaw bones are relative to the middle of the skull. It’s kind of like if you take your car to the mechanic and they explain whether or not your front end alignment is ‘in line’ or not!
The reason for the front end alignment angular measurement is that I need to know if surgery may be an option one day, and this helps me to understand how effective it might be. Let me explain. The articular disc sits on top of the condyle (jaw bone) and if the two condyles do not work in unison with each other -i.e. if they are tipped differently, then putting that disc on top of the condyle may or may not work too well. Just like the wheels on the front of your car- if one is turned right and the other is turned left, then two new tires will just wear out very quickly. If your mechanic is honest with you, he/she will not sell you two new tires- he/she will explain that a front end alignment will make your new tires last so much longer.
Well, dear readers, this is where you need a good TMJ mechanic (please excuse the analogy). If you begin treatment and those condyles are angulated at 67 degrees on the left side, and 87 degrees on the right side, then surgery is far less likely to work and the patient should know this. For this reason, you need to explain to the patient that we need to use our ALF appliances for a year or two to get the cranial bones re-aligned. With all good luck, this will level out the sockets for the jaw joints and allow the condyles to reshape and re-align to a more balanced angulation. It’s good to be balanced.