557 Changing the Paradigm for Treating TMD

0:00A special thank you to our sponsors for supporting the show. As a dental hygienist, your focus should be on patient care. Not tracking down supplies. Net32 makes it easy to find the products your practice needs, compare options, and order with confidence. Less time managing supplies means more time focused on patients. Net32, the smarter way to buy dental supplies. Visit net32.com-rdh. The surgery has some value, but I could not face a patient and look them in the eye and say, this is a surgery that is best for you. I'm going to do this for you, knowing that a third of the time they would be back with the new year or two in the same symptoms. This is a device and protocol. This isn't something you just stick in somebody's mouth and hope to see what happens. You've got to know a little bit about the nuances. You have to know a little bit about anatomy, cell biology.

1:04If you're not getting the response you expect, you need to know why. Treating symptoms is nonsense. Just make the inflammation go by way by resting the joint according to a protocol. Just like the orthopedic search is due for tennis elbow, tennis elbow, and TMD are the same disease. Exact same disease. Exact same pathophysiology. And welcome back listeners to another episode of a Tell Too Hygienous Podcast. I am Dave and I am here with Jessica and Jessica. I have something exciting to tell you. So in this week specifically, it was told to me by not one, but two to three people that I know with. One of them being one of my coworkers. But my neighbors and so shout out to Pedro Nakamura and shout out to Dr. Williams.

2:09And I have four patients who told me this week that they are listening to our amazing episodes in that they're having a lot of fun. And that makes me really excited. Slightly nervous that you know, I get to hear me on your headphones on the way to the gym, Pedro. But I'm excited and I just want to thank all the listeners for our support. And I'm just so excited for today's guest because I am just at the edge of my seat learning a little bit more about what we're going to be talking about, which is TMD. And obviously we'll have that effect, our TMJ and such as with that further ado, let's talk about our guest. We have an expert on TMD with us today. We are joined by Dr. Tony Urbanek and he is, I'm going to coin it. You're like the godfather of TMD. That's what I'm going to say. And he has a dual degree in oral and max official surgery and his career has banned more

3:11than five decades. So he knows what he's talking about. He earned his DDS and MS and anatomy and cell biology from Indiana University and completed his medical degree internship and residency at Vanderbilt University. While at Vanderbilt, he also held a research fellowship with the National Institute of Dental and Craneo Facial Research, studying facial growth anomalies through laser-induced intra-uterine surgical models. Watch out rabbits. Dr. Urbanek's coming for you. After decades of treating some of the most complex, max, max, the facial conditions and performing TMJ surgery for 36 years, Dr. Urbanek began questioning the traditional approach to temporal and debular disorders. That question led to approximately 15 years of research and ultimately to what he describes as a new paradigm for understanding and treating TMD. Following the underlying inflammatory disease process, rather than simply managing its

4:11symptoms. Today, he is president and CEO of TMJ Services and works with a network of clinicians providing non-surgical TMD treatment. But dentistry is not all Tony does. He has founded charitable medical clinics in Haiti and Jamaica. He has owned an aviation-fixed-based operation served for 20 years as an aviation medical examiner and become president of an organization representing 1,500 private pilot physicians. A private pilot himself for 54 years. He admits, this is one of my favorite parts of his bio, that that experience has provided more than a few hold my beer moments along the way. His greatest joy, however, is his family, his wife Ann, three grown children, seven grandchildren, and one great-grandchild. So Dr. Obannick, we are so excited to have you here and maybe give a little bit of context about why I said that rabbits should fear you.

5:16Well that was a little of our pre-conference discussion. My work on the facial growth and development was on the rabbit model. I used the rabbit as a model primarily because number one, they're easy to work on, but they make a little baby rabbits and I was doing intrauterine fetal surgery. Once you figure out how to do the surgery itself, you had plenty of little rabbit fetuses to work on and to do this particular kind of research using, creating facial anomalies, facial problems induced by laser intrauterine leaves. So yeah. How fascinating. I have to say that first, part of the research, I don't want to focus too much on this, but I had to learn to anesthetize these rabbits and I have to admit, talking about the problem

6:18that the rabbits have, I did away with several rabbits just trying to figure out how to do the anesthesia for these little rabbits and keep them alive before I was able to actually proceed with the research itself. But anyway, most of the rabbits lived and they were happy that they could participate in such interesting research. Bless rabbits. Bless rabbits. The word that caught me was the anomalies that you did anomalies. One of the things I find as an anomaly in dental hygiene or dentistry in general is you have a patient come in and they say that they have TMJ and I go, well, yeah, I also have TMJ. And the anomaly is that it's not actually what they're describing to you as TMJ. They're really saying, I have TMD.

7:19There's discomfort. There's a disorder. There's a dysbiosis happening with my TMJ. And you have done TMJ surgery for 36 years. So what made you stop and say, there's got to be a better way to treat this? Jessica, that occurred very, very easily after 36 years of doing every type of TMJ surgery possible. I did everything from total joints to lysis and lavage. If there are oral surgeons listening, they'll be very meaningful then. Those are different levels of surgery. Half of them through an arthroscope and half of them open joint surgery. Open joint meaning you make an incision, go into the joint itself and do whatever kind of surgery you're going to do with that joint. And then through an arthroscope, just like knee arthroscopic surgery or hip arthroscopic surgery, you use an arthroscope and do your surgery through instruments and watch your

8:20surgery on the television screen. The point is I did over 2,000 cases and after evaluating my statistics, I found out that the third of my patients, no matter what kind of surgery I did for them, would be back within a year or two, sometimes six months with the same symptoms. Now looking back through the retrospective scope, I found that two thirds of them to this very day are doing well. But a third of them would be back. I have a file with two thirds or not two thirds, but I have a file with some of my patients come back after 20 years and they go, you know, the operated side is doing well, but now I'm having trouble on this side. So surgery has some value, but I could not face a patient and look them into eye and say, this is a surgery that is best for you and I'm going to do this for you knowing that a third of the time they would be back within a year or two with the same symptoms.

9:21Couldn't do that. I thought about that over a long weekend. I walked in my office on a Monday morning to my staff and I said, ladies, I decided we're not doing any more TMJ surgery. And that was a huge part of my practice. I was basically the TMJ surgeon in Nashville, Tennessee on the private side, other than the Vanderbilt. They were surprised, but I just I couldn't see facing patients because when I did ortho gnathic surgery, micro neural surgery, cleft palate, cleft lip surgery, I could predict what was going to happen. I would tell them exactly what to expect and that would turn out that way. And that is the reason that I decided that I wasn't going to do any more surgery and it was a defeat for a moment. I was defeated and I remember the morning, it was the Monday morning and I remember going back to my office and sitting at my desk before the patient started, very defeated. And then I kind of had an idea. I said, you know, you've got a lot of experience here in research.

10:22You got a lot of background. Why don't you take a look and see if you can figure this out. And I did. I decided that I was going to do the research and actually the story that goes with that was surprised me because if you're going to do research, where do you start? Out on a disease, any disease you want, pick the disease. You start out with the patient, the person who has a disease and I have plenty of those. I have plenty TMJ patients, quote, TMJ patients. Every single one of them. And so I told my staff, I said, don't tell the patients. I won't see them just tell them come in for a consultation. I want to talk to them. And this is what I heard. I did a survey on about 20 patients and they'd come in and I say, I just want to find out from you, what do you think about this? What can you tell me about the issue? What does it mean to you? What does your husband say about it? Give me the symptoms. What makes it better?

11:22What makes it worse? And I sit there and listen. Just listen for 15 minutes, 20 minutes, 40 minutes, 45 minutes. You're listening to at least 24 women. I heard something like this, something similar. If I put my finger, my tongue, a pencil eraser, piece of cloth between my front teeth and gently bite down, it feels better. I had never heard that before. I heard a lot of things from these ladies because it's, by the way, it's primarily females. I mean, you need to know that if anybody who treats TMD, you need to know it's 90% females. Why? It's in the literature. My value is that I know how to read literature and I have read it. Reading is essential. It's a female problem because estrogen exacerbates inflammation. That's kind of the end of the story here. But at that time, that's why you need to know it's a female problem. Estrogen exacerbates inflammation. So I had the patients tell me if I put my finger, my tongue, a pencil eraser, which is

12:23my front teeth, it feels better. I heard that enough. I went in my lab and I made a little device of my own design that went between the front teeth that I figured that they could talk with, that they could wear 24, seven, except when you eat, you can't eat with this thing in your mouth. But you can drink liquids, you can drink coffee. And I had a lot of experience doing cleft, we up in cleft palate work and a lot of experience making devices for clefs and trauma and orthognatic surgery. So I made this device. I gave it to the first lady in line and I said, put this in your mouth and keep it in 24, seven, except when you eat and come back in three weeks. I just want to see what would happen. I didn't tell her she was an experiment, but I didn't feel I needed. I wasn't going to hurt her with it. And she came back in three weeks. I walked in the room and she looked up at me and this was a lady who had had the typical 20 years of headache, ear, egg, jaw pain, neck pain. The symptoms by the way are frequent and or recurring headache, ear, egg, jaw pain,

13:28neck pain, tinnitus, ringing in the ears, subjective hearing loss, which is that feeling of fullness in your ear. But we would call it subjective hearing loss because they go to the ENT doctors, get the work up and say, I can't hear out of the ear and the ENT doctor says, no, no, I'm telling you. There's nothing wrong with your ear. And the patient says, no, I know there is that subjective hearing loss, dizziness, vertigo, which are those three are the non-painful symptoms, which the ENT is called, called minniars disease and don't have any solution for minniars disease. And then upper back shoulder pain, arm hand finger tingling and numbness and various kinds of jaw locking. Those are the symptoms of TMD. And this woman had most of those, or at least half of those symptoms. And I walked in three weeks later, walked in the room. And I said, how you doing? And she looked her up and she says, doc, thanks, my pain's gone. That's just like, I took a step back. I literally remembered vividly. I took a step back and I go, really?

14:29And she looked at me like I wasn't expecting that, which I wasn't. And that's where it started. And so I had a long line of these females. And I brought them in one at a time and made a custom device similar to that. Within three weeks to two months, all of them came back significantly improved. Not everybody came back in three weeks and says, all there's pains gone. It didn't happen. But we now know what the numbers are after treating over 5,000 patients with personally 5,000 patients with this device in protocol. It's not just a device. It's not a widget. It's a device in protocol. And I'll explain in a minute what I really discovered. But that started the ball rolling. That is what started the ball rolling. So I did another 24 cases just like that. And the patients came in and one point or another said, thanks, my pain's gone, my neck pain's gone. I can chew now.

15:29Whatever their response was. And after about 24 cases, I realized I had no idea what the cause was. I'm no more, yeah, what I want. I like it works. True, but it worked, right? So I went back to the books. I mean, again, you know, I went back to the books. I have this broad background knowledge, MD, DDS, Cell Biology, Anatomy, Two-Year-NIH. And I went back to the, and especially anatomy. And this is what I discovered. It's all in the literature already. It has been in the literature for 70 years. And it is the following. And I'm going to, because we have limited time here, I want to just spell it out. And then, you know, fact check it, if you'd like, you can do that easily. The orthopedic surgeons, if they had kept control of this joint, these joints, the temperament able to joints, this problem would have been solved 70 years ago.

16:32That is my belief. That is my statement. Because the orthopedic surgeons knew all about what I'm about ready to tell you. And the dental profession didn't listen or hear or want to hear. I'm not sure which. We had selective hearing. So the data has been known by the medical profession, orthopedics, particularly, for a long time, decades, decades and decades. And here's what they know. Inflammation in a joint. See, all the dentists are taught in dental school. Maybe Jessica, this is maybe what you teach your hygienist when you teach them. I don't know. But the dentist, I can tell you this, every dental school in the country teaches that this joint is different, unique, complicated, no less. Not true. That is why they never were able to figure it out. This joint, the temperament able to joint, works like every other joint in the body. And when you start out with that premise, and fact, that is a fact, then it's easy to

17:33see what's going on. All right. So here's what happens. When the temperament ever joint gets damaged, the joint gets damaged for only three causes, three categories damage the temperament to the joint. The one everybody focuses on, the thing is that the only one is Bruxism, clenching and grinding. We could talk about that for almost an entire 30 minutes. Day year. Clenching and grinding. Bruxism. Acute trauma. The most common is motor vehicle accidents and especially whiplash injuries, because when the next snaps back, the mandible drops, snaps open and damages the internal tissue within the joint. And then the third is functional malocclusion. The functional malocclusion, that would explain it completely, that it takes 20 minutes or 30 minutes. But the bottom line is functional malocclusion is either where the teeth or the jaws, or both, are in such bad harmony that they overload the joint. What all three of those circumstances create is overloading the joint.

18:36Bruxism, trauma, and Tennessee, it's for the guys, it's four by fours off the back of the pickup truck or barfights. And then for the ladies, it's motor vehicle accidents and then functional malocclusions, which all of you seek on a daily basis, one way or another. And they're very common. Literally, at least 10 to 15% of patients have significant functional malocclusions. Okay? Those are the three things that damage a joint. When a joint becomes damaged, it creates inflammation. What is inflammation? Inflammation is the body's response to repair, to heal. That is what inflammation is. Wherever in the body it is. Okay? When the inflammation does not heal for whatever reason. You can talk about, you know, you get additional insults or the damage was so bad, it's not going to heal well or you've displaced something. But once the healing inflammation is there long enough, the cell types turn into what we

19:39call chronic inflammation. And chronic inflammation cells have a different biology to them. They have a different cell fluids that they create that damage the joint. So now you're off to the races. You have a damaged joint that has chronic inflammation. And here is what has been in the literature for 70 years. Chronic inflammation will send autonomic nervous system signals, ANS sympathetic portion. I know I'm getting a little deep with the big words here. We got it. We got it. We know ANS. We know PNS. We got it. Good. Excellent. So you have, you have chronic inflammation. It sends an autonomic signal, sympathetic portion to the brain stem. It doesn't go up into where we think it basically to where we have action and your mechanisms call in the brain stem and says, I'm inflamed. I'm damaged. I'm inflamed. That's in the reticular system where all the nerve, the nerve begin and they are all

20:43congregated in the same place in the very small brain stem. The brain stem then takes this information and sends a signal back out autonomic nervous system. I'm going to help you out. Don't move the joint. Just don't move it. I know. Just become tight. We're going to help you out. And then they send signals to the muscles of massacration first. And we know where those are. And if you have neurounatomy, Jessica, which I know you do because you taught it, right? If you have the muscles of massacration and the origin and assertion of these muscles, they get tight for sure, but the pain is not coming from the muscles. It's coming from the where the muscles are inserted onto the bone. Why there? Because the periostume is where the nosyceptors are. The pain receptors are in the periostume of the bone. So when you have these big muscles, the masseter, the temporalis, the internal external terroglyide, the myelohyloid, these muscles get tight. They pull on the bone and wherever they're attached to the bone, origin and or insertion,

21:46is where it's going to hurt. And this pain can move around from side to side, from muscle to muscle. And sometimes patients will come in. They'll show you exactly where the anatomy is. I mean, the number of times people come in and they hurt right there every morning. Well, Jessica, what is there? What? Right there. Now you're telling me you're insertion. Yeah, you're talking about the temporalis muscle. Yeah, you're the insertion points right there. And they're telling you what this disease is all about, almost. I don't know. But anyway, so now, but if that holding, trying to hold the jaw still, what you can't, right? If you continue to Brooks, you got to eat a couple times a day, whatever you're doing, you're talking, you're on the cell phone, you're moving your joint, you're not holding it still. It's not going to heal. If it doesn't heal, these signals continue on into the brainstem. The brain says, hey, I told you, hold the jaw still. Now what I want you to do is hold the whole head tight, tighten up.

22:47Man, don't move. That is why neck pain is the second most common symptom of TMD. True. If you if you talk to anybody who treats TMD to any degree, they will tell you headache is number one, neck pain is number two. And then if that is not enough to tighten up the head, the jaws, and then the head through the neck, then it sends our signals to tighten up the entire upper shoulder girdle and patients will complain constantly of upper back and shoulder pain and tightness. And then the last symptom that I mentioned, which is not well known, but I'm not the only doctor who actually has found this out. I did it independently because we had one of my patients come in years ago after I started treating it this way and say, you know, thanks so much. My headaches gone and my neck pain is gone. But what about this tingling in my arm and my fingers because it went away too? I said, can you tell me how that and I went, I have never heard of that before.

23:47I mean, I have no idea. About six months later, another woman comes in and it's pretty much the same story. So I went back to the textbooks. I went back to Grayson Attyby actually, trying to figure out why that would be and how that happens is your, your strap muscles, the scaling muscles on the side of the neck, their little strap muscles. When they get the signal, we get tight through the strap muscles, go the brachial plexus. And the brachial plexus supplies the arm hand and fingers and patients will complain when those strap muscles tighten up on the brachial plexus arm hand, but especially fingers and especially these last two digits, the little finger and the one right next to it, not all the time. It was very, but I can tell you more often than not, patients who have that symptom and not everybody has that symptom. It's not one of the primary symptoms, but they'll talk about those last little fingers or the ones that are numb. Anyway, so that is the mechanism of what's going on.

24:51And then there is the non-painful, that's the painful symptoms. The non-painful symptoms, again, I had to go back to the book and I go, you know, I had the broad background. So I pulled out the Grazonatomy, and sure enough, when I lecture on this, I actually pull up the diagrams off of Grazonatomy, there is a Fisher, literally an opening. A Fisher is a lengthy opening, okay? A Fisher called a Petro-Timpanic Fisher. It was identified in 1680 by an anatomist by the name of Johann Glasser in Switzerland. 1680, we've known about this Fisher. And this Fisher allows inflammatory fluid to go from the Glenard Faso, from the Glenard Faso, the temperender rejoined, into the middle ear. And when you get inflammatory fluid, I don't think you're going to get cells going up

25:53there. But inflammatory fluid going through the Petro-Timpanic, quote, Glasser Fisher, it's also called the Glasser Fisher. Into the middle ear, it affects the hearing mechanism and the vestipular mechanism to cause what? Tinnitus, which is the proper, not tonight, is tinnitus, ringing in the ears, fullness in the ears, subject of hearing loss and dizziness. And how I know that, I know that is fact, because we have had now after 5,000 cases that I've personally treated. And this isn't count the other doctors in the United States who are used this technology that I developed. The ringing, fullness and dizziness go away. I mean, it's like, it goes away. Now all of these symptoms do not go away simultaneously. I'm the first to tell you that. People symptoms come down pretty fast. Tinnitus, subjective hearing loss and vertigo dizziness.

26:53Those are two separate. They're not identical, but they, for the patient's point of view, I'm dizzy. They go away slower. Sometimes it takes several months for those to calm down. And tinnitus is almost the last symptom to go away we have found. Sometimes that takes, can take six months, eight months, even a year sometimes. And I got a lot of stories about that. But that is the mechanism, both painful and the non-painful mechanism. And we have now doctors who are licensed because I discovered it. I'm going, now I've got 50 cases, 100 cases, and I'm going, wow, this is amazing. I wonder if I could put a patent on this little device. And sure enough, it took two years to do that and a couple more years to get the FDA clearance so I could tell other doctors about it. Now we have a company that makes these things and teaches other doctors how to use the protocol because, again, I think you heard me say this is a device and protocol.

27:56Is this something you're just sticking somebody's mouth and hope to see what happens? You've got to know a little bit about the nuances. You have to know a little bit about anatomy, cell biology. If you're not getting the response you expect, you need to know why. And there are reasons. I mean, we figured that out years ago. If you have a patient, you're not getting the right response that you're expecting. There are only a couple of reasons that could be happening. And then you handle those and then they get the response. So, I see we're running for one time. I just want to say that I had to, so we have this company and we teach other doctors to do it. And we had to call it, I had to give up. I had to call it the urbanic device and protocol because when I surveyed my patients and we had a lot of those, this was 10 years ago, which did a survey and the patients wanted to call it the top two survey number responses were save my life device and miracle device.

29:01And I went, that's why, you know, like the polpial guy on PV. Isn't that synonymous with urbanic? Isn't it, you know, save your life and miracle? Isn't that what your name means, Dr. Romantic? No. It's just around, in middle Tennessee, of course, in middle Tennessee, pretty much everyone knows about what we do here. That's for sure. So, if, and I do need to get this in in two minutes, I really believe in you. This is the one thing I wanted to get across. Hygiene, the hygienist in our country are the, are the first person's people to see these patients and have the best opportunity to diagnose them. It's easy to diagnose. This is not a complicated disease. Now you know the symptoms. You ask the patient, do you have any of these symptoms? 45% of patients will say yes.

30:0245% of females have temporary joint disorder. And then you, you have symptoms and then you do make, you can, you confirm your diagnosis by walking beside or behind the patient, having them open widely, put your fingers in the glenoid phosphofermally, firmly, worn the patient, by the way. Don't do it without telling what's going to happen and have bite down quickly. Have them close quickly. If the joints inflame, they will say, out or some of them scream. It hurts. If it hurts, the joints inflame. Now you know what the proper diagnosis of TMD should be. It should be inflammation of the joint. Doing Botox and that's, that would be a, that would be a totally different thing to talk about is nonsense. Getting symptoms is nonsense. Just make the inflammation go by, away by resting the joint according to a protocol, just like the orthopedic surgeons do for tennis elbow, tennis elbow and TMD are the same disease.

31:05Exact same, exact same disease, exact same pathophysiology. Elbow, brain, don't move the joint, your forearm hurts. That's what tennis elbow is. Perfect. Well, I mean, that's super practical. I mean, I think anybody listening to this right now can put their fingers instead of their ear canals and just do that quick test and see if that's something that it's, we are all suffering, including ourselves, right? I mean, you mentioned numbness. How many hygienists have numbness in their hands, right? It could be not just our posture or seeing our patients clinically, but it could also be, you know, the fact that we may have TMD as well. And it starts with us and nothing like, like, explaining to the patient that we also suffer from that as well, like sensitivity, right? We also suffer from sensitivity from time to time and being able to kind of properly screen these things and help our patients out is what we're here about. And I love episodes like this because we get to learn so much and we get to have a lot of practical takeaways that we can implement immediately.

32:07And listeners, I'm going to put a lot of information and doctors or orbednics information here as well in the show. So we can, if you want to explore more of these research in case studies and his information, that's what we have that for. Thank you, Dr. Urbanick. We appreciate you. Thank you, Jessica. Thank you, Dave. That's a wrap on today's episode of a tale of two hygienist podcast. If this conversation made you feel seen, inspired or even just a little fight up, share it with a fellow hygienist or fellow dental professional, share it with your neighbors, your friends, share it with everyone. And that is how this community grows. Make sure you subscribe, leave us a review and connect with us on social media so that we can keep on going with this conversation. Remember, you career, your voice and your story matter here. We're David. And Jessica. And until next time, keep learning, keep laughing and keep showing up for yourself and for each other. This has been a production of Endeavor Business Media, a division of Endeavor B2B.