TMJ Surgeon.com A Celebrity’s Story

Celebrities often have their personal health issues revealed in the media, particularly those issues of endurance and long term treatment that impacts their career significantly.  Rebecca Russo, actress/singer was gracious enough to share her experience with “TMJ” in an issue of  a  Connecticut newspaper “Republican-American” in November, 2010.

Refer to www.rep-am.com/articles/2010/11/09/lifestyles/health.

This is a media article about Ms. Russo’s fight with advancing TMJ despite non surgical orthodontic treatment .

If you read the article carefully, these facts will emerge:

1. Rebecca Russo related subjectively that her problems with orthopedic joint instability of the jaw joint (TMJ popping and clicking) became established during adolescence.

2. At the advice of her general dentist, she was referred to an orthodontist who treated her mild dental crowding condition with dental braces.

3. During her two years of treatment, her pain became worse and function deteriorated.  According to accounts, a good cosmetic result was assured, but jaw pain and joint function worsened.  She married and for the following couple of years, things got worse.   One night, on stage and during a performance, she sustained an acute subluxation or dislocation  of one or both joints. (Open joint locking). She finally was referred to a provider who understood the importance of imaging patients, ordered MRI examinations, and discovered gross deterioration of both joints.  Her orthodontic dental and jaw alignment conditioned had relapsed.  Ms. Russo’s career was basically suspended for two years during complicated management required to perform joint replacement. This  occured during her mid to late twenties….just at a time in career development when she could least afford the set-back.   Due to her perserverence and the talented work of her surgeon, Ms. Russo was able to return to work, on stage.

The blog section of this web site is devoted to providing an evidence based model using information from the literature, examples of MRI imaging and surgery to provide readers with a perspective of a health issue that the NIH estimates effects 10% of the American (and world) public.  It is also designed to allow patients affected by this problem to be educated in this area when having to face important decisions about their own management.

Rebecca Russo’s experience is not unique.  In fact, in my professional career, her story is quite common.  Here are some important points.

1. Rebecca related that the onset of her functional problems began in adolescence.  This is important for several reasons.  Most patients relate this, at least those who experience advanced osteoarthritic destruction of the joints by their 20s or 30s. Research has conclusively shown that osteoarthritis of the human jaw joint has a mean onset between age 25 and 35. This is a significantly advanced timetable relative to other orthopedic systems.  (The first confirmation of this was put in the literature 35 years ago !)  1 (References cited below)  (1)

The reason is that developmental impingements (see other  blogs of surgical/MRI examples and a case of developing impingement in an 11 year old patient) often advance during the final years of skeletal jaw growth and development.  Impingements of the jaw joint leading to significant joint derangement, like impingements of the shoulder joint, will significantly damage if not destroy the important functional cartilage of the joint system during attempted normal joint use and range of motion.

2.  The most common perception among general dental providers is that generic “TMJ” disorder is a problem of occlusion or the way teeth fit, or a combination of stress and psychophysiologic disorder.  This being their paradigm, referral to dental specialists who change bite or occlusion structure in patients often takes place. Almost never are these patients sent for proper joint imaging to be able to discern who just might be an at risk patient.  It is unfortunate that this is not common non-surgical clinical practice.

Simmons, Katzberg, and Westesson have published in the orthodontic and general dental literature relative to MRI evaluation of non surgical and orthodontic treatment, but there are few other such papers. Patients with Wilkes / Piper II (reducing derangements) show improvement with lower jaw anterior repositional appliances (ARA) and the occlusion adapted to MRI evaluation of an orthopedically stabilized/corrected joint.   (3) (4) (5) .  Lundh and Okesson have likewise published clinical studies of success with the ARA but based on traditional radiograph evaluation.  (6,7)

Aadvanced Wilkes III derangements or greater may not likely respond favorably, particularly if the condition worsens during treatment.  The reason:  biomechanical engineers have shown that the jaw joint is maximally loaded during mouth opening, and not  necessarily with the teeth in contact.  This science, published outside of the influence of political dentistry, refutes the concept that ideal tooth alignment or occlusion will have much impact in most cases of advancing dysfunctional joint derangements that impact the mouth opening function. (ie:  progressing jaw popping and locking with pain during mouth opening and closing maneuvers) (2)

When orthodontists  (and many oral surgeons for that matter) begin to recommend proper imaging prior to certain treatments and make a concerted effort to understand what the biomechanical engineers are telling us, perhaps numbers of these cases will decrease over time.

3.  Advancing  TM joint arthrosis in women is seen 2-3 decades earlier than the same degree of destruction in other orthopedic systmes of the body.  This has been discussed frequently in this site.

4.  Perhaps Rebecca Russo’s advancing condition could have had an altered course with a different paradigm.  Admittedly, this is speculation when looking from outside –  in.  However, what can not be argued, is the lack of imaging never tells us anything.  Almost all advancing health care issues carry the mantra of early discovery, diagnosis and appropriate management based on the paradigm of understanding physical function and the consequence of irreversible disease.  NOT TMJ !!  Imaging is almost never recommended by many “TMJ Specialists” and surgery is always a last resort…only after years of failed stubborn attempts of different dental treatment methods and much expense.   Only  the paradigms similar to Dr. Costen’s syndrome and “muscle spasm ” because the teeth do not fit right”  are the only recommendations and considerations for many patients, particulary adolescents with advancing disease from a multiplicity of causes.  (See editorial/blog comment from August 2010 in this web site blog section)  Rebecca Russo is an example of methodology and paradigm suggested by this editorial.

5.  The consequences of no interest in making an accurate diagnosis  with imaging prior to treatment can have devastating consequences in select cases.  Just as Rebecca Russo, Burt Reynolds and others who have indured significant life impairment from an unfortunate delay in appropriate diagnosis.

WSK

1. Gallo, Luigi M. : “Modeling of Temporomandibular Joint function Using MRI and Jaw-Tracking Technologies-Mechanics”, Cells Tissues Organs 2005; 180; p. 55. (See multiple references to this epidemiologic data in bibliography)

2. Tuijt, M., Koolstra JH, Lobbezoo F, Naeije,M. :  “Differences in loading of the temporomandibular joint  during opening and closing of the jaw”.  Journal of Biomechanics, 43 (2010) 1048-1054.

3. Simmons HC: Orthodontic Finishing after TMJ Disc manipulation and recapture”, International Journal of Orthodontics, volume 13,  2002, Page 1-6.

4.  Simmons HC and Gibbs SJ :  “Recapture of temporomandibular joint disds using anterior repositioning appliances: An MRI study”Jnl of Craniomandibular Practice.  vol. 13, No. 4, pp. 227-237. 1995.

5.  Katzberg RW, Westesson, P-L:  Diagnosis of the Temporomandibular Joint.  W B Sounders Company, 1993.

6. Okeson JP: “Long-term treatment of disk-interference disorders of the tempormandibular joint with anterior repositioning occlusal splints.  J Prosthet Dent, 1988, Vol. 60; 611-616.

7. Lundh H, Westesson P-L, Jisander S, Eriksson L:  “Disc -Repositioning onlays in the treatment of temporomandibular joint disk displacement.  Comparison with a flat occlusal splint and with no treatment”  Oral Surg, Oral Med, Oral Path, 1988, Vol. 65, 155-162.