In the 1980s, a growing number of dentists were "treating" TMJ disorder by grinding away parts of people's teeth. The "theory" was that when teeth "gear" together exactly, then people stop grinding their teeth. The dentists who were claiming great results didn't publish any controlled studies, but they made a lot of money (at first), often charging what would be more than $10,000 in today's money for the procedure. A growing number of people began filing lawsuits after breaking teeth clenching, stating their teeth had been weakened by these dentists, and the controversy grew.

By by late 1989, so many people were sustaining injuries from these dental procedures that a group filed a lawsuit to try to prevent an American Dental Association workshop where it was feared money hungry dentists with big egos would spread even further the myth of "curing" TMJ disorder by grinding away parts of people's teeth. The lawsuit didn't stop the workshop, but it did draw a lot of public attention, so the research presented in the workshop became heavily scrutinized.

The workshop was originally scheduled to take place in a 225-person auditorium, but after the controversy, about 700 dentists wound up attending. The survey of scientific literature examined at the workshop showed that while TMJ disorder can lead to malocclusion (bad bite), bad bite does not lead to TMJ disorder.

Studies examined at the workshop demonstrated that any change to someone's bite (whether the change makes the teeth fit together better or worse) increases TMJ problems for some people and decreases TMJ problems for other people. In one of these studies, people with TMJ disorder who had good bites agreed to let their dentists add "bumps" (made from composite filling material bonded to the teeth) on one or more of their teeth to create an uneven bite. For some of the people, this resulted in their TMJ symptoms decreasing. For others, it resulted in their TMJ symptoms getting worse.

After the workshop in late 1989, the number of dentists claiming that they could treat TMJ disorder through occlusal adjustment began to decline. This was probably in part because of the conclusive evidence to the contrary, and in part because of the rising number of lawsuits being filed against dentists who made such claims. But the lure of money is strong, so the dentists who had been doing occlusal adjustments by grinding away parts of people's teeth began to switch to doing occlusal adjustments by capping people's teeth, knowing that they were less likely to get sued because the capping did not weaken people's teeth.

Unfortunately, any dentist may choose to advertise himself or herself as a TMJ specialist. There is no accredited training in treating TMJ disorder, and many dentists warn that the dentists who choose to call themselves TMJ specialists are often among their least skilled and most money-oriented colleagues. The problem in the profession is so serious that the national Institutes of health has put up a web page on TMJ disorder, warning the public that there is no such thing as an accredited TMJ specialist, and warning people against any TMJ treatment that includes any non-reversible procedures (such as occlusal adjustment or surgery), because no such procedures have been scientifically shown to be effective.

Even with all that information available, many people assume that because a dentist is allowed by law to do a given procedure means that procedure has been shown to be safe and effective. While such laws exist for the marketing of medicines and over-the-counter medial appliances, licensed medical professionals are exempt form such laws, and it is still common today for dentists who are self-proclaimed "TJM experts" to charge $15,000 to $20,000 for occlusal adjustment procedures where every tooth gets capped. None of these so-called experts offer a money-back guarantee of any particular result, and these procedures make TMJ problems worse for many people.

Some dentists attribute more than half of their income to profits on mouth guards. It is against the law for an MD to make a profit on a medical device that he or she makes for you, but there is no such law that applies to dentists. If you find this troubling, you are not alone. At dental shows, mouth guard manufacturers often have giant signs reaching 20 feet in the air, advertising what high profits dentists can make on their mouth guards. It is not uncommon for a self-proclaimed "TMJ specialist" dentist to sell a mouth guard for $700 to $2000, when the mouth guard costs less than $75 to make (including molds and technician time).

The story gets more scary. Dentist-made mouth guards are not subject to FDA testing and safety regulations, while the manufacturers of mouth guards sold in pharmacies and on line have to be prove to the FDA that their products are safe and effective. That often means that mouth guards that you buy in the store have gone through documented clinical trials, while mouth guards made by a dentist have not.

The story gets even more scary. One of the things that dentists claim makes their mouth guards "better" is that they are custom molded to fit your teeth. Unfortunately most of the custom-made mouth guards sold by dentists consist at least in part of cast acrylic, which is thousands of times more toxic to have in your mouth than many over-the-counter mouth guards. Cast acrylic is made by mixing two poisonous resins to make a (mostly) non-poisonous plastic. But as you might guess, no mix is perfect, so some of each of the poisonous parts remains in the final product and leaches out into your mouth. How much? Some estimates say that about 10,000 times as many toxic molecules come out of a typical dentist-made mouth guard as were found coming out of the molded plastic water bottles that caused a scare in the news a few years back.

Ask your dentist, and you will discover there aren't any clinical trials that show that such $700 to $2000 mouth guards help people any more than the $40 ones sold in stores. In fact often the ones sold in stores have gone through clinical trials, and the ones sole by dentists have not.

The standard practice of most self-proclaimed "TMJ specialist" dentists (they are all self-proclaimed, because there is not such accredited specialty) is to prescribe a custom mouth guard or splint in the hopes of reducing TMJ symptoms. In the majority of cases, the first mouth guard prescribed either does not help, or makes things worse. At first this may seem strange, but in light of how nighttime clenching habits work, it makes sense.

A Nighttime clenching habit is an addiction that part of the subconscious has developed to a particular set of sensations coming from the mouth and the roots of the teeth during clenching. The particular set of sensations is different for each and every person.

It is normal for any person to find that using one particular design of mouth guard will have them clench less, and using another design of mouth guard will have them clench more. That is because the first design of mouth guard happens to reduce the sensations that person's subconscious craves during clenching, while using the second design of mouth guard increases what that person's subconscious craves during clenching, thus causing more clenching, and more TMJ problems.

Many dentists are honest about this, and will suggest that their patients try a number of inexpensive mouth guards (purchasable online or in a pharmacy) to find out what design may help them the most.

Unfortunately, many other dentists are not honest about this (or have deluded themselves), and say that their prescription mouth guards can more predictably cure TMJ symptoms. It is the world "predictably" in such a statement that is not true.

There is a big financial conflict of interest that pushes dentists to recommend a custom mouth guard (which is likely to cost you between $300 and $2000) over an inexpensive over-the-counter mouth guard. If your dentist makes such a recommendation, we recommend that you ask your dentist for a money-back guarantee on the mouth guard, that if using it does not improve your symptoms, you don't pay for it. Some dentists will agree to this.

Surgery should be a last resort in seeking relief from TMJ symptoms. Unfortunately, there are many oral surgeons who recommend surgery in situations where many other professionals would recommend against surgery, so if you get to a point where you are considering surgery, definitely get a second opinion, and make sure that at least one person whose opinion you get is not a surgeon.

In an on-line discussion (on the non-profit website TMJHope.org) between a large number of people who had undergone TMJ-related surgery, the majority reported that they remained in serious long-term pain after the surgery. This is likely to be the case when the nighttime clenching habit remains in place after the surgery, and the surgery usually does not change the nighttime clenching habit.