TMJ 'dysfunction' - Health implications

Dr Aseem Malhotra writes in the Guardian:
"When former airline pilot Tony Royle came to see me last year to seek reassurance that it was OK to participate in an Ironman event, having stopped all his medications 18 months after suffering a heart attack, I was initially a little alarmed.

But after talking to him, I realised he had made an informed decision to stop the medication after suffering side effects, and instead had opted for a diet and lifestyle approach to manage his heart disease.

His case is a great example of how evidence-based medicine should be practised. This is the integration of clinical expertise, the best available evidence and – most importantly – taking patients’ preferences and values into consideration.

But our healthcare system has failed to keep to this gold standard of clinical practice for the most important goal of improving patient health outcomes. The consequences have been devastating."

An article by the CDC says:

"Modern medicine, through over-prescription, represents a major threat to public health. Peter Gøtzsche, the co-founder of the reputed Cochrane Collaboration, estimates that prescribed medication is the third most common cause of death globally after heart disease and cancer.

A general practitioner recently writing in the BMJ, said that evidence-based medicine is polluted with “fraud, sham diagnosis, short-term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes”, all leading to “over diagnosis and misery”.

In more temperate tones, Goldberger and Buxton recently suggested in a JAMA Viewpoint article that:

"Personalized medicine and guideline-based medicine “present conflicting priorities”, with evidence-based guidelines derived from clinical trial data failing to recognize the heterogeneity of the patient population to which they will be applied.

The existence of these guidelines then acts, they say, as a barrier to the development of personalized approaches that would be more appropriate for different population subgroups – including those likely to gain no benefit from the intervention."

The two most prestigious journals of medicine in the world are The Lancet and The New England Journal of Medicine. Richard Horton, editor-in-chief of The Lancet, said this in 2015:

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue”

Dr Marcia Angell, former editor-in-chief of NEJM wrote in 2009 that:

“It is simply no longer possible to believe much of the clinical research that is published or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor”

Evidence-based medicine is broken is the heading in an article written by a General practitioner Dr Des Spence in a VERY INTERESTING article in the British Medical Journal. He goes on to say:

"Evidence-based medicine (EBM) wrong-footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fuelling over diagnosis and overtreatment.

You see, without so-called “evidence” there is no seat at the guideline table. This is the fundamental “commissioning bias,” the elephant in the room, because of the drug industry controls and funds most research. So the drug industry and EBM have set about legitimising illegitimate diagnoses and then widening drug indications, and now doctors can prescribe a pill for every ill. The billion prescriptions a year in England in 2012, up 66% in one decade, do not reflect a true increased burden of illness nor an ageing population, just polypharmacy supposedly based on evidence. The drug industry’s corporate mission is to make us all sick however well we feel. As for EBM screening programmes, these are the combine harvester of wellbeing, producing bails of over diagnosis and misery."

Some of us were made aware of all this by the great Eustace Mullins in his classic "Murder by injection" who tells us about the whole conspiracy to defraud people and governments. This is a must-read for anyone who wants to better protect themselves. Murder by Injection: The Story of the Medical Conspiracy Against America

Retired heart surgeon Dr Donald Miller, Jr. explained what Evidence-Based Medicine is and how it has slithered its way into health care in America in an important article called Modern "Medicine at the Crossroads" that was published in The Journal of American Physicians and Surgeons in the Fall of 2015. Here are some important excerpts:

"Doctors in academic medical centres write practice guidelines. They base them on clinical trials that randomize populations of patients with a given condition into treatment and placebo groups and choose treatments that are statistically shown to work best. According to the tenets of evidence-based medicine (EBM), epidemiological and biostatistical ways of thinking provide what its proponents consider “best evidence.”
An example of further deterioration is the medicine Lyrica (pregabalin). "It is one of the world's best-selling drugs—but its success is as much to do with bad science and unfounded claims of medical researchers".

Researchers at McGill University in Canada looked at the ways hype has been built up about Lyrica.

They discovered that doctors were prescribing the drug for conditions for which there was little or no evidence that it could help. In one example, the researchers found that the drug has been prescribed for more than a decade as a treatment for low back pain—but there haven't been any large rigorous trials that prove its effectiveness.

Surprisingly, these unfounded claims haven't been driven by the manufacturer—at least not directly—but instead by researchers who have been awarded funds by government agencies or their own medical centres.

As a result, clinical trials are doing the very reverse of what they are supposed to do: they are designed to alert doctors and patients to ineffective and costly treatments when instead they are promoting them, the researchers say."

(Source: JAMA Internal Medicine, 2018; doi: 10.1001/jamainternmed.2018.5705)

Dr. Seena Fazel of the University of Oxford in the UK and colleagues write in the BMJ after looking at a swedish study:

The team looked at a Swedish registry data on 191,973 people aged 15 and older prescribed pregabalin or gabapentin in 2006-2013. "During that period, 5.2% were treated for suicidal behaviour or died from suicide, 8.9% had unintentional overdoses, 6.3% had serious car accidents resulting in emergency hospitalization or death or were arrested or convicted for a traffic offence, 36.7% had head or body injuries, and 4.1% were arrested for violent crimes."

This adds up to 61.2% have some serious one type of effect. Other adverse effects are excluded.The drug, often used for back pain, has not got one iota of a chance to take anyone's pain away, as you will have read in this forum.

EBM downgrades traditional forms of medical evidence, notably a doctor’s clinical experience and understanding of pathophysiological mechanisms of disease, both unquantifiable. This forum is the ultimate evidence that most illness is amenable to physical treatment and absolutely nothing to do with EBM of drugology.

Evidence-based medicine applies the principles of epidemiology to individual patient care, basing that care on statistical trials. Probing EBM, co-author Clifford Miller concludes, “EBM has failed in the real world of medicine, in terms of its use in making medical decisions and in proving causality."

Practitioners are tightly controlled. A medical doctor does not venture outside his strictly controlled remit.

A dentist dare not investigate illnesses, which are traditionally attended to by doctors, even if the evidence clearly shows, as shown on this forum in numerous articles, that only dental interventions will help alleviate the symptoms of the patient.

The governing bodies have been set up to erase them from the register for the slightest infractions and destroy their livelihoods. Whole armies of lawyers appear to be working for these life-threatening, dangerous quangos.

The controlling bodies are policing organisations devoted to evidence-based medicine with none of the open-mindedness needed for the clinical practice of complex cases which our practice is submerged with.

As noted earlier, all along in this article, it appears that evidence-based medicine is a ruse to mislead and defraud. This forum attempts to inform the public of what really is the cause of illness.

Practising global care, encompassing the effects of the asymmetry of the skeletal system on systemic health, is the main way to treat patients.

Setting up evidence-based trials appears derisory. We have been doing it forever. All it has produced is widespread chronic illness and drugs, some at extortionate costs, which have never cured any patients but regularly cause serious adverse effects needing even more drugs leading to unworkable polypharmacy with no end in sight.

We need a multidisciplinary approach or a Functional Medicine approach to care for the sick. None of which our professional bodies are designed to tolerate as it affects the cosy relationships and revolving door appointments between the governing bodies and commercial interests.

We are here for the wider audience - the thousands of victims of fraudulent practices who have been left destitute by the perversions of many EBM practices.

Some 3 months after I wrote this article, I suddenly remembered an incident about EBM which I must share with you.

When I was a dental undergraduate, we used to attend clinics with a professor who was seeing patients presenting with TMJ pain or bruxism. His treatment was invariably a drug, which regulates the monthly menstrual cycle, and he is blamed most of the cause of TMJD/bruxism etc. to be of psychosomatic origin worsened at the time of menstruation. The patients were invariably female, so the drug, which regulated the menstrual cycle, was apt. He was against using bite-raising appliances because, according to him, "You can never wean the patient off them".

However, the use of bite raising appliances (splints) is rife in multiple maxillofacial departments of hospitals and general dentists treating TMJ pain.

Many patients are routinely told that they have nothing wrong with the jaw joint, and they should do something about their stress levels. This, although, their TMJ symptoms may have started soon after their wisdom teeth extractions.

Years later when I discovered a possible answer to ME/CFS etc. I called upon my supervisor from a research institute where I did my thesis for my Masters and invited him over to discuss how we could do some science-based study and get some scientific papers out. The gist of my conversation was about the TMJ and how best to treat it without drugs or splints.

He said he had been working with a professor on a similar project, but was very disillusioned that the professor was manipulating the research so that he could publish the outcomes that he wanted. He was comparing a drug to splints for jaw treatment and got the desired result, which was that the drug was far superior! It was the professor mentioned earlier!

I hasten to add that, according to my long experience, neither the drug nor the splint has any chance of healing any patient but more likely to make the patients' condition worse.

To me, this was comparing the 'bad' (splint) with the 'very bad' (drug) and then purporting that the 'very bad' (drug) was 'less bad' than the 'bad' (splint) and the conclusion that the drug was actually good! Frighteningly, this is the sort of way conclusions are drawn for the advocacy of many drugs.

This indeed was my first-hand experience with this particular "Evidence-Based Medicine" as far as dentistry is concerned, still affecting patients to this day. That incident took place more than 40 years ago.

What transpires is that there are two choices, drugs or splints. It is either a psychosomatic illness or a problem, which needs splints.

This happens to be the basis of TMJ treatment ever since, whereby patients are literally fobbed out of hospital TMJ departments without any real treatment. The patients are routinely told that there is nothing wrong with them, even when they present with excruciating pain in their jaws. They are told that the problem is due to bruxism, clenching, stress etc. Patients are advised to take anti-depressants or eat soft food. Others are prescribed with plastic splints.

Please note that Evidence-Based Medicine supposedly relies on empirical evidence which is measured, unbiased, and replicable

Anecdotal evidence is using one’s personal experiences and stories to illustrate one's point, but making conclusions based on one person's anecdotal evidence is insufficient, BUT when hundreds of patients say the same thing, it can no longer be considered anecdotal..

Compared to empirical evidence, it is even more convincing as it is:

1) Measurable by the level of recovery of a large cohort of patients;
2) It is unbiased as it is given by a diverse population with each one hardly knowing the other;
3) It is unbiased because no one is going to say they recovered if they did not;
4) And it is most certainly replicable time and again.

By its very success, it beats all empirical evidence which only produces limited results, is carried out on small sets of numbers for very short periods, is often biased, produced by and for the fortunes of pharmacological organisations where the profit motive far exceeds the altruistic model of patient care.
Here are some of the many testimonials I have, to support my contentions.

A patient's husband wrote last week:
"Following a period of treatment with Dr Amir, my wife has totally recovered after almost 20 years of illness with Fibromyalgia that had left her unable to work despite the many medications she was prescribed. She lost the best years of her life and her situation appears to have been caused by a dentist pulling several teeth out, effectively shrinking her jaw.

We have a very handicapped son, and looking after both my son and my wife whilst going to work full time to earn a living has been quite an ordeal. Someone is responsible for our losses and the subsequent mental stress incurred."
A, Barnes"

[color=#0000FFF]This patient is 20 years old:[/color]
"I have been seeing Dr Amir for 9 months for the treatment of jaw misalignment and TMJD. After unsuccessful orthodontic treatment as a teenager, I was referred to a maxillofacial department of a hospital, where I was prescribed amitriptyline [for jaw pain]. The drugs helped only by dulling the pain but came with lots of unwanted side effects.

Finally, I got in touch with Dr Amir, and he began to help me resolve the problem at the source - the jaw misalignment. My jaw was painful and inflamed because it was in the wrong place, putting a strain on the surrounding muscles and having a knock-on effect on the head, neck, shoulders, and rest of the body. He has been working with me to correct this, with different dental appliances and by showing me correct swallowing and breathing techniques, which help to keep the teeth and jaw in the correct place and return proper blood flow to the head. Progress is slow but steady, and I am finally on the mend. I can eat more, and faster, and I am less tired in general. I also feel more alert and daydream less. Thank you, Dr Amir!".....................AW

Here is what a 53-year-old, who has complained of jaw pain since the age of 14. She gives it a score of 10 out of 10 for jaw pain and has the following to say:
"I have suffered, for over forty years, with severe bruxism. I have had various dentists, NHS and private, all of whom have prescribed the use of a range of different night splints. The grinding and, even worse, daytime clenching, became unbearable, [Severe TMJD] after having four crowns on my second molars. I developed balance and walking issues and was referred for MRI scans. I discovered Dr Amir, whilst researching balance issues online. I became a patient in autumn 2017. Since then, I have been undergoing work to realign my jaw. It involves the use of various devices.

I travel from the Midlands to see Dr Amir. He has provided me with a unique, personalized, holistic care plan, way beyond anything I have ever experienced before, both private and NHS. My treatment has been life-changing, and I look forward to my visits. I am making excellent progress and I thoroughly believe Dr Amir has helped in my ongoing recovery. I have seen a great improvement in my bruxism. My sense of confidence and well-being is better than it has been for years. My walking/balance is much more stable and my outlook positive. Thank you, Dr Amir."................JP

Revised January 2021
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