Billy came to Dr. Arthur Chal in what he described as “excruciating pain” from his TMJ disorder. He was 73 years old. A quick look at his teeth shows that they are stained and severely worn. Many dentists who pride themselves in their TMJ work would be tempted to prescribe a full-mouth reconstruction, with crowns on all the teeth. Dr. Chal’s approach, however, is to get complete information before taking any steps to solve the problem. A CT scan of his temporomandibular joints shows that the joint on the left is grinding bone against bone every time he opens or closes. The condyle has degenerated and the disc is gone. This was the source of his pain.
Dr. Chal proposed a simple removable orthotic that Billy could wear that would balance the forces in his mouth and take the excessive pressure off his left side. Since he has his own laboratory on the premises, Dr. Chal was able to accomplish this. Almost all other dentists who do work like this send their orthotics to an outside lab for fabrication. The result is that they lose control of the process and introduce possibilities for error.
The result? In Billy’s words, “After fitting me with an appliance, my pain was completely gone in two days and has not returned.” With this simple orthotic appliance, Dr. Chal was able to help Billy avoid surgical reconstruction of his left TMJ, which would have cost about $25,000 in surgical fees plus the hospital stay and anesthesia. In a thank-you note to Dr. Chal, he said, “The team involved in my treatment has been truly impressive and I feel that I have received the best treatment available at any price.” There are no “after” photographs of Billy’s teeth because no work was needed on his teeth—their appearance was satisfactory in his eyes.