The early dentists who attempted to help TMD patients through occlusal therapy include the following:
Nathan A. Shore (1914-1984) Spent 40 years focusing on “TMJ Syndrome”, NYC
Harold Gelb, NYC, did much to popularize “TMJ” from the 60’s thru the 80’s. He had several controversial methods, including putting condyles in what he called the “4/7 position” and building a “Gelb splint” which did not follow the principles of occlusion.
In the early 70’s several dentists who had been trained in gnathology began eliminating the more esoteric methods (i.e., tripodized occlusion) and making it more user-friendly for clinicians. I call it gnathology-lite. They include: Peter Dawson, Henry Tanner, Niles Guichet, Peter Neff, Bob Lee, and Terry Tanaka. They perpetuated the concept of treating TMD through focusing on the occlusion, although Dr. Tanaka has done much to advance our understanding of the TMJ with excellent anatomical research via cadaver studies.
Barney Jankelson, a Seattle dentist, invented a jaw tracking device in the early 70’s. He incorporated the use of TENS on the jaw muscles, and claimed that this method proved where the jaw “belongs.” He then advocated rebuilding the occlusion to this “scientific” position, which almost always resulted in opening the bite. His mantra was “If you can measure it, it’s a fact; if you can’t, it’s an opinion.” He is considered the father of electrodiagnostics and neuromuscular dentistry.
Dr. George Goodheart, D.C., 1918-2008, Detroit, Michigan. In 1964 Goodheart developed applied kinesiology—a method of “testing” the body in ways that “diagnosed” any physiologic or medical condition the patient may have. For dentists, this technique was popularized by George Eversole, who had studied with Goodheart. Many dentists interested in TMD took weekend courses from Eversole in the 1980’s. Applied Kinesiology is widely used by chiropractors today.
Bill Farrar (pronounced “fair-ah”), Montgomery, AL, 1924-1985. Bill Farrar, along with an oral surgeon, Bill McCarty, “discovered” the internal derangement of the jaw joint. Prior to Farrar, the biomechanical function of the joint was poorly understood. In 1979, Farrar began lecturing on his discoveries, which transformed our understanding of this condition. He introduced (along with others) transcranial x-rays to study condylar position. He introduced disc re-capturing and jaw unlocking techniques. He used a pull-forward appliance on many of his patients to prevent their jaws from locking again.
o Review: The underlying philosophy regarding appropriate condylar/mandibular position for TMD patients divides these experts into two basic camps:
Centric Relation/ Ideal occlusion
Gnathology,
Restorative occlusionists
Anterior Condylar Repositioning
Kinesiologists
Gelb
Jankelson
Farrar
We will revisit when and where to employ condylar repositioning later on. Farrar was erroneously interpreted as saying that you had to hold the condyle forward forever. He never said that. However, he is the one most responsible for “phase II” dentistry on TMD patients. More accurately, Farrar (along with Gelb, Jankelson, kinesiology) is used as an excuse by too many dentists to perform phase II dentistry (orthodontics and/or extensive crownwork) on TMD patients.
The lite gnathologists, who I will now call the occlusionists, especially Dawson and Guichet, were adamant that Farrar was wrong about what caused jaw clicking and the need for provisional condylar repositioning. They dismissed kinesiology, Gelb, and Jankelson out-of-hand as little more than quacks.
#6 The claims of so-called experts in the field
By the early 1980’s, it became the battle of the gurus with egos, primarily between the occlusionists and Bill Farrar. The occlusionists ganged up on Bill Farrar. He was telling us that attempting to put TMD patients in centric relation was iatrogenic. He was bringing their jaw forward to recapture their disc, or at least reduce joint capsulitis. The occlusionists regarded this as heresy. However, Farrar was unflappable at conferences in which he was attacked. I was privileged to be with him every year until he died in 1985 of emphysema. He was only on the TMD national stage for 6 years, but he made a huge impact on TMD treatment throughout the world.
Over 900 dentists traveled to Farrar’s small Montgomery AL office from 16 foreign countries and 46 states. He taught 79 courses in Montgomery between 1980 and 1985. He published numerous articles in American and European dental journals over a 25 year period. He worked in his office until he died.
“My time is short, I will fight and I am not bitter. I have accomplished much of what I wanted to do. It has been exciting…Criticism on a professional level is actually beneficial, because it stimulates us to re-think and re-test our viewpoints and concepts. We must not accept old ideas not based on scientific fact.”
--Bill Farrar
“Dr. Farrar considered his patients his primary teachers. His clinical findings encouraged him, even drove him, to scientific contributions. He possessed a mind that did not allow intermissions and a heart that reached out to his patients.”
--Dr. Jack Haden
In his final days, Farrar was heard to say, “Medical science has not yet been able to attach a prognosis of doom on man’s spirit nor to predict the physical strength it can harness. I ask only to contribute to life as long as I live it.”
Bottom Line: Bill Farrar caused a huge paradigm shift in the world of TMD. More than any other before or since. Those who profess expertise in this field are standing on the shoulders of Bill Farrar, whether they know it or not. For more on Dr. Farrar, see Jack Haden’s guest editorial in the Journal of Craniomandibular Practice, Oct, 2008, found here: FarrarHadenCranioArticle.pdf
For those of us who grew up in the world of gnathological occlusion, we could see the writing on the wall. We realized within a year of Farrar’s 1979 revelations that the days of manipulating patients into centric relation, making splints in that position and subsequently equilibrating them into this position was not the answer for TMD patients. If the disc is dislocated, as it is in the majority of TMD patients, there is no such thing as “centric relation.” The most you can hope to accomplish is identify an “adapted centric position” (Dawson’s term).
Also, by the late 1970’s we had some excellent clinicians who were leading the way in looking at more than just occlusion in evaluating and treating these patients. They include:
All three organizations support the use of splints, although they use them for different purposes and have different beliefs about the mechanism of how a splint works.
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