Your body is interconnected. If you’ve hurt your neck, you’ve probably hurt your jaw joints. But if they go hand in hand, why don't more dentists collaborate with their medical colleagues? To break down the barriers between dentistry and medicine, Kirk Behrendt brings in Dr. Tiffany Lamberton, founder of TMD Collective, to highlight this neglected side of dentistry. Comprehensive, interdisciplinary care will only benefit your patients! To learn how to get started, listen to Episode 768 of The Best Practices Show!
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Main Takeaways:
Quotes:
“I think when general dentists hear TMD, they want to go like, ‘I don't want to treat joint patients. That seems complicated.’ But what we forget is that everyone has jaw joints. Everyone needs to move their jaw joints to open their mouth to get fillings, to chew, to eat, and to function.” (1:52—2:13) -Dr. Lamberton
“I am very passionate about interdisciplinary care. I think that when we have complex problems, we forget how to communicate and collaborate with our friends on the medical side. So, going back to my background as a physical therapist, as a PT, you deal with injuries to the neck and spine, the cervical spine, all the time. People get in car accidents, or they get whiplash, and we forget that, a lot of times, the jaw joints are injured at the same time that the cervical spine is injured — and those injuries can go hand in hand. I think a lot of dentists forget — a little bit of like, ‘Oh. Well, let's send that to the PT because I don't know what to do.’ So, what I want to empower general dentists to do is really learning to work together as an interdisciplinary team with our colleagues on the medical side. So, whether you're doing airway dentistry and you're talking with an ENT, a sleep physician, a PT, maybe a chiropractor, maybe a myofunctional therapist, each person on that team has a unique perspective and a way of looking at things, and they can really add to our practice and to our patients.” (3:06—4:26) -Dr. Lamberton
“What we're realizing is that even in these young patients, not everybody has healthy joints and not everyone has an ideal airway space. So, rather than waiting until it's a full problem as an adult, we have this opportunity to intervene in some of these young kiddos’ lives and be able to guide growth but have that guidance be dictated by modern imaging.” (5:30—5:59) -Dr. Lamberton
“No matter what the treatment is that we're proposing, if you're starting to see some high-risk things as a dentist, maybe some red flags, maybe the patient has some limited range of motion with how they're opening, or maybe you see some deviation as they're chewing, maybe you have heard from their clinical history some things that you want to dive into a little bit more like, ‘Hey, tell me about that car accident you said you were in six months ago. What happened?’ So, bringing all those skills together as a general dentist so that we're very comprehensive in how we assess our patients. Getting the answer first before we jump into a treatment is so key. And I think it's hard because we want to jump into clear retainers, or we want to jump into full-mouth rehab, or we want to jump into veneers and smile design. All those things are fun, exciting, and clinical topics that we've been well-trained at. But if you're missing some of those key, overall, big-picture items, you could maybe get yourself into trouble later on down the road where maybe you have this beautiful veneer case that you've done, but then six months later the patient starts breaking their restorations, and then you're tearing your hair out.” (9:41—11:10) -Dr. Lamberton
“I say to my endodontists, ‘Could you ever go back to practicing in the 2D world — where now you have cone beam CT — with a limited field of view? [Today], you can see every single canal. You can see every little bit of anatomy. And now, you have magnification. You have a microscope. Could you ever go back and practice the way that you did 10, 15 years ago?’ Most of them are like, ‘No.’ So, I'm like, okay. Well, let's apply that to the macro scale. Now that we have a bigger field of view with the cone beam CT, we can get the joints in the picture. We can look at the bone quality around the teeth. To borrow what Dr. Jim McKee says, the teeth are extensions of the maxilla and the mandible. So, if we can see that framework first and know our treatment that we're proposing, whether it's appliance therapy, whether it's clear retainers and orthodontics, maybe moving the teeth, or it's restorative treatment, if we have that picture, all of a sudden, it's like a crystal ball.” (12:17—13:35) -Dr. Lamberton
“If we're finding out in that young, pre-orthodontic patient that the joints are not healthy, then I think it changes the discussion of the prognosis that we're having with both the parent and the patient. Yes, we can fix your smile. But we have these limitations, or we may need to do another step in the process, or you may need to have another type of consultation as part of our comprehensive picture. I think airway has become a really hot topic in dentistry, and a lot of people are utilizing sleep screening and understanding the importance of including that in your medical model. But I really do think we can't leave the TM joints out of the picture. They're the neglected ones.” (14:38—15:29) -Dr. Lamberton
“Sometimes, I think when you purchase a big piece of equipment, you get the sales rep, you do the training, and then it's like, ‘Now what?’ You don't want to have an investment piece of technology in your practice that you're not utilizing or that your team is not utilizing. So, I think having those resources too, because we do have a lot of education materials that are available to us. But you can start drowning in YouTube or podcasts. There are so many ways to get information. I think when you have a like-minded group of practitioners that are connected and networking together, it can be really powerful.” (20:28—21:09) -Dr. Lamberton
“I think the quicker we can use those digital platforms to collaborate, share, and lend our perspective to the interdisciplinary team, it's going to all be for the benefit of the patient. So, right now, I think there are some barriers with cost and different systems. Obviously, maybe an academic or a hospital-based system may have better access or better funding to some of these things. But I feel hopeful that as technology is quickly and rapidly progressing, some of these questions will be answered and be a more efficient system for our patients. Because even an MRI right now, the cost can be prohibitive to patients. But you think about it, any other part of the body — if you had a rotator cuff tear, or you had an ACL tear in your knee — medicine is already using MRI as part of their diagnostic process. So, I would love to see dentistry jump into that with two feet and progress faster as well.” (22:43—23:59) -Dr. Lamberton
“Connecting with like-minded practitioners on social media, different platforms like LinkedIn or Instagram, can be really great ways to connect with other dentists quickly. And it's not just seeing each other's beautiful restorative work. It’s also, ‘How are you treating this type of patient? If you're seeing this type of high-risk TMD in a very young patient, what's next?’ So, I think connecting with other like-minded practitioners is so important to elevating our patient care.” (24:18—24:54) -Dr. Lamberton
Snippets:
0:00 Introduction.
0:43 Dr. Lamberton’s background.
2:54 Why this is an important topic.
7:12 What dentists get wrong about TMD.
11:36 Imaging and its importance in dentistry.
15:35 The importance of study clubs and finding community.
21:22 The future of the barrier in dentistry and medicine.
24:01 Final thoughts.
25:43 About the Women in Dentistry Symposium.
28:34 About TMD Collective.
Dr. Tiffany Lamberton Bio:
Dr. Tiffany Lamberton is a Washington native who has dual degrees in both Physical Therapy and Dentistry, both from Loma Linda University. When she graduated with her DDS degree, she was also inducted into the Omicron Kappa Upsilon National Honor Society and received awards in Oral Pathology and Leadership. She currently has focused her practice on evaluation and treatment of Temporomandibular Joint (TMJ) Disorders and is available for New Client appointments via her website www.tmdcollective.com. She will be a speaker for the Pacific Northwest Dental Convention and is delving into the educational world speaking about TMJ, Airway and Myofunctional Therapy. She is a member of the ADA, WSDA, and is a Pierce County Dental Society Board Member. She is also a member of AOMT and the Chicago Study Club. Dr. Tiffany considers herself a life-long learner! She lives in the North End of Tacoma with her husband and two children, and enjoys snowboarding, wake surfing, and Pilates.