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Help! My Patient Has a Small Mouth! Working Alongside TMJ Physiotherapists – GF020
‘Easy Dentistry on Difficult Patients is still Difficult’ - Dr Lincoln Harris
Patients with small mouth opening can be a huge pain in the back for Dentists - but did you know there are ways we can significantly improve their mouth opening through physiotherapy?
https://youtu.be/v_u9sBAGliU
Watch GF020 on Youtube
In this episode I’m joined by Dr. Tzvika Greenbaum, a specialist TMJ physiotherapist who's here to spill the beans on his journey from headaches to jawaches. We bring to light the jaw-dropping collaboration between dentists and physiotherapists, making dental treatment easier for both you and your patients.
Need to Read it? Check out the Full Episode Transcript below!
Highlights of the episode:00:00 Intro01:02 Dr. Tzvika Greenbaum03:39 Dentistry meets physiotherapy09:33 Range of movement10:23 Asymmetry11:20 Prevention12:20 Advice to dentists14:34 Stretching16:17 The dental gym16:57 Sleep bruxists vs. awake bruxists19:28 Reducing sleep bruxism20:52 Obstructive sleep apnoea22:03 Statistics and diagnostic criteria25:16 At-home exercises27:20 Pain and discomfort28:39 Rehabilitation30:14 When to involve a physiotherapist31:12 Expected results32:21 Screening34:15 Dr. Greenbaum’s event39:04 Outro
Dr. Greenbaum’s upcoming course: protrusive.co.uk/greenbaum
If you liked this episode, you will also like 3 Simple TMD Exercises
Did you know? You can get CPD from the Web App or Phone App and watch premium clinical videos, for less than a tax deductible Nando’s per month?
Click below for full episode transcript:
Jaz's Introduction: One of my mentors, Dr. Lincoln Harris, once taught me that easy dentistry on a difficult patient is still difficult, and nothing makes our dentistry more difficult than that patient who just can't open, or the patient that keeps closing their mouth. Like, it's impossible to do high quality work in that kind of a patient.
Jaz's Introduction:Hello, Protruserati. I'm Jaz Gulati, and in this Group Function where we just focus on one theme, today's big topic is "Help! My patient Can't Open Their Mouth!" And you'll be amazed with some physio with some exercises with some training if you like your patient can actually open significantly more allowing you to do better dentistry and allowing the patient to get better outcomes. We're joined today by our first ever Israeli guest Dr. Greenbaum who is a physiotherapist who specialized in the area of TMD and he'll be coming soon to the UK.
So I thought ahead of his visit, let's talk about a really important topic that I think is going to help you guys in the real world where our patients are struggling to keep their mouth open. What causes this and how can we get involved either just by yourself or working in tandem with a physiotherapist? Let's join the main episode now and I'll catch you in the outro.
Main Episode:Dr. Greenbaum, welcome to the Protrusive Dental Podcast. How are you?
[Tzvika]Hey, hi Jaz. I'm very well. Thank you very much. And thank you for inviting me to speak about my favorite topic, which is Rehabilitation of Patients with Temporomandibular Disorders.
[Jaz]It's great to be able to help our patients in pain. And this is exactly what it's about, pain and discomfort. And I'm going to really try and extract all the knowledge and experience that you have. But just share with the Protruserati listening right now, what is your background? How did you niche into rehabilitation of temporomandibular disorders and psychogenic and in that area?
[Tzvika]Well, my bachelor's degree was back in 2004 in Haifa University in Israel. And after that, I headed up to Australia, South Australia to learn a master's degree in musculoskeletal and sports physiotherapy and a very well-known degree. But in that degree, I started to get into the topic of cervical spine.
Upper cervical spine rehabilitation of patients with headaches. It was a new thing for physiotherapists to rehabilitate patients with cervicogenic headaches. And when I came back to Israel after the Masters, I started to see many patients with headaches. And then I realized that many of them are complaining on temporomandibular disorders.
Back then I didn't know exactly what, how to define it, but it was clicks, lockings, pains, bruxism, all kinds of complaints classically involving the masticatory system. And then I've realized that there is a topic that is very relevant to my patients, to a majority of my patients, that I don't know enough.
And that was the trigger to start the PhD project in Tel Aviv University back in 2012 or 2013. And there was a professor, Professor Winocur in Tel Aviv University that was actually looking for the physiotherapist to join his team to research the involvement of cervical spine in patients with TMD and that was an excellent match because I could learn from the dentists about our facial pain specialist basically about temporomandibular disorder, and I could share my knowledge about cervical spine with them.
So that was a five years of ongoing research project where I was assessing patients with temporomandibular disorders for cervical spine involvement impairments and all kinds of deficits. And during that time, I had the chance to learn about the connections between cervical spine and temporomandibular disorder. And that was my way to that amazing and interesting clinical world.
[Jaz]So the work you do now, how much of that is clinical? How much of that is alongside dentists and going on from that, what is the best way that dentists and physios can work together?
[Tzvika]One of the main problems in the physiotherapy clinic is that according to the epidemiological findings data, we need to see much more temporomandibular disorder patients, but actually we don't see them so much.
So, there is a big gap between the needs, the demand for patients with TMD and the match to rehabilitation, to musculoskeletal rehabilitation. I think dentists are the best professionals to close these gaps because dentists do see patients with TMD how they see them because they ask their patients to open the mouth.
And when you need to open the mouth, that would be the best screening for temporomandibular disorders, even without diagnosing the exact specific diagnosis. But you understand that there is something with the masticatory system, something with the TMJ, and that would be an excellent trigger to refer the patients to the appropriate physiotherapy.
So, we see that in different countries that I teach, such as Belgium, for example, I've been teaching in Belgium since 2017. And back then, six years ago, the physios did not know what is temporomandibular disorder? How can they get these patients? And while training physiotherapists and also training them to contact dentists, they started to get more and more referrals.
And now when I come to Belgium, to Brussels and to Leuven and to Ghent, they keep telling, they tell me all the time that it's an excellent cooperation because they get, the dentists were looking for the clinicians that can help the patients and the physios were looking for the clinicians that can refer them to patients. So that's an excellent match between the diagnosis and the referral. And the rehabilitation, practitioner.
[Jaz]I totally agree. And with my management of temporomandibular disorders in practice, I don't think I can get the results without the physio that I use. So hopefully she'll be joining us when you are visiting the UK in December, Krina Panchal be joining us.
I've told her all about you. So, she's excited to learn from you. And then, she's learned from Rocobado and all these people around the world because just like you said, physios, it's in the UK. And now you said Belgium as well when they come out of physio school. They'd learn from like the neck downwards, right?
They don't learn about the TMJ, which is just a real loss. But I can see from their perspective, you mentioned that there is a disparity in terms of how many patients should be seeking care from physios compared to what they are. And I think dentists are indeed the link we should be recognizing that physios are in a great position, those who are trained in it are in a great position to help our patients, and we're going to get better results, patients being more comfortable, less discomfort, better mouth opening, all those things that we want from our patients when you work with a physio.
So, yeah, I strongly believe there should be a synergy between dentists and physios. And you told me recently before we hit the record button that you were in Hong Kong and a lot of the delegates, I attended weren't just physios or healthcare professionals, there were dentists as well, which I think is amazing. I think we can learn so much from each other by attending sort of each other's sort of educational circles. What kind of things were the dentists in Hong Kong interested to learn about from you?
[Tzvika]I think there were two main things for them is one is to understand the specific diagnosis of patients with temporomandibular disorders, not just to know something is wrong with that system.
But to understand exactly based on the available evidence, yeah, the body of knowledge that we have, what is the specific diagnosis? And secondly, what can physiotherapists offer patients with TMD? So, what can we actually offer? And what is the prognosis? How to cooperate with the physical therapist?
So, these were two main things and it was very interesting because in the first day, it was a day for more for the diagnostic component. They were really up to it and wanting to understand everything and be part of doing that. And in the second day, they were just observing the physiotherapist, just mainly observing how physios can actually approach with the hands on.
We had some case studies there,
View all episodes
By Jaz Gulati‘Easy Dentistry on Difficult Patients is still Difficult’ - Dr Lincoln Harris
Patients with small mouth opening can be a huge pain in the back for Dentists - but did you know there are ways we can significantly improve their mouth opening through physiotherapy?
https://youtu.be/v_u9sBAGliU
Watch GF020 on Youtube
In this episode I’m joined by Dr. Tzvika Greenbaum, a specialist TMJ physiotherapist who's here to spill the beans on his journey from headaches to jawaches. We bring to light the jaw-dropping collaboration between dentists and physiotherapists, making dental treatment easier for both you and your patients.
Need to Read it? Check out the Full Episode Transcript below!
Highlights of the episode:00:00 Intro01:02 Dr. Tzvika Greenbaum03:39 Dentistry meets physiotherapy09:33 Range of movement10:23 Asymmetry11:20 Prevention12:20 Advice to dentists14:34 Stretching16:17 The dental gym16:57 Sleep bruxists vs. awake bruxists19:28 Reducing sleep bruxism20:52 Obstructive sleep apnoea22:03 Statistics and diagnostic criteria25:16 At-home exercises27:20 Pain and discomfort28:39 Rehabilitation30:14 When to involve a physiotherapist31:12 Expected results32:21 Screening34:15 Dr. Greenbaum’s event39:04 Outro
Dr. Greenbaum’s upcoming course: protrusive.co.uk/greenbaum
If you liked this episode, you will also like 3 Simple TMD Exercises
Did you know? You can get CPD from the Web App or Phone App and watch premium clinical videos, for less than a tax deductible Nando’s per month?
Click below for full episode transcript:
Jaz's Introduction: One of my mentors, Dr. Lincoln Harris, once taught me that easy dentistry on a difficult patient is still difficult, and nothing makes our dentistry more difficult than that patient who just can't open, or the patient that keeps closing their mouth. Like, it's impossible to do high quality work in that kind of a patient.
Jaz's Introduction:Hello, Protruserati. I'm Jaz Gulati, and in this Group Function where we just focus on one theme, today's big topic is "Help! My patient Can't Open Their Mouth!" And you'll be amazed with some physio with some exercises with some training if you like your patient can actually open significantly more allowing you to do better dentistry and allowing the patient to get better outcomes. We're joined today by our first ever Israeli guest Dr. Greenbaum who is a physiotherapist who specialized in the area of TMD and he'll be coming soon to the UK.
So I thought ahead of his visit, let's talk about a really important topic that I think is going to help you guys in the real world where our patients are struggling to keep their mouth open. What causes this and how can we get involved either just by yourself or working in tandem with a physiotherapist? Let's join the main episode now and I'll catch you in the outro.
Main Episode:Dr. Greenbaum, welcome to the Protrusive Dental Podcast. How are you?
[Tzvika]Hey, hi Jaz. I'm very well. Thank you very much. And thank you for inviting me to speak about my favorite topic, which is Rehabilitation of Patients with Temporomandibular Disorders.
[Jaz]It's great to be able to help our patients in pain. And this is exactly what it's about, pain and discomfort. And I'm going to really try and extract all the knowledge and experience that you have. But just share with the Protruserati listening right now, what is your background? How did you niche into rehabilitation of temporomandibular disorders and psychogenic and in that area?
[Tzvika]Well, my bachelor's degree was back in 2004 in Haifa University in Israel. And after that, I headed up to Australia, South Australia to learn a master's degree in musculoskeletal and sports physiotherapy and a very well-known degree. But in that degree, I started to get into the topic of cervical spine.
Upper cervical spine rehabilitation of patients with headaches. It was a new thing for physiotherapists to rehabilitate patients with cervicogenic headaches. And when I came back to Israel after the Masters, I started to see many patients with headaches. And then I realized that many of them are complaining on temporomandibular disorders.
Back then I didn't know exactly what, how to define it, but it was clicks, lockings, pains, bruxism, all kinds of complaints classically involving the masticatory system. And then I've realized that there is a topic that is very relevant to my patients, to a majority of my patients, that I don't know enough.
And that was the trigger to start the PhD project in Tel Aviv University back in 2012 or 2013. And there was a professor, Professor Winocur in Tel Aviv University that was actually looking for the physiotherapist to join his team to research the involvement of cervical spine in patients with TMD and that was an excellent match because I could learn from the dentists about our facial pain specialist basically about temporomandibular disorder, and I could share my knowledge about cervical spine with them.
So that was a five years of ongoing research project where I was assessing patients with temporomandibular disorders for cervical spine involvement impairments and all kinds of deficits. And during that time, I had the chance to learn about the connections between cervical spine and temporomandibular disorder. And that was my way to that amazing and interesting clinical world.
[Jaz]So the work you do now, how much of that is clinical? How much of that is alongside dentists and going on from that, what is the best way that dentists and physios can work together?
[Tzvika]One of the main problems in the physiotherapy clinic is that according to the epidemiological findings data, we need to see much more temporomandibular disorder patients, but actually we don't see them so much.
So, there is a big gap between the needs, the demand for patients with TMD and the match to rehabilitation, to musculoskeletal rehabilitation. I think dentists are the best professionals to close these gaps because dentists do see patients with TMD how they see them because they ask their patients to open the mouth.
And when you need to open the mouth, that would be the best screening for temporomandibular disorders, even without diagnosing the exact specific diagnosis. But you understand that there is something with the masticatory system, something with the TMJ, and that would be an excellent trigger to refer the patients to the appropriate physiotherapy.
So, we see that in different countries that I teach, such as Belgium, for example, I've been teaching in Belgium since 2017. And back then, six years ago, the physios did not know what is temporomandibular disorder? How can they get these patients? And while training physiotherapists and also training them to contact dentists, they started to get more and more referrals.
And now when I come to Belgium, to Brussels and to Leuven and to Ghent, they keep telling, they tell me all the time that it's an excellent cooperation because they get, the dentists were looking for the clinicians that can help the patients and the physios were looking for the clinicians that can refer them to patients. So that's an excellent match between the diagnosis and the referral. And the rehabilitation, practitioner.
[Jaz]I totally agree. And with my management of temporomandibular disorders in practice, I don't think I can get the results without the physio that I use. So hopefully she'll be joining us when you are visiting the UK in December, Krina Panchal be joining us.
I've told her all about you. So, she's excited to learn from you. And then, she's learned from Rocobado and all these people around the world because just like you said, physios, it's in the UK. And now you said Belgium as well when they come out of physio school. They'd learn from like the neck downwards, right?
They don't learn about the TMJ, which is just a real loss. But I can see from their perspective, you mentioned that there is a disparity in terms of how many patients should be seeking care from physios compared to what they are. And I think dentists are indeed the link we should be recognizing that physios are in a great position, those who are trained in it are in a great position to help our patients, and we're going to get better results, patients being more comfortable, less discomfort, better mouth opening, all those things that we want from our patients when you work with a physio.
So, yeah, I strongly believe there should be a synergy between dentists and physios. And you told me recently before we hit the record button that you were in Hong Kong and a lot of the delegates, I attended weren't just physios or healthcare professionals, there were dentists as well, which I think is amazing. I think we can learn so much from each other by attending sort of each other's sort of educational circles. What kind of things were the dentists in Hong Kong interested to learn about from you?
[Tzvika]I think there were two main things for them is one is to understand the specific diagnosis of patients with temporomandibular disorders, not just to know something is wrong with that system.
But to understand exactly based on the available evidence, yeah, the body of knowledge that we have, what is the specific diagnosis? And secondly, what can physiotherapists offer patients with TMD? So, what can we actually offer? And what is the prognosis? How to cooperate with the physical therapist?
So, these were two main things and it was very interesting because in the first day, it was a day for more for the diagnostic component. They were really up to it and wanting to understand everything and be part of doing that. And in the second day, they were just observing the physiotherapist, just mainly observing how physios can actually approach with the hands on.
We had some case studies there,