Dear Spear fellows,

Hope all is well.

I recently saw a patient who had multiple local occlusal equilibrations done within a yr. When I saw him last yr, he complained of sudden bite change with only front teeth touching but back teeth not, I diagnosed him tentatively with TMD and referred him to see a TMD dentist. He didn't go because he believed bite adjustment would work. When I saw him days ago, he had two local occlusal equilibrations done that the dentist adjusted the teeth where he felt hit hard, after the adjustment he would feel better; but before long, his bite changed again, teeth at a different location hit hard, so the dentist did it again. when I saw him days ago, he asked me to do the same, which I declined and instead explained to him how an unstable joint could cause bite change and constantly chasing the bite would not solve the problem, as the source of the problem was his unstable joint.

He told me he knew he had TMD but 10 yrs ago a dentist did full mouth occlusal equilibration for him which set his bite all balanced until a yr ago, so he believed occlusal equilibration would do the work again. He asked me to refer him to a dentist who could do full mouth occlusal equilibration, so I referred him to a local prosthodontist and wrote on the referal sheet ' bite change frequently due to TMD ' in the hope the prosthodontist would motivate him to address the TMD as well. His PAN taken at the same visit showed angular-shaped right condyle compared with the oval shaped left condyle, but I'm not sure if it's wnl, I will post it when I'm back to the office.

Could you share your knowledge on what the treatment might be for unstable condyle such as in this case?

Thanks.