Educating Patients: The TMJ joint (4 different phases of the joint)

Educating patients on dental conditions can be very challenging for many dentists. A complete dentist has even more challenges, especially when it comes to explaining joint conditions with their patients. The complete dentist starts the examination by examining the joint first. Based on what we know, there are four categories or phases of joints that we need to discuss: the green joint, there are two in the yellow-joint category, and the red joint. Talking to your patients about each of these categories is very important, because if they understand the condition, they can understand the recommended treatment is necessary. We start with the green joint.

The Green Joint (Stable and Healthy)

The green joint basically refers that the centric relation is equal to maximum intercuspation. There is no hidden slide. The joints can be loaded with verification and there are no signs of occlusal breakdown. There are no signs of instability. Unfortunately, these are the patients that we don’t see very often, but our goal is always to get our patients to the green state. When you’re discussing the green joint to a patient, there’s really not much to explain except the fact that things are stable, and healthy, and you want to maintain those patients in that state.

The Yellow Joint (Tension or Discomfort)

When it comes to the yellow joint, there are two types of conditions:

1. Centric relation can be verified, but there’s a hidden slide.
2. Centric relation cannot be verified because of tension, which we know is related to the muscle.

When it comes to educating patients on a yellow joint, I think it certainly helps them to understand what a green joint is and explaining to them how their joint differs from a healthy joint. If there’s a click or a pop, most patients will understand that during the examination. It becomes very critical when it comes to explaining that particular joint during the examination. I recommend engaging your patient during the examination. If you feel there’s a click or if you hear a pop, explain that to the patient. Explain why this is important. Also, explain what the ramifications are of not treating this condition. As Peter Dawson said for years, “Explaining the implications of not treating a condition can be even more important to a patient.” When you can’t verify centric relation due to tension, it’s important to communicate to the patient that they must be deprogrammed in order to verify that. That can be done right at chairside and that can be done at following visits as well.

The Red Joint (Unstable and Painful)

When we get to the red joint, usually these patients are symptomatic. They are complaining of pain. They have very limited range of motion, and they’re usually very uncomfortable. Educating patients on this type of joint becomes a little bit easier because they’re there because they have a need. However, explaining to them what is going on within those red joints is even more important. The communication becomes even more effective when you have to order an MRI or if you’re using a Doppler.

It’s important to completely keep the patient engaged and explain what a green joint is and how the red joint relates to the green joint. Remember, your patients will come to you with all kinds of joint situations. As a complete dentist, it is important to understand the differences between the green joint, the yellow joint, and the red joint, but also, more importantly, it’s important to educate your patients in how you would approach care.

Learn more about the TMJ at our live course, Core 1: Occlusion Smile Design