It can be challenging to treat TMJ and facial pain patients. The constraints of time, staff training, insurance coverage, and even trepidation about making mistakes are all realistic barriers when it comes to providing treatment for TMD. Many doctors simply want nothing to do with a TMJ patient. Others want to treat only the basic "occlusal muscle" disorders and then move on to the "real dentistry." Patients requiring more "advanced treatment" are then referred to "specialists." Most dentists believe that TMJ patients should have a splint, but there are a lot of different splints on the market. There can be confusion about the best timing for dental treatment, countered by strong debate that "the occlusion has nothing to do with the temporomandibular joint." Orthodontists believe that they prevent "TMD" by doing bracework in children or adults. Restorative dentists try to rebuild crippled bites before a "patient gets into trouble." Surgeons try to fix temporomandibular joints with jaw osteotomies, typically without even imaging the joint. Different occlusal techniques are advocated, and they seem at odds with one another. Yet patients claim improvements with many variable types of treatment. A dentist may feel lost trying to read a CAT or Magnetic Resonance scan, and it may "seem impossible" to get these images. Many dentists want to find a common philosophy and they may be torn between "going to Pankey" or "going to LVI." Do they listen to Dawson or should they see Spear or Kois? Some look to pain management as the answer, but that is when it really may get confusing. What can one really believe about subject areas such as prilotherapy, chiropractic treatment, botulism toxin, acupuncture, anterior deprogramming splints, "neuromuscular" bites, bimanual manipulation, Gelb appliances, pharmacological management, or even stress therapy?
Over twenty-five years ago Dr. Mark Piper turned down an academic chairmanship to move to St. Petersburg, Florida, to affiliate his practice with Dr. Peter Dawson. Both brought strong but differing backgrounds to the treatment of TMJ patients. Piper had medical and dental degrees, with years of residencies in oral and maxillofacial surgery and general surgery as well as training by Dr. Clyde Wilkes, the father of modern day TMJ surgery. Dawson had what many considered the most prestigious occlusion practice in the world, and he had literally "written the book" on occlusal problems. Although a seemingly incongruent match, Piper and Dawson became great friends, to the benefit of the field. In fact this was the first time that two strong individuals with polar opposite training and background had come to a common philosophy about occlusion and TMD. The understanding of disk derangements grew further with Piper's introduction of Doppler and differential arthrography. Looking back, these techniques seemed advanced at the time, but the field kept changing, and these original tests became more rudimentary.
Within a few years of Piper's arrival, Dawson retired from clinical practice to focus his efforts on full time teaching through the Dawson Center. Meanwhile Piper opened the Piper Clinic and began seeing the most complicated TMJ and facial pain patients in the world. While Dawson was at the forefront, Piper was working diligently in the background, patient by patient. As the collaboration continued, this seemed to be the best combination to advance student's understanding of TMD and occlusion. Piper forged ahead with more new developments- microsurgery, joint and pain classifications, MRI and CT scans, and RSD treatment, and in part Dawson drew upon this information for his lecture material. This marriage of the past and the present worked well and continues to this day.
In 2003, as the Dawson Center directors were considering Dawson's future spokesman, Piper was told that "no dentist would ever listen to a surgeon about the occlusion." Realizing that his opportunities at the Dawson Center were limited and feeling strongly that his concepts of joint related occlusion had to be heard, Piper then opened the Piper Education and Research Center (PERC). Overall the focus became one of complementing and supplementing the Dawson Center curriculum and at the same time trying to find the common thread that had been missing in the unification of different occlusal philosophies. As it turns out there is a common thread, and it is in the work that Piper had been doing with partial disk displacements and the resulting occlusal changes. Hence the concept of Joint Based Occlusion (JBO) became the unifying theme in the development of Joint Based Dentistry (JBD). The concepts of JBO and JBD have not been taught at any other center in the world, and they are the hallmarks of training at the Piper Education and Research Center. This is the background that allows us to make our promises to doctors.
Our promise to doctors is to present the most complete understanding available in continuing education about the temporomandibular joint and of the occlusion that is dependent upon this joint as well as the pain patterning that results from injury to this joint.
We promise to explain the pros and cons of every philosophy of treatment currently available to patients, with no bias either for or against any particular technique.
We promise to openly critique all forms of diagnosis and therapy for the best benefit of the patient and the treating doctor.
We promise to continually seek and to teach the truth in everything that we do.
We promise to not only teach occlusion but to teach it from a thoroughly documented occlusal and joint analysis.
We promise to leave nothing to the imagination, and we will demonstrate complete case workups inclusive of CT and MRI images of the joints.
We promise to teach from the most thoroughly documented patient base in the world.
We promise that our concepts of "Joint Based Dentistry" will be the driving force behind the practice of occlusion in the future.
We promise that our teaching facility will always provide the best environment for modern education.
We promise to teach the best concepts of the 21st century and to continually update our materials.
We promise to give PERC doctors the best clinical preparation available in the fields of TMJ, occlusion, and facial pain.