Overview of Americans Are Not Going To The Dentist Enough (Shortwave, NPR)
This Shortwave episode (host Emily Kwong) explores why many Americans avoid dental care and the consequences—focusing on temporomandibular joint disorders (TMD/TMJ). Oral surgeon Justin Richard explains what TMJ is, who gets it, how it's diagnosed, treatment options (from simple appliances to surgery), and why routine dental care and better dental education matter.
Key points and main takeaways
- Prevalence: An estimated 5–10% of Americans have some form of TMD.
- What TMJ/TMD is: Problems with the temporomandibular joint (the jaw joint beneath the ear) and the cartilage pad that allows smooth movement; dysfunction causes popping, clicking, locking, jaw deviation, pain, and stiffness.
- Teeth matter: Teeth provide structural support for the jaw; missing or uneven teeth can change jaw mechanics and increase TMD risk.
- Diagnosis: Thorough clinical exam plus imaging (X-ray; MRI is the definitive test for cartilage/soft‑tissue position).
- Treatments (least to most invasive):
- Conservative: Occlusal appliances (custom splints), dental management, physical therapy, behavioral changes.
- Minimally invasive: Arthrocentesis (joint lavage), injections such as PRP (concentrated growth factors), off‑label injections have been attempted.
- Open joint surgery: Reserved for specific structural/cartilage problems; often not needed for most TMD.
- Cautions: Avoid over‑the‑counter or DIY occlusal appliances bought online — they can worsen problems.
- Systems change: Need for standardized TMJ education across dental training so clinicians share a common foundation for diagnosis/treatment.
- Broader context: Low dental attendance can delay detection of serious conditions (e.g., oral cancer).
Topics discussed
- Anatomy and function of the temporomandibular joint
- How missing teeth or uneven chewing creates biomechanical strain
- Signs and symptoms of TMD to watch for (locking, dislocation, deviation, chronic pain)
- Diagnostic process: listening/clinical exam, X‑rays, MRI confirmation
- Range of treatments and when surgery is considered
- The problem of DIY dental devices and internet remedies
- The need to improve and standardize dental education about TMJ
- Public-health note: fewer people seeing dentists means more missed disease detection; NPR fundraising/Giving Tuesday mention
Notable quotes / insights
- “The overwhelming majority of TMJ issues are related to a cartilage pad…not being in the proper position.”
- “The teeth ultimately are the support system to the joint.”
- “MRI proves it. MRI doesn’t lie.” (on confirming cartilage displacement)
- “If you’re worried about TMD, who should you see? Always start with your dentist. They’re like your primary care doctor for your mouth.”
Practical advice / action items
- If you have jaw pain, popping, locking, or asymmetrical movement: see your dentist first.
- Don’t buy over‑the‑counter or DIY occlusal appliances from the internet — they often cause harm.
- Ask your dentist about a custom occlusal splint if indicated; discuss imaging (X‑ray or MRI) for persistent symptoms.
- Consider minimally invasive options (arthrocentesis, PRP injections) before open joint surgery in many cases.
- Maintain routine dental visits for early detection of TMJ problems and other oral health issues (including oral cancer).
Who’s on the episode / production details
- Host: Emily Kwong
- Guest: Justin Richard, oral surgeon (specializes in TMJ)
- Produced by: Burley McCoy; edited by Rebecca Ramirez; fact‑checked by Tyler Jones and Jimmy Keely; audio engineer Jimmy Keely; VP of Podcasting Beth Donovan
- Contact: shortwave@npr.org (for listener questions)
One‑sentence summary
This episode explains how TMJ disorders develop, how dentists and oral surgeons diagnose and treat them (from splints to surgery), why routine dental care matters, and why you should avoid DIY fixes.