Research and Published Papers by Dr. Simmons

Simmons HC, Bledsoe WS, Kilpatrick SR: Contemporary Mainstream TMD Diagnosis and Treatment. AudioDent Department, Academy of General Dentistry. An audiotape continuing education series for national distribution, November 1994

Contemporary (1994) mainstream TMD diagnosis and treatment are presented in an audiotape panel discussion. Diagnosis and treatment of TM disorders are covered from initial examination to completion of treatment. Treatment methods used by the clinicians for each category of patient are described.

Simmons HC, Gibbs SJ: Recapture of Temporomandibular Joint Disks Using Anterior Repositioning Appliances: an MRI Study. Journal of Craniomandibular Practice October 1995;13:227-237

ABSTRACT: Thirty consecutive patients seeking treatment for painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess the relationship between the recapture of displaced disks by anterior repositioning appliances (ARA) and the relief of symptoms. After standard clinical workup including assessment of pain, maxillary and mandibular ARAs were constructed that repositioned condyles to the Gelb 4/7 position. Magnetic resonance imaging (MRI) was performed before and immediately after the insertion of ARAs. Initial MRI findings showed 26 joints with reducing disk displacements in 17 patients, seven partially-reducing joints in four patients, 14 nonreducing joints in 11 patients, and 13 normal joints in eight patients. Postinsertion MRI showed recapture of disks in 25 of 26 reducing displacements (96%), but no recapture in partially-reducing or nonreducing joints. All but one of the normal joints remained unchanged. Pain assessment showed significant relief of symptoms in all three categories. The degree of pain relief was significantly greater in recaptured reducing disks than the other categories (p < 0.05). ARA therapy provides effective pain relief regardless of disk status, although a greater degree of relief may be achieved in recaptured reducing internal derangements.

Simmons HC, Gibbs SJ: Initial TMJ Disk Recapture with Anterior Repositioning Appliances and Relation to Dental History. Journal of Craniomandibular Practice October 1997;15:281-295

ABSTRACT: Fifty-eight consecutive patients in a referral based practice seeking treatment for complex chronic painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess the recapture of displaced disks by anterior repositioning appliances (ARA) and the improvement in disk position in those disks that did not fully recapture. After standard clinical workup, including assessment of pain, maxillary and mandibular ARAs were constructed which repositioned condyles to the Gelb 4/7 position as determined by cephalometrically-corrected linear tomograms. Multi-planar magnetic resonance imaging (MRI) was performed immediately before and after insertion of the mandibular ARA, showing three-dimensional recapture of disks in 85% and improved disk position in 6% of reducing displacements. Disk position was improved in 28% of nonreducing joints, but none were totally recaptured. Recapture or improvement was achieved in 91 % of reducing, 28% of nonreducing, and 63% of all joints with internal derangements. Initial disk position, reduction on opening and recapture by ARA were statistically independent of patient age, number of teeth missing, number of third molars missing, malocclusion (Angle's class), overjet, overbite, prosthetic appliances, and previous orthodontic treatment. It was concluded that ARA therapy provided effective recapture of displaced TMJ disks that reduce upon mouth opening. In this population of patients with chronic TMJ pain, previous dental treatment had no statistically significant effect on the incidence of internal derangement or on disk recapture by ARA therapy. There was no evidence of adverse effect from orthodontics, prosthetics, or any other dental care.

Gibbs SJ, Simmons HC: A Protocol for Magnetic Resonance Imaging of the Temporomandibular Joints. Journal of Craniomandibular Practice October 1998;16:236-241

ABSTRACT: The complex concepts and procedures of magnetic resonance imaging (MRI) are unfamiliar to many dentists. Similarly, many radiologists lack understanding of the clinical requirements of the dentist for accurate assessment of TMJ abnormalities. Thus, TMJ imaging procedures may be inadequate or incomplete, may vary from facility to facility, and sometimes from patient to patient in a given facility. A protocol for TMJ imaging is presented which meets dental requirements and is rapidly performed in the MRI facility. The protocol may be copied and attached to the prescription to the imaging center. It may be modified or expanded to accommodate specific patient requirements or equipment performance.

Simmons HC: Orthodontic Finishing After TMJ Disk Manipulation and Recapture. International Journal of Orthodontics Spring 2002;13:7-12

ABSTRACT: Orthodontic treatment has as its goal in most patients to achieve a cosmetic and functional result.  There are functional goals for all orthodontic treatment and in some few cases the functional out-way the cosmetic; an example would be a cleft-palate case.  Orthodontic finishing to a specific condylar position is not routinely a goal of orthodontic care.  The reason for this is that only patients who have pain, dysfunction and a negative change in quality of life from their temporomandibular apparatus need this tangential type of treatment.  Research has shown that most patients suffering from a temporomandibular disorder (TMD) have displacement of the temporomandibular disk(s).  Research has shown that when the mandibular condyle is repositioned to the Gelb 4/7 position that the temporomandibular joint disk is recaptured to a normal position between 85% and 96% of the time.  The Gelb 4/7 position has been equated to the physiologic position of the mandibular condyle in the glenoid fossa.  TMJ condyle repositioning to the physiologic position has been correlated to disk recapture proven by magnetic resonance imaging (MRI).  A case is shown in which a displacement without reduction is manipulated into reduction and maintained with orthodontic correction.  TMJ disk displacement without reduction is usually preceded by TMJ disk displacement with reduction.  Pumping of the upper joint compartment can assist in reducing the TMJ disk displacement without reduction.  Magnetic resonance imaging before and after the manipulation and after orthodontic treatment are shown.  A detailed method of orthodontic finishing that maintains a specific condylar position and TMJ disk recapture is shown.

Simmons HC, Kilpatrick SR: A Survey of Dentists in the United States Regarding a Specialty in Craniofacial Pain. The Journal of Craniomandibular Practice January 2004 22:72-76

ABSTRACT: In an effort to explore whether a specialty for craniofacial pain is warranted, the American Academy of Craniofacial Pain commissioned an opinion survey of dentists.  The survey population (N=4000) was stratified by specialty, so that dentists in affected areas would be adequately represented: 500 orthodontist and dentofacial orthopedists, 500 oral and maxillofacial surgeons, 500 periodontists, 500 prosthodontists and 2,000 general practitioners.  A total of 930 dentists responded for a 23.2% response rate.  The survey had multiple purposes: 1) to measure the percentage of craniofacial pain patients perceived in dental patient populations; 2) to determine whether each dentist prefers to treat the disorder or; 3) prefer to refer craniofacial pain patients to clinicians specializing in the disorder; and 4) whether dentists favored or opposed the formation of a craniofacial pain specialty.  The respondents' perception of the prevalence of craniofacial pain among their patients was 13.9%.  A majority of the responding dentists, 54.7%, are in favor of a craniofacial pain specialty.  Overall, 65% of dentists treat craniofacial pain patients, although more than half, 55%, of all dentists also refer such patients.  Even 43.6% of dentists who regularly treat craniofacial pain favor a specialty, while 76% of those who do not treat such patients favor the specialty.  The data presented here advocate development of a dental specialty in craniofacial pain.

Simmons HC, Gibbs SJ: Anterior Repositioning Appliance Therapy for TMJ Disorders: Specific Symptoms Relieved and Relationship to Disk Status on MRI. The Journal of Craniomandibular Practice April 2005 23:89-99

ABSTRACT: Forty-eight consecutive patients seeking treatment in a referral based practice for complex chronic painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess specific symptom relief from anterior repositioning appliance (ARA) therapy and the relationship between specific symptom relief and the status of the TMJ disk.  Each patient was assessed on 86 symptoms based upon whether each symptom was present before treatment and absent, better, unchanged or worse after Maximum Medical Improvement (MMI).  The most common symptom was occipital cephalalgia (95%).  The least common symptom was pain and burning of tongue (8%).  A profile of a temporomandibular disorder (TMD) patient was developed.  The typical TMD patient has cephalalgia, mainly in the occipital, temporal and frontal region, pain upon chewing food, pain upon opening and closing the mouth, TMJ pain, pain in the back of the neck and difficulty chewing food.  Before treatment, patients with bilateral displaced disks had more symptoms than those with unilateral displaced disks and the opposite side normal.  After MMI the maximum benefit (percent of pretreatment symptoms relieved) was found in patients with normal or recaptured disks.  The minimum occurred in patients whose disks did not recapture with therapy.  ARA therapy improved or eliminated symptoms in all patients in the study.

Simmons HC: Guidelines for Anterior Repositioning Appliance Therapy for the Management of Craniofacial Pain and TMD. The Journal of Craniomandibular Practice October 2005 23:300-305

ABSTRACT: Guidelines for Anterior Repositioning Appliance Therapy are reviewed.  Topics covered are: Introduction, History, Definitive Treatment vs Supportive Therapy, Value of Normal Disk Position, Availability of TMJ Disks for Recapture, TMJ Disk Recapture Methods-Clinical vs Imaging Assisted, Orthopedic Principles of ARA Therapy, Indications for Use of ARA, Effectiveness of Treatment Modalities, Dual Appliance Use During ARA Therapy, Phase I Defined, Superiority of ARA Therapy to Flat Plane and No Treatment, Phase II Defined, ARA Principles Used in Other Areas of Dentistry and Conclusions on ARA Therapy.

Simmons HC, Editor: Craniofacial Pain - A Handbook for Assessment, Diagnosis and Management. The American Academy of Craniofacial Pain, Chroma, Inc., 2009

ABSTRACT: This is a handbook for healthcare providers for the assessment, diagnosis and management of craniofacial pain patients.

Simmons HC: A Critical Review of Dr. Charles S. Greene's Article titled "Managing the Care of Patients with Temporomandibular Disorders: A New Guideline for Care" and A Revision of the American Association for Dental Research's 1996  Policy Statement on Temporomandibular Disorders, Approved by the AADR Council in March 2010, Published in the Journal of the American Dental Association September 2010. The Journal of Craniomandibular Practice January 2012, 30:9-24

ABSTRACT: Dr. Charles Greene's article, "Managing the Care of Patients with TMDs A New Guideline for Care," and the American Association for Dental Research's (AADR) 2010 Policy Statement on Temporomandibular Disorders, published in the Journal of the American Dental Association (JADA) September 2010, are reviewed in detail.  The concept that all temporomandibular disorders (TMDs) should be lumped into one policy statement for care is inappropriate.  TMDs are a collection of disorders that are treated differently, and the concept that TMDs must only be managed within a biopsychosocial model of care is inappropriate.  TMDs are usually a musculoskeletal orthopedic disorder, as defined by the AADR.  TMD orthopedic care that is peer-reviewed and evidence-based is available for some TMDs.  Organized dentistry, including the American Dental Association, and mainstream texts on TMDs, support the use of orthopedics in the treatment of some TMDs.  TMDs are not psychological or social disorders.  Informed consent requires that alternative care is discussed with patients.  Standard of care is a legal concept that is usually decided by a court of law and not decided by a policy statement, position paper, guidelines or parameters of care handed down by professional organizations.  The 2010 AADR Policy Statement on TMD is not the standard of care in the United States.  Whether a patient needs care for a TMD is not decided by a diagnostic test, but by whether the patient has signficant pain, dysfunction and/or a negative change in quality of life from a TMD and they want care.  Some TMDs need timely invasive and irreversible care.

Spencer JR, Patel M, Mehta N, Simmons HC, Bennett T, Bailey JK, Moses A: Special Consideration Regarding the Assessment and Management of Patients Being Treated with Mandibular Advancement Oral Appliance Therapy for Snoring and Obstructive Sleep Apnea. The Journal of Craniomandibular and Sleep Practice January 2013 31:10-13

ABSTRACT: This position paper, as developed by a Task Force of the American Academy of Craniofacial Pain on Mandibular Advancement Oral Appliance Therapy for Snoring and Obstructive Sleep Apnea, contains recommendations for dentists engaged in the management of patients with snoring and obstructive sleep apnea utilizing mandibular advancement oral appliances.  The recommendations are supported by current scientific evidence, published standards and guidelines, and expert panel consensus.  Snoring and obstructive sleep apnea (OSA) affects millions of people.  Oral appliance therapy (OAT) is recognied as an effective therapy for many with primary snoring and mild to moderate OSA, as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies.  Dentists are playing a much larger role in the screening and management of patients with snoring and OSA as part of a multi-disciplinary team.  It is also recognized that OAT has the potential to cause untoward side effects, including temporomandibular joint (TMJ) pain and dysfunction. The present paper highlights the need for dentists who manage patients using mandibular advancement OAT to be competent in the assessment, diagnosis and management of temporomandibular joint disorders (TMDs) and craniofacial pain disorders.  The authors of this article are all clinically engaged in the management of patients with snoring and OSA, and reached consensus based on their review of the current evidence, published guidelines and clinical experience.  It is the opinion of the authors that dentists experienced and knowledgeable in the assessment, diagnosis and management of TMD and craniofacial pain applying this knowledge to the management of patients with snoring and OSA using OAT will provide their patients with the best prognosis and most successful treatment outcomes.

Simmons HC 3rd: The Periodontal Probe and the Millimeter Scale. Editorial, The Journal of Craniomandibular and Sleep Practice April 2013;31(2);77-78

Simmons HC 3rd: Who is in Control - the Teeth or the Temporomandibular Joints? Editorial, The Journal of Craniomandibular and Sleep Practice January 2014;32(1):11-12

Simmons HC 3rd: Temporomandibular Joint Orthopedics with Anterior Repositioning Appliance Therapy and Therapeutic Injections. The Journal of the California Dental Association August 2014 42:537-548

ABSTRACT: TMD orthopedics is the assessment, diagnosis and management of orthopedic disorders of the temporomandibular joint (TMJ).  Anterior repositioning appliance (ARA) therapy for TMJ internal derangements is successful in long-term recapturing of discs in reducing and nonreducing joints at a rate of 64% and in regenerating degenerated condyles in some cases.  ARA therapy for TMJ internal derangements is subjectively successful in relieving symptoms in reducing and nonreducing disc displacement TMJs in this study at an average rate of 94.5 percent.

Simmons HC 3rd: Muscles are Slaves. Editorial, The Journal of Craniomandibular and Sleep Practice October 2014;32(4):252-253

Simmons HC 3rd: The Unlocking Window. Editorial, The Journal of Craniomandibular and Sleep Practice July 2015;33(3):167-168

Simmons HC 3rd: Why are Dentists Not Trained to Screen and Diagnose Temporomandibular Disorders in Dental School? Editorial, The Journal of Craniomandibular and Sleep Practice March 2016;34(2):76-78

Copies of the above research are available by e-mailing Dr. Simmons at hcstmj@aol.com.