Let's Talk Teeth

An Innovative Approach to TMD w/ Dr. Tony Urbanek

• Saadman Alamgir

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In this episode of Let’s Talk Teeth, we are joined by Dr. Tony Urbanek, a distinguished oral maxillofacial surgeon with over 40 years of experience in the field and a renowned specialist in TMD treatment. Join us as we discuss his Dr. Tony's unorthodox journey in undergrad, his accelerated progress through dental school, and his groundbreaking research combining dental and medical training at Vanderbilt University. Dr. Tony dives deep into his focus on non-surgical treatment for TMD, explaining the physiology behind the condition and sharing insights about his patented device designed to alleviate TMD symptoms.

Feel free to reach out to Dr. Tony at tony@tmjservices.net, and tune into his podcast 'TMD Demystified' on YouTube and Spotify!


00:00 Introduction and Guest Introduction

00:18 Dr. Tony's Educational Journey

00:44 Discovering a Passion for Dentistry

01:29 Challenges and Triumphs in Dental School

02:17 Advanced Studies and Early Career

05:16 Innovative Research and Breakthroughs

07:25 A Distinguished Career in Oral Surgery

09:27 Encouragement for Aspiring Dentists

12:03 The TMJ Journey and Non-Surgical Solutions

17:44 Personal Insights and Final Thoughts

26:10 Unexpected Results in Early Cases

26:36 Understanding the Mechanism of TMD

27:57 Linking TMD to Other Conditions

29:17 Mechanisms of Pain and Inflammation

35:39 Introducing the TMJ Device

45:10 Advice for Dental Students

51:30 Final Thoughts and Contact Information

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Saad Alamgir:

Everyone. Welcome back to another episode of Talk. we have Tony Urban. Dr. Tony, if you don't mind just kind introducing yourself, telling us a little where school what you're doing now.

Jeff Urbanek:

That may take a few minutes, but I'll try to make it brief. I've had a very eclectic life intentionally I went to college in Cleveland, Ohio, born and raised in blue collar town, Gary, Indiana. Worked my way through dental school. Actually paid for what worked my way through college, working in the steel

Victor Razi:

Oh

Jeff Urbanek:

and went

Victor Razi:

wow.

Jeff Urbanek:

college in a private university in Cleveland, Ohio. A little Jesuit school called John Carroll. It's not so little anymore, very traditional college. When I was in college, I decided to be a dentist, mainly because my older brother was a dentist. And everybody thought my older brother was really successful. And I decided that everybody thinks my older brother's six, he was nine years ahead of me and he was already actually a dentist, right. And everybody like bragged on my older brother and I wanted him to brag on me. So I decided to go to dental school and I had enough, I had enough. See I had enough grade point average to do it. But let me tell you, I am not always, when you hear the rest of the story, you gotta hear. If you hear the rest of the story, you gotta know the beginning of the story. I, I like to teach I like to tell people things that can help

Victor Razi:

Sure.

Jeff Urbanek:

I may drop a little of these bombs on you as we go

Victor Razi:

Okay.

Jeff Urbanek:

but I wasn't a very good student in my freshman year in college. I actually succeeded in getting a 1.7 out of

Victor Razi:

I will see

Jeff Urbanek:

the

Saad Alamgir:

Wow.

Jeff Urbanek:

And the reason wasn't because I was drinking too much beer or chasing the girls. It was because I hated being taught things I couldn't use.

Victor Razi:

Understandable.

Jeff Urbanek:

I hated it. Didn't enjoy it, didn't want it. It just floored

Victor Razi:

Sure.

Jeff Urbanek:

But as I said, my older brother, I had to suck it up. My older brother was a dentist and so I decided, okay, I'm gonna suck this up and I'm gonna deal with this. I made my grade point average enough by the time I graduated that I got a place in a couple dental schools, actually a couple of them. And I chose my home state, Indiana

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

to go to dental school. They have very good dental school there. And they taught me how to be a dentist really well. So I got the dental school and lo and behold, they started teaching me these things called the basic sciences. And I thought, oh my God, I can, this is interesting. I could use this. If you know how the body works, you could really

Victor Razi:

Sure.

Jeff Urbanek:

And I, and it really, it really took to me, and I did very well at it. I was the one or two people in the class that really enjoyed the basic sciences and we weren't there just to get into the clinic, you know, get through biochemistry, histology anatomy, so you could get

Victor Razi:

Sure.

Jeff Urbanek:

You, you've done it right.

Saad Alamgir:

Yeah. Yes, sir.

Jeff Urbanek:

And so I did really well. And and when I got into the clinics my goal was to be an oral maxillofacial surgeon. I ran through the clinic requirements pretty fast and I finished dental school in three years and I thought

Saad Alamgir:

Wow.

Jeff Urbanek:

pretty good.

Saad Alamgir:

Yeah.

Jeff Urbanek:

In a four year program, and I thought the dean was gonna shake my hand and hand me my diploma. I really did. I didn't know the dean knew me. I never met the dean. He never talked to me. But I got a call a few days after I finished all the requirements. I got a call from the dean's office and see me. I said, all right, he's gonna shake my hand and say, good data, boy. And went down to the dean's office and all the dean kept saying was Mr. Urbanek dental school is four years. And after he said that about four times in sequence, I thought he was trying to tell me something. I asked him, are you trying to tell me something? He says, yes, you're gonna be here in Indianapolis. You're not going anywhere

Victor Razi:

I am, uh,

Jeff Urbanek:

because dental school is four years, son.

Victor Razi:

held hostage.

Jeff Urbanek:

And so a true story,

Victor Razi:

Yeah.

Jeff Urbanek:

you, you know. So I thought about it. I had already applied to several And I knew I did well enough to get into

Victor Razi:

Sure.

Jeff Urbanek:

So I went over to the anatomy department where I was well known, and I asked the chairman of the Department of Anatomy if he thought that he'd let me in the program to do a master's degree in cell biology and anatomy. And he says, why do you wanna do that? And I said, I think it'll help me when I get to be an oral maxillofacial surgeon. He says he says, maybe you're right, maybe you're wrong. But whatever reason, we're happy to have you. So I entered the program and finished the 24 month pro, he says, and I said, are you gonna do the same thing the dean did to me in the dental school? If I finish early, are you gonna keep me around? He says, no, you finish the 24 month program. And I said I only have 10 months. says if you can finish it in 10 months, you're gonna have your degree. So the short version is I did my thesis, I did my project, I did 24 credits, and I finished in 10 months. It was

Saad Alamgir:

Wow.

Jeff Urbanek:

very.

Victor Razi:

pushing the envelope there.

Jeff Urbanek:

I actually had, I was in my U-Haul van and went to the printers in my van on my way to Nashville to pick up my printed thesis because I, they demanded I have a printed thesis and leave one copy for me and three copies in the anatomy department. I. Circle back to the anatomy department. The medical school dropped off my thesis and went off to Nashville. What's in Nashville,

Victor Razi:

Uh.

Jeff Urbanek:

And I had, I was admitted to a rather unique special program at Vanderbilt where I did did medical school and a internship residency in oral maxillofacial surgery, and actually PhD in cell biology.'cause my degree master's was in cell biology and anatomy. they had a. A degree, a program for me in cell biology and anatomy, and it was kinda all smushed together. Won't describe

Saad Alamgir:

Wow.

Jeff Urbanek:

was. It was about a six, six year program where they smooshed it all together when you go

Victor Razi:

Sure

Jeff Urbanek:

Last couple years of met, last couple years of medical school, OMS and did a research project with the N-I-H-I-I was grant, I had a grant from the NIH for doing an independent research project on facial growth and development. That's how I paid for medical school. I applied for a grant and there was an ex, ex enough money on the grant that paid for

Victor Razi:

that's all.

Jeff Urbanek:

And that research grant was entitled creating animal models, reproducing animal Models with facial defects using the laser and intrauterine fetal surgery. I proved in the next couple years that you could actually create animal models with facial defects growth problems of the

Victor Razi:

Hello.

Jeff Urbanek:

In incited caused by laser. Doing surgery inside the uterus. And the animal model I used was the rabbit. So we proved that the first laser in Tennessee lit, literally the first laser in Tennessee in 1978. There were no lasers at Vanderbilt, even in the physics department. There were no lasers in the medical school in Memphis. There were no lasers in the OMS program in Knoxville. the, but the Air Force has a research and development center here in Tah, Tennessee, their national research center. And I called down there and put on my Vanderbilt doctor voice and I said, do you have a laser? And they said, yeah, we do. And they loaned it to me for a couple

Victor Razi:

Interesting.

Jeff Urbanek:

so I ended up, so that's a long way of saying, long way of saying I'm an oral mess. I decided at the end I didn't wanna go into academics, which is actually where I thought I was gonna end up. I decided to be in private practice right at the end of all this, and I spent the last 50 years as an oral maxillofacial surgeon, primarily doing the major hospital kind of end of it, doing orthognatic surgery, micro neurosurgery, cleft, lip cleft, palate cancer reconstruction. Tremendous amount of tempera, ular joint surgery. I was the TMJ surgeon in Nashville, Tennessee for 36 years until I decided I didn't wanna do any more TMJ surgery, which was 14 years ago. So I had a, I have a very a very exciting adventuresome in oral maxillofacial surgery. And along the way for my own purposes, I founded a clinic medical dental clinic in

Victor Razi:

sure. Sure.

Saad Alamgir:

Wow.

Jeff Urbanek:

that had never seen a doctor before. And then from that I was For 50 years and I used my airplane to to do all this charity work and to do a lot of other things that I enjoyed doing.

Victor Razi:

Yeah. Very unique story. Dr. Tony, and I'm sure you know yourself it's almost unlike any other I've heard very unique things and yeah, I couldn't imagine. First of all, just doing dental school in three years and then them telling you, Hey, you gotta stick around town.

Jeff Urbanek:

It was, I mean, it was. I mean, I was, I mean, I was shocked, but yet I knew he was serious. And then you're not gonna argue

Victor Razi:

Right,

Jeff Urbanek:

I mean, you know, it's Hey, you want your diploma, this is what you gotta do.

Victor Razi:

right.

Jeff Urbanek:

And, but I took the opportunity. I, he, I said, what would you like me to do? I said, what would, I literally said, okay, what would you prefer I do? And he said, looked at me. He says, you can do anything you

Victor Razi:

Sure.

Jeff Urbanek:

And I said can I go play golf? He says, yeah I was, I.

Saad Alamgir:

Surprised you didn't choose that option?

Jeff Urbanek:

That's not my personality

Saad Alamgir:

Yeah.

Jeff Urbanek:

I spent, I learned how to fly airplanes and I actually don't enjoy playing golf. I tried it. I don't particularly

Victor Razi:

Fair enough.

Jeff Urbanek:

A lot of

Victor Razi:

Yeah.

Jeff Urbanek:

Maybe you two do.

Saad Alamgir:

Yeah, I've been getting pretty into it since starting professional school. It's been a lot, but

Jeff Urbanek:

Well, you do what you have time for, but I'd like to make a comment because I, I believe, if I'm not correct, that most of your listen listeners are either in dental school or in pre-dent and wanna know what's going on in dental school. Is

Saad Alamgir:

yes

Victor Razi:

That is correct.

Saad Alamgir:

Yes, sir. It is.

Jeff Urbanek:

With my background, let me just tell you'cause I like to encourage people. I definitely like to encourage young people and

Victor Razi:

Sure.

Jeff Urbanek:

definitely like to bring people into our profession, which I think is one of the best professions, if not the best profession dentistry. So lemme just say this at the beginning and I won't preach anymore. Hopefully I don't preach

Victor Razi:

We're here for it. We're here for it.

Jeff Urbanek:

But your dental basic training you set up to do basic dental work, I want everyone out there to know you can make anything you want out of your dental career. you can follow the usual and customary path, and we all know about that. I don't need to take any time talking about you can go this and you can do

Victor Razi:

Sure.

Jeff Urbanek:

all that stuff. But literally any person who gets this degree and is smart enough then one way or another, either, either professionally, another going through specialty or even as a general dentist, whether general dentist or a specialist, you can make a lot of different choices in your career to. Prepare yourself and take, make yourself a niche of some kind. Now, it doesn't have to be a single niche, but something that you do really well.

Victor Razi:

Sure.

Jeff Urbanek:

That you enjoy and have a passion for, which is the other thing, don't do things you don't have a passion

Victor Razi:

Sure.

Jeff Urbanek:

Find something that you really like to do. Learn how to do it well by either by education or practice.'cause right when you finish dental school, you have the license to practice,

Victor Razi:

Right.

Jeff Urbanek:

And you know, practice makes perfect. So the more you practice, the better. Are you better

Victor Razi:

Sure.

Jeff Urbanek:

So the first lesson that I can say to young professionals, young, professional, dental students or people who wanna be dentists, is keep in mind that you don't have to follow the usual and customary path. You can make a path for yourself. You may have to work harder at it, or you may have to be creative at it, find something about dentistry, in dentistry that you really like, and then do that.

Victor Razi:

Sure.

Jeff Urbanek:

And it works really

Victor Razi:

Yeah,

Saad Alamgir:

Yeah.

Jeff Urbanek:

So that's kind of my lesson number one. I have a lot of, I teach a lot on the different

Victor Razi:

sure.

Jeff Urbanek:

on not only just dentistry, how to run a practice how to stay out of the weeds, running a practice, things like And then so I the TMJ surgeon among other high kinds of surgery that I did, but 2000 TMJ cases. And after 36 years of it, I decided that TMJ surgery was not going to be the long-term solution for the TMJ problem. And I had followed all of my careers, reading all the journals and going to the meetings and listening to my colleagues, and I did all the different kind of procedures from total joints up to lysis and lavage and all the things you may not know about quite now. Won't know about much of this when you finish dental school, but the point is all the different surgeries and 30 and 14 years ago, I walked into my office one morning a weekend thinking about it because a third of my patients that I did surgery for. TMJ surgery four would be back within a year or two with the same symptoms. Now, when I did orthognathic surgery, you know, reconstructing

Victor Razi:

Sure.

Jeff Urbanek:

faces for various reasons, cleft palate surgery lip palate, or micro neural surgery, reconstruction, I would look at a patient and I would be able to tell them and show them exactly what they can expect, exactly what the outcome was gonna be and exactly what was gonna happen with TMJ.

Victor Razi:

never.

Jeff Urbanek:

A third of the patients I couldn't predict and a third of'em would be back. And so when I decided not to do any more surgery, and my staff were quite surprised'cause it was a large part of my

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

And I said, we're just not doing it anymore.'cause I'm, I can't look at a lady'cause it's 90% females, 10% males. And I can't look at a lady and tell'em I'm gonna fix'em when I know that a third of'em are gonna be back within a year or two with the, within the

Victor Razi:

Sure.

Jeff Urbanek:

So what I did, because of that broad background, which is actually the reason why I shared with you this broad background of biology anatomy, medical degree, dental degree, that I decided I was gonna see if I could figure it out, figure out why nobody could figure out the answer to T-M-D-T-M-J. I did. So I did. That's another whole story. It's not a long, complicated story, but just to share

Victor Razi:

of course.

Jeff Urbanek:

the generalities with you. And by the way, you can look all the details up on my podcast, my own podcast or my own

Victor Razi:

Okay.

Jeff Urbanek:

It's all there.

Victor Razi:

Will do.

Jeff Urbanek:

The general concept is this you're gonna surprise when you get into the, to your whatever you're gonna, your dental school's gonna call it. Some dental schools call it dental medicine, or some people call it the TMJ Clinic or the Facial Pain

Victor Razi:

All right.

Jeff Urbanek:

There's a lot of misinformation about TMD out there. big problem is you will be taught if you have not already been taught. And I'd stick by it. And it is, it gonna make you controversial if you say this, the TMJ is not a different joint you are taught, will be taught that this joint is different. It's unique, it's complicated, and nobody can figure it out. And that's not true. The issue was that establishment, the dental schools, the dental profession was never gonna figure out this thing called. TMD tempera

Victor Razi:

Right.

Jeff Urbanek:

better known as TMJ, the name of the joint, they're never gonna figure it out as long as they keep saying that it's a different joint. Because actually you have to understand that this joint operates like any other joint in the

Victor Razi:

Sure.

Jeff Urbanek:

And that really was, is what my la the latter part of my career has been built around the non-surgical treatment of TMD. The real mechanism in physiology of TMD disease and how to treat T MD's disease non-surgically. But you have to start, you have to start from the concept that this joint operates like any other joint in the body because it does, The good Lord did not call out this joint and make a different

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

and the knee

Victor Razi:

Right.

Jeff Urbanek:

And actually this is, maybe a little showstopper for you eyeopener, but tennis elbow and TMD are the same disease. They operate the same way. TMD, and that gets into, it's all on the podcast that I do and the, in the blog that I do, by the way, I'll just say right now, the podcast

Victor Razi:

Yeah.

Jeff Urbanek:

and. Located on Dental

Victor Razi:

Okay.

Jeff Urbanek:

Name of the podcast is all the same every Tuesday. Every Tuesday, sometime during the day. I do a 30 to 35 minute podcast ver

Victor Razi:

Okay.

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

And it's called TMD Demystified. And you can find it on Dental Town, you can find it on YouTube, and you

Saad Alamgir:

Okay.

Victor Razi:

Awesome. Yeah.

Jeff Urbanek:

last Tuesday I did, I think I did my 226

Victor Razi:

Congratulations.

Jeff Urbanek:

tm, TMD, demystified, it's all about TMD, every kind of way you could dissect it, everything, you could talk about it

Victor Razi:

Sure.

Jeff Urbanek:

scientifically the misinformation, the way to treat it, the way not to treat it, the nonsense that goes on

Victor Razi:

Yeah.

Jeff Urbanek:

Et cetera, et

Victor Razi:

That's awesome.

Jeff Urbanek:

Again, getting back to, and I use myself an example, what I told you, I like to. Lead and I like to talk to people who have the opportunity to improve their life. And young dental students certainly need to do that, and you got a good profession going or you can get into a good profession. But I would highly recommend you. Look at it, or you work at it from a point of view that you can be unique in this field if you want it to be. Now you can do, you know, you can go to a DSO and go through that process or open your own pro practice and do that, either one of'em you can it's a good deal. I mean, it's a way to, you know, hone your skills and learn your, you know, practice your profession, My point to give it a second time. It is important if you want to, not everybody wants to, and everybody wants to focus that hard, but to, you know, focus on an area that really say, I love doing this. I really enjoy doing this. And then focus on that area, expand on it, learn it really You don't necessarily have to be a specialist to specialize. Okay. And and do something that is really fun to

Victor Razi:

sure.

Jeff Urbanek:

If it isn't fun, you shouldn't be doing it. If you know that you're doing what you're supposed to be doing, if you walk in every morning and you go, this is fun. And I'm serious now and when I quit having fun doing surgery, and it took me 50 years, but I can tell you one morning, one morning I went to walk in an operating room. I walked around the corner to walk into the room and I went, this is work. And it stunned me. I mean, I had the thought, you know, I'm not looking forward to this. This is a

Victor Razi:

Right.

Jeff Urbanek:

And I literally took a step back, didn't go into the room, and I thought, oh my God, over with. It's time to quit. I'm not having fun anymore.

Victor Razi:

Yeah. Interesting take.

Jeff Urbanek:

Does that make

Victor Razi:

Yeah,

Saad Alamgir:

Yeah,

Victor Razi:

makes perfect sense. Dr. Tony, uh, first of all, thank you for kind of elaborating on your whole story and kind of your motivators and what it is that you find is important on the field. I think you did a very good job. Being very, uh, straight to the point on what it is that has been important to you throughout your career. Uh, one of my questions that kind of piggybacks off the topic that you bring up is how did you find out that TMD is something that you wanted to focus your career on? Uh, I feel like a majority, over 50% of oral surgeons end up doing just bread and butter, wisdom, teeth implants, bone grafts, all that. How'd you know that that's something you're interested in?

Jeff Urbanek:

Victor. To correct you. It's more than 50%. Nowadays. It's 95% of young oral surgeons out, spend four to six years going through an OMS program and learn all this fancy surgery, which is enjoyable and a lot of fun. And then they come out and all they wanna do is wisdom teeth and

Victor Razi:

All right.

Jeff Urbanek:

And I don't encourage, I don't encourage the young doctors to do that at all, but it's not 50%, it's 90%. And I. I'm not for it. Alright. But I'm not trying to go around your question here. Happy to. You know, I tell my patients and all my colleagues, be careful the question you ask me, because you're gonna

Victor Razi:

Right,

Jeff Urbanek:

You're gonna get an honest answer, and it may not be the answer you

Victor Razi:

right.

Jeff Urbanek:

And for patients, I tell'em all the time, I said, be careful of the questions you ask me, because you're gonna get a straight answer and it may

Victor Razi:

Yeah.

Jeff Urbanek:

be the

Victor Razi:

Well, I mean, I.

Jeff Urbanek:

You're gonna get the answer, you're gonna get the answer you need,

Victor Razi:

Sure.

Jeff Urbanek:

So what made me focus on TMDI, I really kind of old told you part of the

Victor Razi:

Sure.

Jeff Urbanek:

After 2000 cases, I didn't feel really good about. surgery. I always like to help people, but I had to stop because I was not successful enough at doing TMJ surgery. Third of the patients would be back. That's

Victor Razi:

Right.

Jeff Urbanek:

And now you can't find an oral surgeon to do TMJ. Almost

Victor Razi:

Right.

Jeff Urbanek:

so why did I decide? I decided that I had enough background. I had enough training and experience two years with the NIH doing facial growth and development research. Laser research, facial growth research on rabbits. I'm I might be able to figure this out. I didn't know whether I could or not, but I decided that I'm gonna see if I could figure this out because I knew my general dental colleagues did not have the answer, and I knew my oral surgery colleagues did not thought to be the answer.'cause I did all that. So I did the research. It wasn't hard and, and then I got into it. And then once I got into it and we found out the successful route non-surgical to treating this disease, which really wasn't what I figured out what the solution was, what the research led me to was the actual physiology of what creates all the symptoms. And so I let the cat out of the bag. It's give you the basic that's on the all of the podcasts. Inflammation within the ular joint creates all these symptoms directly. There's a lot of pseu s pseudoscience that talks about my myofacial, pain dysfunction syndrome and a bunch of things that most of your people who listen to you, I'm speaking Greek to them now, so I don't mean to speak Greek for your listeners, there, there's so much miss. I, I, it's not even misinformation, it's just nonsense this disease from both medical and dental side. The medical doctors dunno anything about it, and they just throw pills at it. They throw drugs at the draw at the wall to see whether they stick and they don't. And the, and my dental colleagues, half of them make a night guard and hope the patient doesn't come back. And the other 50% of dentists stick their fingers in their ear when they hear TMD because they know nothing works and they don't wanna fall into a black wall. But I think I, I went and did the research and where do you start? Research, gentlemen, if you are gonna do some basic research, you don't have to have degrees to figure out where do you start when you wanna do some medical research?

Saad Alamgir:

Google

Victor Razi:

Sure.

Saad Alamgir:

Just got

Victor Razi:

Yeah.

Saad Alamgir:

literature reviews. Google, we gotta find out what's out there.

Jeff Urbanek:

Think harder. Think again. See if I can, I won't break. I'm not kind of, I'm not trying to. If you have a medical problem, where do you start? You start with the patient. You start with the person who has this disease. Right? Because I had a lot of those. I had a long line of those, and so I told my ladies that. My patient, my my staff members, I said, alright, tell the ladies when they call in, I'm not treating TMJ surgery anymore, but I want to talk to'em. I wanna interview'em. So what I'd do is I bring up a patient in potential patient with all the symptoms, headache, earache, jaw pain, neck pain, et cetera. I'd say, tell me all about it. I'm not gonna sit here and tell you what I'm gonna do for you surgically, or listen to your symptoms and tell you what I think is best. I want you to tell me what you think about it. What do you think makes it better? What makes it worse? What does your husband think about it? Does the dog bark when it hurts? What phase of the moon is it, you know? When it hurts and I heard a lot of stuff. I'm gonna tell you exactly how this started. You, I'm gonna answer your question. It's a little longer, but you know what made me get into the TMD thing?'cause if you had asked me. 20 years ago, 25 years ago that I, in my career doing non-surgical TMD, I'd say, you're nuts. That's

Victor Razi:

Right.

Jeff Urbanek:

that, no, that, that's not possible. But anyway, so I interviewed about 25, 24 women. They're all women, 90% women. And ask'em that question and encourage'em to talk. And over the first 24, I heard 12 times, 12 women said something like, if I take my finger or a pencil eraser, or my tongue, or a piece of cloth and gently put it between my front teeth, it feels better. I have never heard that before. It made no sense. Literature didn't talk about that. Surgeons didn't talk about that. The general dentist didn't talk about that. They made night guards and gave it to the patient. I never heard that before, but that's what the lady said helped. So I went in my lab, my little lab where I used to make oral maxillofacial, orthognathic splints and things for the cleft palate kids and stuff like that. I made a device right between the front teeth that they could speak with, they could talk with, they could wear long enough because I had a lot of experience treating cleft palate kids and putting things in people's mouth, trauma, et cetera, that they could use, talk with, et cetera. And put it in the patient's first patient's mouth. She has, she was 50 years old with 20 years of headache, jaw pain, neck pain. And I said, put it in your mouth. Keep it in 24 7. Except when you eat, take it out to eat. You can't eat with it in your mouth'cause your back teeth don't touch. You're only front teeth touch. I said, put it in there and hold it in place or it hold it's held in place with a little ball class. And come back in three weeks. And this lady came back in three weeks. I walked in the exam room and I said, how you doing? And she said, thanks doc, my pain is gone. It's

Victor Razi:

Oh wow.

Jeff Urbanek:

I and I stepped, I took a step back. I mean, she stunned me. I think she saw that I looked stunned. She looked at me like, weren't you expecting that She didn't know, I wasn't expecting that. She didn't know she was an experiment. And then I did another 20 cases, and they all didn't come back at three weeks and said all a hundred percent of their symptoms were gone. But they all came back, said they were better symptoms. Symptoms decreased significantly. And so then I, and then honestly, and then. I realized after 20 cases or so that I had no idea how it worked. No. I knew that, you know, putting something in your pa in a patient's mouth and separating the back teeth you know what you did, but you didn't know what you did. You didn't know how that worked. Right. And that took a little time back at the. Books and more thought experiments. Literally, you know, Einstein actually came up with his theory relatively with thought experiments. If you look into that, it's an interesting interesting study. But basically as it works out what you did, what you do when you something that only touches the front teeth. enough for a length of time you're unloading the joint because 90% of the loads on the temporal joint come from posterior teeth. Every dentist knows that. You guys should know that And you're unloading the joint like a set of crutches, unloads a bad knee. So if you have an inflamed knee or an inflamed temperament to joint and you do the same thing, unload the joint long enough, the inflammation's gonna die down. And then once I determined that, then I had to figure out how inflammation creates each and every one of those symptoms. And that really was the discovery, but it wasn't out of poll cloth. All that information is already in the textbooks. why I can honestly say. Tennis elbow and TMD are the same disease. Tennis, A elbow operates the like TMD, and from the painful point of view, there are

Saad Alamgir:

Right.

Jeff Urbanek:

symptoms. There are non-painful symptoms that the ENT surgeons call Mannie's disease. Mannie's Disease is a well-known set of symptoms called tinnitus, which is ringing and dis ringing and, buzzing in the ear fullness in the ear like you have water in your ear. That is called subjective hearing loss. wrong with the earing hearing mechanism, but you have water in it. Feels like you wa got water in your ear. You've been up in an airplane. And then dizziness, vertigo, those three symptoms. The ENT docs call Meniere's Disease. And if you go to an ENT doc with one or more of those symptoms, they're gonna, they're gonna do a very expensive workup and say you have Meniere's disease, and the patient's gonna say, oh wow. Good, we now we know what it is. What do you do about it? And the NT docs shake their head, roll our eye and say, we don't have an answer from a year's disease.

Victor Razi:

Yeah.

Jeff Urbanek:

But we know that. tinnitus, subjective hearing loss and vertigo are well-known, well-established symptoms of TMD. Known. Everybody agrees on it. It's not me saying that, and that those symptoms go away so that not, those are the non-painful, non-painful symptoms are created by inflammation, but through a separate mechanism. The mechanism that creates the pain is the mechanism that creates tennis elbow, which is when a joint becomes inflamed. By damage. By damage, you damage a joint. Three different ways. You can damage a joint three different ways. There's only three ways to damage a joint. Bruxism. Acute trauma and functional mal

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

and then you damage a joint enough, it's gonna create chronic inflammation, and the chronic inflammation creates the symptoms. Now, how does that happen? It's I tell patients and I lecture on it nationally, and here's how it goes. You have a, you have an inflamed joint. Let's talk about the elbow and then we bring it up to the TMD. Elbow becomes inflamed because of too much repetition.

Victor Razi:

Sure.

Jeff Urbanek:

By the way, you gotta know, you gotta know this. Tennis elbow is too much tennis, but where I come from, blue collar town, steel mill town, Gary, Indiana, nobody played tennis the ladies. Played bingo six nights a week at every church, and they'd have a line of bingo cards, literally six, sometime, four or five lines. And they spent all night long going like this. No, no kidding. All night long. You have 10 cards here, 10 cards here, 10 cards here. And they do this all night long. You know, it's it's a religious bingo is what it's.

Saad Alamgir:

Yeah. That's awesome.

Jeff Urbanek:

this all night long. And it got to be funny in town because there was a disease called bingo elbow. Too much repetition of the

Victor Razi:

Interesting.

Jeff Urbanek:

Alright, so what happens is too much repetition causes damage to the lateral epicondyle of the elbow. And the sympathetic nervous system sends a signal to the brainstem, to the brain. Brainstem doesn't go up here where you know things are going on to the brainstem, where the autonomic nervous system happens. You guys know that. You're taught that, and the autonomic nervous system says, oh my God, you're damaged. We're gonna help you out. Don't move the joint. Don't move. The

Victor Razi:

Mm-hmm.

Jeff Urbanek:

move. And it sends a signal back down through the sympathetic portion of the autonomic nervous system to the muscles that what move that joint.

Victor Razi:

Sure.

Jeff Urbanek:

And that's why tennis elbow people complain of pain in the forearm. They don't complain of pain here, On

Victor Razi:

Right

Jeff Urbanek:

You can push on that and it will hurt because it's inflaming. But they complain of pain in the forearm and the wrist. So let's bring that up the TMJ. I think you can figure

Victor Razi:

story. Yeah.

Jeff Urbanek:

You can figure, you should be able to figure out what I'm

Victor Razi:

Little bit.

Jeff Urbanek:

When this joint becomes inflamed,

Saad Alamgir:

Uh

Jeff Urbanek:

it signal to the brain. Stem says, I'm inflamed. The brain stems, oh my God, I'm gonna help you out. Don't move the jaw joint. Don't move the

Victor Razi:

Lock up,

Jeff Urbanek:

The jaw. The signal comes back down to tighten up

Victor Razi:

right?

Jeff Urbanek:

Tighten up the muscles. Mastication, you know, the five major ones, right? Temporalis, masseter, external, internal external. External, internal. Oid and mylohyoid. Right? Interesting. You know, patients will complain that TMD they'll complain right there where my Ohio attaches on the inside of the mandible. It works the same way. And the medical doctors call the patients crazy'cause the pains move around all the

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

doctors don't know what to do about it because they're still operating on the theory that it's just too much bruxism. Right. You're wearing out. You are wearing out your muscles. Muscles get tired. No. Muscles don't get tired muscles don't. Muscles don't have pain sensors in'em. Muscles don't hurt. Muscles can burn. You go. When you guys go to the gym, when you young guys go to the gym and you work out too much, you caught the muscles to burn, but that's not pain. The muscles created where the muscles are attached to the periosteum and where the per and the periosteum is where the nociceptors are. Right. Remember nociceptors. Gotta speak in Latin. They can't say, they can't say pain receptors, they gotta say nociceptors because it sounds good. the pain comes from where the muscles are attached to the bone. So wherever your muscles mastication are attached to the are attached to the bone is where it's gonna hurt when they get the signal to tighten up. And then when that doesn't do good enough, the signal coming down, tighten up. Don't move the jaw. Don't move the jaw. Then the signal comes down, Hey, I told you don't move the jaw, and I hold the whole head tight, tighten up. the second most common symptom of TMD is neck pain. True. I mean, that is the second most common symptom of TMD is neck pain. That doesn't, when that doesn't do it, and people ignore the pain or doesn't go get it, fixed the right way, and they do all kind of nonsense. Then the signal comes down and says, tighten up the shoulder girdle, and you get. Tight jaws, tight neck, tight shoulder girdles, upper neck pain and tightness. And then the symptom that is starting to come out, because I'm teaching it, starting to come out and become more common, is arm hand, finger tingling and numbness. And that is created when the

Saad Alamgir:

Wow.

Jeff Urbanek:

get tight and they squeeze the brachial plexus. You know, remember your strap Or I'm an anatomist by training, God, excuse me, I'm a geek. And the strap muscles on the side of

Victor Razi:

Sure.

Jeff Urbanek:

Tight. They get the signals that get tight when they tighten up, they squeeze the brachial plexus, right? And when they squeeze the brachial plexus, it causes the arm to be. Feel feel tingly Sometimes painful and that goes away when the inflammation goes away because the muscles relax and don't tighten. And don't squeeze the brachial plexus.

Saad Alamgir:

Wow.

Jeff Urbanek:

It's a really, it's, and all that information has been in the literature. I didn't create

Victor Razi:

Yeah.

Jeff Urbanek:

I just connected the, so the answer. That's a long way of saying, why did I get into this? I got into this because patients need it. Because, you know, because the majority of our patients that I see and the other doctors who use the device that we now have, it's patented. It's FDA cleared, it's university studied and the the most, most common patient we see has decades of headache, earache, jaw pain, neck pain, and been seen by five, 10 doctors of different varieties of all varieties. And everybody shakes their head and does stuff that doesn't work. And that's why I, that's why I do it. That's why I

Saad Alamgir:

Yeah.

Jeff Urbanek:

it. and that's, yeah.

Saad Alamgir:

First, Dr. Tony, it's incredible that you were able to explain that in such a. I wanna say simple way, you know, just explaining the process in which things happen and, you know, the inflammation just just spreads along your whole body essentially. That being said, you did mention kind of lightly about what your product actually is. Do you mind going a bit more in a detail about what the actual product is and you've seen results, and if you've done just any studies on it in general too. Those things that.

Jeff Urbanek:

I certainly can. I just want to, I wanna give the disclaimer, I don't want to, I didn't do this to speak, to be to be commercial. I you know, but I'm happy to, I mean, the

Saad Alamgir:

I didn't, yeah, and I didn't mean it like that. It's just, you know, it's a very interesting product that you've developed and I think our listeners would be interested in just hearing a little more about it.

Jeff Urbanek:

You know, as long as, you know, there's a conflict of interest. I am, you know, I'm president and CEO a company called tMJ services and we're the ones that this device. Now, it's a very simple thing for those of you who may in the future or presently know, it's, this isn't the only thing that you put handbook between your front teeth, but the other things that you put your arm, your front teeth, you can't talk with them. You can't speak with them. They're very uncomfortable and sometimes cause problems. But anyway, it is a tool. I call it a tool. It is fits. Over the maxillary front teeth, and you have to have some way to keep it in place to retain it, right? The first iteration was just using ball class, like you'd make a retainer, for orthodontics with ball class in a device. But now this thing is made CAD CAM 3D printed. And very precise. 3D printing, as I learned, has been very precise as is Cadcam construction. And we, once I figured out how successful it is and I figured out it works, then I decided well. lot of people need this. I wonder if it can be patented. So we did that. That took a few years, and then I got the FDA clearance on it. That took 18 months. we have a company that makes the device and teaches, we're really a, it's a service company, TMJ services. We teach other doctors to do. we do here in the founding practice in my practice, and again, I, as I said, I don't do surgery anymore. I quit doing any kind of surgery about five years ago. And so we now have a company and a practice, the founding practice where I'm sitting right now and it's a very active practice treating nothing but non-surgical TMD. So it's a device and protocol you have to, you just don't make a device and give it to the patient. You gotta know how to use it. You gotta know the nuances. You gotta know how to talk with and teach the patients themselves. when you do that, you get results. The results here when you get patient compliance, hopefully you have begun to see things called patient compliance. If you are a dental student, you need patient compliance.

Saad Alamgir:

Yeah.

Jeff Urbanek:

And but with good patient compliance, our statistics are 95% success rate of getting rid, taking away. of the usual symptoms of TMD, which are, want me to run through these. The usual and customary symptoms of TMD are frequent and or recurring headache, ear ache, jaw pain, neck pain tinnitus, ringing in the ears, subjective hearing loss, vertigo, dizziness, upper back, shoulder pain, arm hand, finger tingling and numbness, which I told you how that works. And then very. Various kinds of jaw locking and those are the symptoms. And if you remove the inflammation or decrease the inflammation in the joint long enough, according to a protocol, and the protocol is 24 7 for two months, nighttime only the rest of your life, what you're doing is unloading the joint consistently. And that's one of the problems with, there are a few other things that I learned after I developed this that there are other things out there that separate the back teeth. The problem is you have to separate them long enough. Carefully enough that you don't cause problems, but yet get the result of decreased inflammation. So that kind of describes the company. TMJ. TMJ services. We teach other doctors. We have, right now we have doctors in about 20 states who are licensed to use the device because it's patented. You have to get a license, you have to take a little course, and I mean a little course, nothing like going to dental school. I mean, you can take a course for a full day here in Nashville, or you can take an online course. It'll take you about three or four hours to learn the nuances. Of the physiology of it. That's really, and the nuances of how to present it to a patient. Right?'cause I found that you have to spend some time educating your patient as what you're doing. It's, and this is a take home message for all you young dentists. True. One way or another. As you practice, whatever you're gonna practice, take the time to educate your patient as to what and why you're doing it. If you're gonna be, if you're doing root canals, tell'em a little bit about how a root canal works. Tell'em a little, you don't have to. You don't have to show'em vis, virtuals or vi vio or whatever,

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

but tell'em what you're doing and what a root canal is and what the statistics are and what the materials are. And maybe, you know, why it's so difficult to do a good root canal on an upper second molar tooth, you know? You know, spend the time educating your'cause. You know, I learned that a long time ago and I applied that to all my surgical cases and I applied that to these non-surgical TMD cases. when I brought it up. You teach your doctors, in this case, we teach our doctors who are part of the network of doctors who do this, to address the patient, how to teach the patient. And it's easy. It doesn't take long. I mean, you, it, you know, you do this whole process of, taking an impression, first of all, doing a consult, making sure the patient has the symptoms, has the problem. You've done your consult, you're sure they got TMD, and then they want treatment. And then you teach'em what you're gonna do and go through the process of follow up for a few months. The whole process takes an hour. Start to finish. Start to finish.

Saad Alamgir:

Wow.

Jeff Urbanek:

delivery. Follow up takes you an hour. And it's very good because, I mean, really getting into the human humanistic part of this, when I did. Maxillofacial reconstructive surgery. I spent of my career in an operating room in a hospital, not in my office. I would come back to my office in the afternoon after a long day in the operating room, and if somebody was sitting in my waiting room begging me to take their wisdom teeth out, I'd go, okay, I'll take'em out. did plenty of, I did plenty of wisdom teeth and dental implants, but I spent most of my career in an operating room and I learned. learned along the way that, you know, education to my patients was the most important thing. But no matter how slick a, you know, major case was that I did, and I was so proud of it and I was happy with it. But rarely did a patient come to me and say, thank you. Now they expected good results. Now that might, you know, that might have given me a nod or two, but when you treat somebody who has. Decades, five years, 10 years. I have a few. I have many patients who have had 40 years of by our system. It's both medical and dental. Not intentionally, I'm not calling out anybody but unintentionally mistreatment by our medical dental system on this thing called TMJ. And when you have a patient that you treat and you make all those symptoms go away. The response is amazing. I, today, I had to see patients today, I, I still see patients once a week. I have an associate who sees'em the rest of the time, but today I had two patients stop and as I discharged'em after a while, you finally get the point. PRN, you're done. Come back if you have any trouble. both of them said, thank you so much. You changed my life. Seriously. And in the

Saad Alamgir:

Awesome.

Jeff Urbanek:

it's not uncommon, didn't happen

Victor Razi:

All right.

Jeff Urbanek:

but it's not uncommon in the south for the ladies to get out of the chair. And I've had it happen multiple times and they'll look, they'll come to me and they'll say, go quote in their southern accent, honey, can I give you a hug? I never had a patient when I did major maxillofacial surgery, ask to give me a hug. Not everyone,

Victor Razi:

Interesting. Yeah.

Jeff Urbanek:

no true. This is true

Victor Razi:

Yeah.

Jeff Urbanek:

This is true stuff, and that actually, now you can imagine, I don't know what you expect when you finish down what you expect to be or do or how you think it's gonna be when you get your degree and you go out there in the world, there is nothing better. I don't care how much money you make or not make, or kind of procedures you do, or what kind of specialist you are, or how big a practice you got. A DSO with 40 practices. There is nothing better. Nothing that I've ever experienced better than a patient saying, my God, you changed my life.

Victor Razi:

That's a great, uh, point to end on there and really is a, I still find it so fascinating too that, you know, you kind of found a, a na, a niche that you really thought was very purposeful and then you kind of went all in and didn't really have a plan B for many years and really have. Develop something so unique that you can offer to people that can really change their lives. Dr. Tony, uh, kind of as we're wrapping up here you know, our dental students and pre-dental students are confused at times just with life and dental school and grades in general. Do you have any final advice you'd like to give for dental students and let's say early dental professionals that have many years of a career ahead of them and how, uh, they can have some type of motivation or, uh, perspective. That, uh, you've got throughout your career in the dental field?

Jeff Urbanek:

We could do a whole different, we had to do a separate episode on that, but I'll try to make a brief. No, I understand. And time, your

Victor Razi:

sure.

Jeff Urbanek:

There's so much I could say. Number one. Every bit of your education is important, every bit of it, and so hopefully the basic sciences sticks that you think. The basic science is you gotta know this stuff well, even if you think that's all you're gonna do is, you know, spend your time in the mouth treating teeth, wanna focus on the basic sciences as much as you can. Number two. I'm gonna give you a hint here. I'm gonna give you a really big hint that helped me tremendously in my studies. Literally my factual, how to study, how to get a grade, how to stay ahead, how not to fall behind, okay? It's not complicated. Nothing I do in my life is complicated. Everything is simple, I'll learn this when you're studying. What other topic makes no difference? And nowadays I used a medical dictionary. I had a big old Dolans. I don't even know what Dolans is. That's your standard operating procedure, medical dictionary. It's this thick. Now we got computers. Do not go past a word that you do not understand. Be very careful. You do not go past a word and you, in medicine, you are faced all the time in the lectures and in the books and in the in whatever the journals. You're gonna read an article, you're gonna be told something. And that word, you do not understand the meaning of that word. And anything after that, you are not gonna understand. You're gonna go blank. And therefore you're not gonna remember it. The way to remember your studies, the way to study it correctly, is to, nowadays, I have to say computer rather than darling's dictionary. When you run across a word, and you know, doctors gotta speak in Latin to sound important. So most of'em are based on Latin, right? And unless you're well versed in Latin. It's gonna be even harder. So always make sure slow down a little bit. Don't you know, because really the time you save by understanding the words that you're reading, look up the word, understand the definition of that long Latin sounding word. gonna take a little more time to do that, but the time you actually save in having to go over and over and then get it wrong, and then get it wrong because you didn't understand it. You can spend a lot of time doing over. Don't understand. So if you study from the point of view that you always clear your words, you know the definition of those medical words, you know the definition of all the verbs and you know all that, that you learned in high school and college, but the medical words is what? What really? Fries. Medical and dental students. go make sure you understand the words and then your memory will be better. You'll understand it better, it'll be more fun. You'll enjoy studying more because the understanding comes more easily and go, oh, I got that man. Oh, now I see that. And that lifts your spirits. But that's what it takes. It may sound. Maybe sound not, you know, maybe not sound right to you, but I'm telling you that if you do that, you, it will take you far as your ability to learn. And that's the problem. You know, when I teach out there in the public, I say everybody in the room slow down. I did a lecture. I was at the Chicago Midwinter meeting. I had 200 people in the room. Filled the room on TMD

Victor Razi:

Sure.

Jeff Urbanek:

people waiting in the hall I told everybody, slow down. I said, don't worry, I don't like to teach. I don't like to teach through a fire hose. I'm gonna go slow. I may go too slow, you know,

Saad Alamgir:

Mm-hmm.

Jeff Urbanek:

we're gonna, we're gonna, we're gonna, I'm gonna make you understand the words that I'm

Victor Razi:

right,

Jeff Urbanek:

and at the end, you're gonna understand a lot more about TMD than you ever did. And so the point is, don't try to learn through a fire hose. You'll

Victor Razi:

right.

Jeff Urbanek:

And I'm sure you've ex, I know each of you and everybody who's listening to this, every person who's listening to this has experienced sitting in a lecture hall and trying to follow the lecturer they've, they're listening to something he said, and the next thing they know, they're 90 seconds down the line and they have no idea what was said for the 90 seconds. They're still back at 90 seconds before, and now the whole, their whole understanding is black is blank. Right. Follow that's

Victor Razi:

Right. Mm-hmm.

Jeff Urbanek:

That's what we're talking about. And

Saad Alamgir:

All the.

Jeff Urbanek:

When you quit doing that stuff, when you actually understand everything that's said understanding the words, then it sticks with you and then you can regurgitate it. Right? We don't learn anymore. We regurgitate things for an

Victor Razi:

Right.

Jeff Urbanek:

but that's the system we use.

Victor Razi:

For.

Jeff Urbanek:

we have to do that. They don't have a better. So that's what I have to say to help your potential students and current students about getting through and sitting on that. Sitting in that chair night after night, reading

Victor Razi:

Right.

Jeff Urbanek:

and trying to learn this stuff and reading your notes. look it up. Make sure you understand the

Victor Razi:

Awesome.

Jeff Urbanek:

I think that's plenty for

Victor Razi:

Yeah,

Jeff Urbanek:

That's

Victor Razi:

Thank you very much for your advice. It was very, uh. I think you're very, uh, specific about your advice and it wasn't all just kumbaya and I think that it, it was straight to the point. I think it does. Uh, it's a really interesting point. I've actually never even, uh, I've heard that before. So that is a good take and really, we really appreciate you, uh, coming on and giving us, uh, your perspective on the world of TMD and how. You've experienced it all and your educational background and how, uh, just, you know, how to move forward in life and in, in the dental field and just learn and grow. So we really appreciate you joining us today, uh, Dr. Tony and, uh, we look forward to keeping in touch. And thank you for joining us.

Jeff Urbanek:

You are welcome. Let me just add one thing, both sad and Victor. Anybody wants to talk to me. I'm available. Happy to talk to people. I love to talk to people. tony@tmjservices.net t and the website is www orban tmj.com.

Victor Razi:

sure. And Doc, one more time. What's the podcast so our listeners know?

Jeff Urbanek:

I have the podcast, which is on Dentaltown, YouTube, and Spotify. Same stuff,

Victor Razi:

sure.

Jeff Urbanek:

Is TMD Demystified.

Victor Razi:

Okay. Thank you Dr. Tony. We have a good night.

Jeff Urbanek:

Yeah, enjoyed it. I really enjoyed it. Thanks for.