Face First Treatment Philosophy
TMJ Pathology, Pain, Growth, OSA
The Face First concept is a process of diagnosis and treatment planning. It allows one to avoid being “trapped” during treatment pathways by addressing all of the relevant maxillofacial pathology. The concept is based on Stephen Covey’s second habit of highly effective people; “begin with the end in mind”. Similar to how an architect or city planner will not start building until they have considered traffic, plumbing, natural lighting, foundational strength, etc., the Face First approach considers the END GOAL before treatment is started. Temporomandibular joint pathology is often not isolated but rather involves four key ares:
The TM joints
The maxillofacial skeleton (secondary to growth disruption and/or condylar degeneration)
The dental occlusion
The airway
Thus, all of these structures must be investigated to rule in or rule out pathology… get an accurate diagnosis. Similarly, if pathology exists, it should be treated… get the correct treatment. Interestingly, abnormalities in the above structures can be evaluated by studying the Face First. For example, childhood pathology in the TM joints may inhibit normal mandibular growth causing a skeletal malocclusion, small airway and deficient chin projection (abnormal face). Figures 1-2 show how this can be organized into a flow chart and algorithm.
Figure 1 Face First flow chart.
Figure 2 Treatment algorithm for adult patients.
Figure 3 Diagnosis to treatment flow chart.
