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Bocalbos v. Kapiolani Medical Center for Women and Children3/9/2000
andible forward and laterally, and then converting [Bocalbos's] upper partial into a splint using acrylic or a similar compound ([Bocalbos] provided this information to me). . . . He further noted that the malocclusion perpetuated and aggravated the pains of the head, neck and shoulder.
(i) . . . f the roots of the teeth are not in the proper alignment, putting a splint over the teeth will cause more misalignment tantamount to paving a road without proper foundation. . . .
Orthodontics is necessary in Bocalbos's case because good occlusal stabilization will provide the most support for the TMJ complexs' functioning since other support structures, like muscles, tendons, and ligaments in the area of the TM joint have been damaged extensively, thus making the joint very unstable and subject to frequent exacerbations of dysfunction. Orthodontics involves re- aligning the teeth so the permanent occlusal work through prosthodontics could be done. . . .
(k) . . . Briefly, the missing teeth did not cause TMD but rather made treatment more complicated and limited the choice of appliance.
Any comprehensive treatment for CMD-TMD must addres three key areas of the body: the muscles of mastication and the neck, the TMJs and accessory structures, and the occlusion. As long as these three areas are not stable, symptoms attributable to the disease/dysfunctional state will persist and the condition may result in some loss of function. . . .
The consists of the mandibular condyle, the disc, the capsule, and the synovial lining. The joint has a complex motion and any disruption in its position can lead to symptoms of CMD-TMD. Bocalbos's TMJs have obviously been disrupted. . . .
The mandible (jaw bone) is involved in the opening and closing of the mouth and allows us to chew and grind food. The teeth embedded in the mandible have to have optimum occlusal contact with the teeth of the upper arch in order to function properly and also to help maintain the condyle-disc- fossa relationship. In Bocalbos's case her bite was changed as a result of the accident. Since the problem was not addressed immediately and the soft tissues were affected, a chronic state of irritation probably persisted. . . .
The ultimate goal of correcting the malocclusion is to treat the TMD. There are two key steps: orthodontics to place the teeth in proper alignment and then prosthodontics to provide a permanent and stable occlusion that will support the proper condyle-disc-fossa relationship and reduce or eliminate the muscle spasms that perpetrate a cycle of dysfunction. A stable occlusion is critical in Bocalbos's case because the other support structures in the area of the joint and the tendons, ligaments, and muscles that connect the mandible and other bony parts of the head, face, and neck have been strained and weakened. Ligaments and tendons are inelastic but flexible and do not heal well especially if stretched beyond the limits of their function. The occlusion affects the condylar position because it is one endpoint during the movement of the mandible.
With regard to prosthodontics, implants have been proposed by [Knouse] because they are stationary and will provide good anchorage for re- building the appropriate occlusal pattern. He proposed a fixed bridge so the occlusion will be stable and not subject to periodic adjustments. Implants will provide some of the posts for a fixed bridge. . . . (Emphases added.)
We believe the failure of the Board to consider McRoberts's letter was also an abuse of discretion for the same reasons previously discussed in Part IV.D., supra.
B.
In its motion for reconsid
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