Americans Are Not Going To The Dentist Enough

Summary

Short Wave – "Americans Are Not Going To The Dentist Enough"

Air Date: December 5, 2025
Host: Emily Kwong
Guest: Dr. Justin Richard, Oral Surgeon

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Episode Overview

This episode dives into why so many Americans are neglecting their dental care, with a special focus on TMJ disorders (TMD)—a collection of conditions affecting the jaw joint. Host Emily Kwong sits down with Dr. Justin Richard, an oral surgeon, to explore the prevalence, causes, and treatments of TMD, and the broader implications of oral health neglect across the nation. The episode emphasizes the importance of regular dental visits and debunks common myths about at-home dental care.

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Key Discussion Points & Insights

1. Dentistry in America—An Overlooked Health Essential

• Confession: Emily Kwong admits this is the show's first episode featuring a dentist in six years.

• Quote:

  “Somehow in the six years that we have been making this show, we've never had on a dentist.”
  — Emily Kwong [01:32]

• Why it matters: Dental health is often sidelined, despite its impact on detecting serious diseases and overall health.

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2. The Nationwide Problem: Avoidance of Dental Care

• Consequences Of Avoidance:

  • Leads to delays in detecting oral cancers.
  • Contributes to a rise in TMJ disorders and other oral health issues.

• Justin Richard’s Perspective:

  “Nobody wants to go to the dentist. Even most dentists don't want to go to the dentist. I don't love it either. I get it. But it's important.”
  — Dr. Justin Richard [02:17]

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3. TMJ Disorders Explained

• What Is TMJ/TMD?

  • TMJ stands for the temporomandibular joint, connecting the jaw to the skull.
  • TMD refers to disorders of this joint, resulting in pain, stiffness, and difficulty functioning.

• Prevalence:

  • An estimated 5–10% of the US population suffers from some form of TMJ disorder.
    — [05:04]

• Symptoms Include:

  • Popping, clicking, jaw locking
  • Difficulty in chewing/talking
  • Jaw pain/stiffness

• Who Is Affected?

  • Causes aren’t fully understood.
  • Loss of teeth can increase susceptibility due to lack of joint support.
  • Quote:

    “People who don't have teeth in the back of their jaw... you get strain on the ligaments that support that cartilage pad, and then you have a problem…”
    — Dr. Justin Richard [05:40]

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4. Functional Role of Teeth

• Support System:

  • Teeth aren’t just for eating—they structurally support the jaw joint.
  • Loss of teeth can cause the jaw to shift, increasing TMD risk.
  • Analogy: Similar to how unequal leg length can misalign the hip, leading to pain.

• Emily's Realization:

  “I never realized our teeth support our jaw. Without it, we would just have a gap mouth.”
  — Emily Kwong [07:36]

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5. Diagnosis of TMD

• Thorough Assessment Required:

  • TMJ exams are detailed—sometimes longer than surgeries.
  • Listen to the patient, look for asymmetries, and imaging (X-rays, MRI).

• Definitive Diagnosis:

  “MRI proves it... MRI doesn’t lie. Once you see it, you know it.”
  — Dr. Justin Richard [09:03]

• Bone Health:

  • The role of “synovial fluid”—lubricates and nourishes the joint. If the cartilage pad is misaligned, both healing and bone health suffer.
    — [09:20]

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6. Treatment Options for TMD

• Non-Surgical Treatments:

  • Occlusal appliances: Like thick Invisalign retainers, these reduce pressure on the jaw.
  • Minimally invasive procedures:
    • Arthrocentesis—flushing the joint with water to reduce inflammation.
    • Injections (PRP, growth factors, fillers—off-label use).

• Surgical Options (For Severe Cases):

  • Open joint surgery is rarely needed.
  • Cartilage repositioning or removal.

• Quote:

  “The majority of TMJ issues probably don't even need surgery.”
  — Dr. Justin Richard [11:29]

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7. The Right Place to Start: See Your Dentist!

• Primary Care for Your Mouth:

  • Dentists are the first port of call for jaw pain and oral health concerns.
  • DIY dental appliances from the internet are heavily discouraged.

• Memorable Moment:

  “Go see a dentist.”
  — Dr. Justin Richard [12:08]
  (Followed by Kwong teasing about his persistence)

  “If you go on Amazon, you can find appliances that you can make at home. Those create more issues, way more issues than they ever solve.”
  — Dr. Justin Richard [12:14]

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8. The Future of TMJ Education

• Standardized Learning:
  • Push for a unified dental education on TMJ, ensuring all dental professionals have a consistent knowledge foundation.

  “If we all can get on the same page... sky’s the limit.”
  — Dr. Justin Richard [13:25]

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9. Notable Quotes & Light Moments

• Emily’s Affection for Her Dentist:

  “As someone who loves my dentist—shoutout to my dentist—it’s great to have you on the show.”
  — Emily Kwong [13:26]

• Jokes about Job Security:

  “It keeps me in business.”
  — Dr. Justin Richard, on DIY appliances [12:36]

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Important Timestamps

• 01:32 – Emily Kwong introduces Dr. Justin Richard and confesses it's the first dental episode on the show.
• 02:17 – Dr. Richard comments on the universal avoidance of dentists.
• 05:04 – Prevalence of TMD in the US is discussed.
• 09:03 – Dr. Richard talks about MRI as the gold standard for diagnosis.
• 11:29 – Discussion of surgical vs. non-surgical treatments.
• 12:08–12:36 – Firm advice to see a dentist, not attempt self-treatment.
• 13:25 – Dr. Richard shares his optimism about the future of TMJ education.

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Takeaways

• Dental visits are crucial—not only for cavities, but for early detection of serious conditions and jaw health.
• TMJ disorders are widespread and often overlooked; effective treatments exist, and most don’t require surgery.
• Teeth matter for more than eating—they’re foundational to jaw function and overall oral health.
• Don’t buy DIY dental devices online; see a professional.

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(If you have questions for the Short Wave team about dental or jaw health, email them at [e-mail]!)

Transcript

[A]

Support for NPR and the following message come from Warby Parker, the One Stop Shop for all your vision needs. They offer expertly crafted prescription eyewear plus contacts, eye exams and more for everything you need to see. Visit your nearest Warby Parker store or head to warbyparker.com hello there. Short waivers. Emily Kwong here with a quick word before the show. So this week is Giving Tuesday. That is the global day of generosity that NPR celebrates every year. But this year is different because it is the first time in 50 years that NPR is operating without federal funding. That is a huge deal and a big challenge, but it is one that we can take on together. At Shortwave, we bring you science coverage that is fun, human that introduces you to new ideas, amazing discoveries and everyday mysteries that helps you feel a little more connected to this planet and the people we share it with. We know all of this matters to you and that is why some of you have already stepped up to share in the cost of bringing you shortwave each week. Like Gloria, a listener in Texas who says, I would be less informed, thoughtful and interesting without fresh air. Throughline, shortwave and up first. I love these programs and I hope they continue. We are so grateful to listeners like Gloria who have stepped up to support NPR this year. You can join them. Sign up for NPR and Mark Giving Tuesday. This is a simple recurring donation that gets you perks to NPR's podcasts. [e-mail] thanks again for your support. Here's the show. You're listening to Short Wave from NPR Shortwavers. It's Emily Kwong and I have a confession. Somehow in the six years that we have been making this show, we've never had on a dentist.

[B]

This is the very first. I'm so excited to be a part, very first of anything.

[A]

I was like, how is this possible? Like, I floss. I have no reason to avoid dentists. But it appears that we as a nation are not going to the dentist enough. Justin Richard tells me that has led to a delay in the detection of oral cancer across the U.S. nobody wants.

[B]

To go to the dentist. Even like most dentists don't want to go to the dentist. I don't love it either. I get it. But it's important. Do your routine care. Do your hygiene. Like, you know, hygienists are amazing.

[A]

Justin, by the way, is technically an oral surgeon. He's based in northern New Jersey, went to dental school in Boston and did his fellowship in Arkansas.

[B]

Yeah, I've been all over. I've tried different areas of the country.

[A]

You've seen so much of America's teeth.

[B]

I have. And some areas of the country have more than others. But teeth, yes. Some areas of the country have more teeth than others. And they have varying degrees of, like, dental problems.

[A]

And one of the biggest problems out there is TMJ disorders, or tmd. That is a suite of disorders affecting the tmj, or temporomandibular joint, which moves every time you chew, speak, or open your mouth. It's a joint that actually connects your jaw to your skull. And when that joint becomes strained or injured, it can cause stiffness, jaw dysfunction and pain. And this is not some niche problem. Tens of millions of people in the US have some form of tmd, and Justin specializes in treating it.

[B]

Really what I do on a regular basis, like every day when we're seeing a new TMJ patient is diagnosis, assessment, figuring out what the problem is and then where it's coming from. And then, you know, that helps direct treatment from there.

[A]

So today on the show, we sit our butts down in the dentist's chair to investigate one of the most pernicious problems of all. TMJ disorder. Why people get it, who's most susceptible to it, and how relief is possible. I'm Emily Kwong and you're listening to Shortwave, the science podcast from npr.

[C]

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[A]

Rooted in a history of diverse products spanning the healthcare industry, from wound care therapies that can accelerate healing to dental restoratives that preserve smiles. See how they're solving for you. Visit solventum.com okay Justin, so I read that an estimated 5 to 10% of the US population has some form of TMJ disorder. That is a lot of people. Do we know what causes this and who is most susceptible to developing it?

[B]

Yes and no.

So the overwhelming majority of TMJ issues are related to a cartilage pad that sits on top of the Bone in your jaw joint and the position of that cartilage pad. Overwhelming majority of people, popping, clicking, locking the jaw. Majority of those issues at some point are related to that cartilage pad not being in the proper position, which affects the movement of the joint and, you know, and then symptoms that are associated with that. Now, who's more susceptible? That's what we don't really know about. Oh, so sometimes, like, people who don't have teeth in the back of their jaw that might lead to an unsupported jaw joint, you get strain on the ligaments that support that cartilage pad, and then you have a problem that is associated with it.

[A]

Got it. Okay. How do our teeth, which sit on the jaw, affect this joint, which is all the way. The jaw joint is like, all the way in the back, right? It's like right below our ear canal. So, like, when we look at the architecture of the jaw, why do our teeth matter?

[B]

Right. So, you know, again, like, the teeth ultimately are the support system to the joint. So, like, let's just say, like, you don't have any teeth on half of your mouth, so you're going to chew on the left side of your mouth and you're going to probably develop a habit with the way that your jaw wants to rotate and shift to be able to function, to talk, to be able to chew, you know, to be able to say how great your podcast is. Your jaw joint is moving around every time that we're speaking or eating or functioning. And so if you're unsupported on one side, you start to develop habits with the way that you move your jaw to be able to function, and then that can weaken the structure. So again, using like, analogous to, like an orthopedic issue, like a hip issue. If you had one leg that's shorter than the other, it's a really common reason for having misaligned, you know, pelvis and start develop hip and back pain. And so really, it's the same type of thing. At the end of the day, I.

[A]

Never realized our teeth support our jaw. Without it, we would just have a gap mouth. I thought the teeth supported my appetite. You know, like, emotionally speaking, the teeth. But the teeth are, like, serving an architectural purpose in our head, right?

[B]

Oh, my God. That's a structure. Oh, no, it's an extension of the bone. And it's harder than bone in some cases. But, I mean, they really do matter. They're supposed to be there.

[A]

What are some of the signs that a person has tmd and what are the Signs that they don't like. How do you even go about diagnosing this?

[B]

Well, my TMJ exam is longer and more detailed than anything else that I do, including most surgeries that I do. And part of that reason is you really have to listen as a provider. And so, like, you know, do they have locking of the jaw? Do they have dislocating of the jaw? Like, you know, maybe just one side of their jaw is having a problem and the other one's moving fine. Maybe their jaw deflects a little bit. You know, it doesn't. Doesn't move so well on one side. But you start by listening, and then, you know, you. You compare, you know, what they're saying to what you're seeing on an exam. And then we take an X ray, we see if, you know, there's changes in the bone. You can get MRIs of the jaw joint, just way same way you get MRIs in a knee. And so, like, you know, those are. Those are forms of assessment.

[A]

How do you say, like, aha. It is temporomandibular joint disorder. It's TMD for sure. What are you looking for?

[B]

Mri.

[A]

Mri.

[B]

MRI proves it. You look at an image and you're like, well, cartilage is supposed to be here, but it's actually there. And you can't. MRI doesn't lie. So, you know, once you see it, you know it. I look at the health of the bone and the position of the bones, and so if there's not a lot of space in there, normal space for the cartilage to be sitting in, then the cartilage probably isn't sitting in the right spot. You can also see the health of the bone. And so inside the cartilage pad, there's synovial cells. And synovial cells produce a fluid that acts like a lubrication, but also nourishment to the bone. And so, like, again, while you're functioning, you're talking, you're chewing, you're breathing, moving your jaw around to do those things, you have to be able to heal from normal function. And so when that cartilage pad is not sitting in the right area, synovial fluid is not in the right area either. You have a diminished capacity to be able to heal, and you start to develop bone changes that you can see on an X ray in a lot of cases.

[A]

Okay.

[B]

And so it's all, you know, it's all related at the end of the day.

[C]

Yeah.

[A]

So once you make a diagnosis or you have a pretty good sense that, yes, Someone has tmd. What treatments are you pursuing? Like what. What do you think people should be doing to get help for this?

[B]

Treatment ranges from things as simple as occlusal appliances. So like a thick invisalign retainer that sits on the teeth and just takes some of the pressure off the joints. Kind of like a knee brace, you know, would be on like a knee injury. But you also have, like, minimally invasive, like, procedures like this procedure called arthrocentesis, which really is just using some needle holes to inject water through the jaw joint, get rid of inflammation, get rid of some byproducts that are in there. And sometimes we inject things into the joint, like prp, which is essentially like a stem cell injection. We harvest some blood and concentrate growth factors from the blood and inject that in and around the joint to help reduce inflammation. People are injecting things like fillers like, that they use for, like, lip off label, obviously, but like they inject that in the jaw joint.

[A]

So these are all of the more minimally invasive treatments. What about more invasive procedures like open joint surgery? What do you think of that?

[B]

Right. I think majority of TMJ issues probably don't even need surgery at all. Yeah, but open joint surgery, you know, can fall into a couple different brackets. If it's a cartilage issue and the cartilage is in the wrong position.

[A]

Yeah.

[B]

You can reposition it and essentially hold it in place with a permanent stitch. But sometimes you have to remove the cartilage. Those are all day procedures.

[A]

Like, if you're worried about tmd, who should you see?

[B]

Always you start with your dentist.

[A]

They're like your primary care doctor for your mouth.

[B]

Exactly, exactly.

[A]

Right. What can people do to manage jaw pain of any kind at home?

[B]

Go see a dentist.

[A]

You can't worm your way out of this.

[B]

No, yeah, sorry. If you go on Amazon, you can find appliances that you can make at home. Those create more issues, way more issues than they ever solve.

[A]

Oh, no. So don't be buying occlusal. That's what they're called, occlusal appliances. Don't go buying those on the Internet.

[B]

It doesn't work.

It keeps me in business.

[A]

When you think about the next generation, how do you want TMJ to be incorporated into.

Education and how people in your field are thinking about it.

[B]

Yeah. So what we gotta do is we gotta standardize our TMJ education across dental education. And then everybody is just getting the same foundation when they're coming out of school and they're knowing they have the same tools at their disposal, same information, knowledge. That's I mean, that's the biggest thing. And we're starting to do that, which is amazing. That's the most exciting thing as a dental community, if we all can get on the same page on what the problem is and how to go about treating it.

[C]

Wow.

[A]

Wow.

[B]

Sky's the limit.

[A]

Justin, thank you so much for talking to me. It was fantastic. And as someone who loves my dentist, shout out to my dentist, it's great to have you on the show.

[B]

Thank you so much, Emily. Really appreciate your time.

[A]

And short wavers. Just so you know, this will not be the last episode we do about the dentist justice for our teeth. So if you have a question, email [e-mail] this episode was produced by Burley McCoy. It was edited by Rebecca Ramirez. Tyler Jones checked the facts. Jimmy Keeley was the audio engineer. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Short Wave, the science podcast from npr.

[C]

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[A]

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