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

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

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.

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.

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]

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]

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]

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]

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]

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]

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]

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]

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.

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.

(If you have questions for the Short Wave team about dental or jaw health, email them at shortwave@npr.org!)