#101 The Importance of Anamnesis in the Diagnosis of TMD/TMJ

When you read the title of this article did it make you feel anxious or not quite aware of your surroundings.  That’s because there was a word in the title you did not understand.  I bet the word you did not understand was anamnesis.  I intentionally placed that word in the title to get your attention, not to make you feel anxious or not fully aware of your surroundings.  I put it there to prove a point.  The point was to prove how easy it is to go past a word you do not understand and how it leaves you blank and somewhat anxious.  I don’t want to leave you blank and anxious so here is the definition for anamnesis.

In medicine, anamnesis (An-Am-Neesis) is the process of gathering a patient’s medical history to help determine the cause of an illness or injury. It’s also known as a patient’s case history. It is derived from the Greek, ana, meaning” back” and mnesis, meaning “recall”

Now read the title of this article again.  Do you feel better?  Do you feel more alert and ready to learn why anamnesis is so important in the diagnosis of TMD/TMJ? You’re not dumb if you did not know the meaning of anamnesis.  Most doctors don’t know the definition of this word even though they use the process of collecting patient’s history every day.

Anamnesis or collecting a patient’s medical history is critical in the diagnosis of TMD/TMJ.  When a complete history is taken, the diagnosis of TMD/TMJ can easily be ruled-in or ruled-out when done in conjunction with a very simple physical exam.

 TMD/TMJ is often misdiagnosed and treated as some other disease or ailment by medical doctors.  When a patient presents with complaints of chronic headaches, the MD’s jump to the conclusion that the patient is suffering from migraines but only after spending several thousand dollars on an MRI of the brain looking for tumors or evidence of a stroke. When the MRI returns as normal a prescription is written for any number of pharmaceuticals, each accompanied by a long list of unpleasant or dangerous side effects. If the doctor had taken a more comprehensive history and found out that there was also a history of clenching and grinding of the teeth in conjunction with several of the other symptoms associated with TMD/TMJ, he would have made the correct diagnosis and saved the patient and the insurance company several thousand dollars and the potential harm of un-needed drugs.

When a patient presents to the convenient care clinic with a history of ear pain there is almost a 100% chance he/she will be prescribed an antibiotic for an ear infection.  It is not uncommon for patients with TMD/TMJ to be seen in several convenient care clinics and given antibiotics at each visit until someone suspects TMD/TMJ and a proper referral is made.  If the nurse practitioner in the convenient care clinic had done a proper anamnesis she would have found out that the ear pain included a history of difficulty opening the mouth and some neck pain.  These symptoms combined with a very simple physical exam that any health provider can learn to do in 90 seconds would have avoided weeks of in-effective treatment and continued discomfort for the patient.

When a patient goes to the ENT physician or audiologist with a history of ringing in the ears, a feeling of fullness in the ears, or dizziness, instead of making a diagnosis of Meniere’s Disease for which there is no treatment, if the health provider would apply an appropriate anamnesis it would be obvious the problem was TMD/TMJ confirmed by a 30 second physical examination of the temporomandibular joints.

Proper anamnesis is necessary to rule-in or rule-out TMD/TMJ.  When several of the symptoms are present, finger pressure on the temporomandibular joints creating pain will confirm the diagnosis of TMD/TMJ.

The anamnesis for TMD/TMJ includes a history of these symptoms.

Chronic or recurring headache, earache, neck pain, jaw pain, ringing in the ears, aa feeling of fullness in the ears (subjective hearing loss), dizziness (vertigo), upper back and shoulder pain or tightness, arm/hand/finger tingling and numbness, limited mouth opening, or a feeling like the teeth do not meet evenly.

Both patients and health care providers should be familiar with the symptoms of TMD/TMJ in order to make a proper diagnosis.

A complete anamnesis, (“gathering the patients medical history”) is critical for a proper and timely diagnosis of TMD/TMJ.