#111 When You Can’t Treat TMD/J Symptoms with an Oral Device

My Associate, Dr. Urbina, stepped into my office last week and asked me to see a patient he was currently examining with typical TMD/J symptoms.  The patient could only open her mouth to about one finger width and could not eat anything other than very soft or pureed food.  Her x-ray also showed evidence of long-standing chronic inflammation within the temporomandibular joint.  These are obvious signs and symptoms of TMJD. She had referred herself into the practice because of our reputation and history of helping people who had difficulty opening their mouth and chewing. 

Dr. Urbina wanted me to be involved in this consultation because the patient also had a three year history of oral cancer surgery without recurrence and he expected my broad experience treating and reconstructing cancers of the mouth and jaws would add an additional dimension to the consultation. 

After a thorough review of the patient’s medical history, including surgical event and post-surgery treatment, it became clear that the patient may have had a previous history of TMJD, but her difficulty opening her mouth was related to excessive scarring associated with her previous surgery, or worse , a recurrence of the cancer.  Her current symptoms were not caused by TMJD.  The appropriate recommendation for this patient was referral back to her original cancer surgeon for additional follow-up. 

My point in sharing this experience is to simply point out that not all patients with the common symptoms of TMJD, which include frequent and/or recurrent headaches, earaches, neck pain, jaw pain, tinnitus, subjective hearing loss, vertigo, upper back and shoulder pain and tightness, arm/hand/finger tingling and numbness, and various kinds of jaw locking, have TMJD. 

When consulting with a patient and listing the symptoms and objective findings on x-ray and physical examination, the physician develops a list of possibilities.  In medical language, this list of possibilities is called the differential diagnosis.  The differential diagnosis is not the diagnosis itself, but the list of possible diseases that could explain the symptoms and findings. Then it’s up to the doctor to continue the investigation until he can rule out all possibilities except one.  Only then can the doctor proceed with recommendation for treatment.  The doctor has done his due diligence and is as certain as humanly possible the treatment he recommends is the correct treatment and is applied correctly to the correct disease. 

There are other conditions and diseases that mimic the disparate symptoms of TMJD.  That’s the reason the medical profession frequently misdiagnoses TMJD.  Medical doctors, physician assistants, and nurse practitioners receive absolutely no training and information on TMJD in school.  When they see some of the symptoms noted previously, they diagnose them as migraine headaches, Meniere’s Disease, and ear infections, frequently using the catch all phrase Trigeminal Neuralgia, that sounds impressive but has no specific meaning other than “pain in and around the head”. 

There are other diseases that can cause these symptoms.  This includes, stroke, brain tumors, cervical disc displacement, oral, salivary gland, and tongue cancer, dental infection, jaw tumors, neurological and nerve disorders, symptoms associated with previous surgical and drug interventions, and sinus infections to name just a few. 

You can see why the patient should be seen by a doctor who is very familiar with the medical and dental diseases that can become part of the differential diagnosis. 

The patented, FDA cleared, university study validated Urbanek Device and protocol is now licensed by a growing number of doctors in 19 states who are knowledgeable in the differential diagnosis of TMJD.  Similar to my associate asking for an additional opinion, when necessary, all of the doctors in our network have access to me when faced with a puzzling set of circumstance. 

That’s the advantage of being a member of a team.  Here at TMJ Services of Brentwood, we are all team players.  Playing as a team, the patient is always the winner.