#29 Patients with TMD Have Reasons to Hope

For some patients with symptoms of TMD life is awful.  This is what I commonly hear.  The specifics vary from patient to patient.  The complaints about the painful symptoms are the most common.  Constant and unrelenting and recurring headache, earache, neck and shoulder pain are the most common.  Sometimes the pains are unique in character, being described as sinus pain, pain behind the eyes, and dental pain.  Arm, hand, finger tingling, and numbness are frequent complaints but usually not life limiting.  The non-painful symptoms of ringing in the ears, (tinnitus, tin-a tus), subjective hearing loss (like you have water in the ear), and vertigo (dizziness) are fairly common and for some also life changing.  Consider how it must feel to always have loud noises in the ear, especially when you are trying to concentrate or go to sleep.  Think of the anxiety a patient has not knowing when they are going to have an attack of vertigo as they are driving down the highway.  And put yourself in the place of the patient who knows they are having trouble hearing, goes to the ENT doctor or audiologist and is told testing shows there is nothing wrong with their hearing.

Any one of the above symptoms can change the way you have to live your life.  And most patients with TMD/TMJ have many of these symptoms simultaneously.

The average patient seen in our clinic has at least six of the above symptoms and suffered with them on average of 15 years.  That’s the average numbers.  Some patients describe symptoms for a year or less and some patients state their symptoms go back 40 or more years. Whatever the duration of symptoms, most say they have seen multiple health care providers for help.  That too can vary between none and 150.  That is not a typo.  I had one patient who swore that over a period of 30 years she had seen 150 different health care providers to help her with her symptoms which were all obviously TMD/TMJ and caused by inflammation within the temporomandibular joint.  Imagine how frustrated some of these patients have become.  They ask for help and nothing offered seems to work. Yet they keep looking for help.  They are hoping to find help.

“Somewhere somebody knows” they keep thinking.  They keep hoping somebody knows the answer and can solve their problems.

Here is the blatant and unvarnished truth about doctors as pertains to TMD/TMJ.  There are two categories. Most health care providers, when faced with a patient with symptoms they either don’t understand or know they cannot treat successfully admit they do not know.  In those instances, they try to send the patient to another provider who they think might know how to help. Sometimes they are not aware of anyone who can help.  The second category is much less frequent, but much more visible. There are those providers trying to help but know they don’t know and are only pretending to know.  They know they don’t know and most often have complicated illogical treatment plans.

The patient has no academic, scientific, or clinical knowledge or experience to determine what to do. It is left up to the patient to distinguish who to trust.  That is why there is a huge amount of skepticism regarding TMD/TMJ treatment.  I have written and spoken regarding this skepticism extensively.  Skepticism is a normal, natural and healthy response when so many people don’t seem to know the answer.  And there are many areas of life where this rule applies.

But my discussion is limited to the confusion about TMD/TMJ.  Doctors who know how to successfully treat TMD should be able to explain to the patient exactly how their treatment works in simple terms the patient can understand.  Both the diagnostic process and treatment should be simple and not complicated.  A complicated treatment is an indicator the provider does not understand the problem.  It is well established in both dentistry and medicine that the most effective treatments are the simple ones. Making it complicated is an indicator that practitioners don’t know what is going on.   The results should occur relatively quickly over a few weeks or months and not years.  And finally, symptom relief should be continuous and long lasting.

These are the best criteria for the patient to select TMD/TMJ treatment.  Using these criteria, the patient should have hope in the provider rather than skepticism.