#5 Why all the Confusion Diagnosing and Treating TMD?
Now that you know what defines TMD and the three categories which create inflammation within the TMJ, it should be a pretty easy problem to fix. Right? If you can get rid of the inflammation in this joint, the symptoms will diminish.
Then why aren’t the medical and dental professions able to do this predictably, effectively, and consistently. That is the million dollar question. In fact, that is not just a million dollar, a ten million dollar, a hundred million dollar question. It is a billion dollar question because that is about how many medical dollars are wasted each year by the medical and dental establishments misdiagnosing, mistreating, or misdirecting TMD. From the patient’s view point, it is difficult to understand why a disease that was diagnosed and investigated for the past 100 years can still me misdiagnosed and mistreated so often.
The answer has two parts. The first part is a well established problem in many businesses and professions. It is euphemistically described as “If your only tool is a hammer, everything looks like a nail.” So regarding TMD and its 10 major disparate symptoms, doctors cannot see how these varied symptoms can be connected, but rather pick out a symptom that they are most familiar with and apply their “Hammer”.
The PIP when confronted with a patient with a history of bad headaches will first order an MRI scan of the brain in order to rule out brain tumors or stroke ($2,000) followed by the usual blood panel ($500), followed by a prescription for which ever medication he believes will be most effective in treating migraine headaches, ($300- $3,000 per year). That exact scenario is played out thousands, if not hundreds of thousands of times per day throughout the United States. The PCP has two choices for treating patients. Use medications or refer the patient deeper into the system.
If the first to see the patient is a Physicians Assistant at the corner walk in clinic and the patient presents with painful ear pain, the PA will look in the ear and tell the patient that they have an ear infection and prescribe a round of antibiotics. (consultation and prescription $300). Since antibiotics won’t decrease inflammation, the pain continues, and the patient may get another round of antibiotic until the PA decides to refer the patient to and otolaryngologist (ENT). When the patient is seen by the ENT he/she finds out that the ear was not infected, but needs to be checked out for an acoustic neuroma with an MRI and some additional testing ($3000). If the ENT has been made aware that ear pain and headaches and subjective hearing loss are symptoms of TMD he may elect to send the patient to a dentist who specializes in treating TMD, of more likely will say, “You need to see your dentist because I think this may be TMD.”
This is where the plot thickens. The patient may end up at their dentist who does not want to treat TMD because he “knows nothing works for treating TMD”. Or he/she may make a night guard and give it to the patient and tell them it will treat their problem, ($400-$600). In the United States half the dentists want nothing to do with treating TMD because they know nothing works and half make the night guard knowing it will not be effective, but they have sent the patient away with something in their hand, or mouth. This scenario also occurs thousands, if not hundreds of thousands of times per day in the USA. In some cases the TMD patient will end up in a dental school/hospital affiliated TMD program where physical therapists, behavioral therapists and psychologists, dental occlusion experts, orthodontists, oral and maxillofacial surgeons will be brought in for consultation. Then more MRI’s and CT scans are utilized to look at all those features that look like nails to those with a hammer. In this case the diagnostic cost alone can exceed $10,000 and treatments $50,000 to $100,000.
These two scenarios described above are not uncommon. Each is very common but certainly not the most excessive waste of money are resources related to misdiagnosis or excessive diagnostic and treatment procedures.
The worst example I have encountered is the application of neurosurgery for a patient with bad headaches who actually had TMD. There is an established developmental problem called Chiari Malformation. This occurs when the brain stem herniates through the base of the skull and causes severe and recurrent headaches. So far, I have encountered two patients from Middle Tennessee who had neurosurgery for Chiari Malformaton when taking a complete history and pressing on the TMJ’s with the fingers would have alerted the surgeon that the bad headaches were likely from TMD and not herniation of the brain stem. I have wondered how many patients throughout the USA with bad headaches have been treated by a neurosurgeon rather than non-surgically for TMD.
My next article will focus on the misdiagnosis, mistreatment, and misdirection by well intended, but mis-informed Oral and Maxillofacial Surgeons. In this area I am well aware and experienced. “Been there and done that”
I look forward to sharing my next installment which will also begin to cover and uncover the second reason there is so much confusion diagnosing and treating TMD.
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