#50 What Physicians Should Know About TMD/TMJ But Don’t

As both a dentist (DDS), and a physician (MD) I understand and share equally the dental and medical professions with my dental and medical colleagues.  Having spent most of my career as an Oral and Maxillofacial Surgeon in hospital operating rooms and hospital physician lounges talking shop with medical colleagues rather than in a dental office, I have an expansive understanding regarding what physicians think about and how they address their work and confront their patients.  I can say, unequivocally, that physicians and dentists address their professions quite differently.

Dentists are taught, starting in dental school, to be totally self-reliant with little to no communication with other dentists except to make a referral to a specialist if they feel they cannot do the service themselves even though it is within the scope of their license.  At that point they have little interest in how the specialist performs the work.

Physicians, on the other hand, beginning in medical school, learn the basics of medicine and surgery with the expectation of more training after medical school and becoming a specialist of one kind or another. Treating a patient is a collaborative team effort. Physicians communicate and refer constantly to make sure the patient sees that doctor with the best training and experience in a particular diagnosis.  Even physicians who go into primary care, pediatrics, and hospitalists are quick to communicate with their medical colleagues the moment they see a patient with something out of the ordinary within their scope of knowledge.

Dentists are much more likely to try and figure it out when they see something out of the ordinary because of their training to be self -reliant.

Medicine is a very collaborative profession.

Dentistry is a very self-reliant profession.

So, what do physicians need to know about TMD/TMJ, but don’t?  Generally speaking, physicians don’t know the list of disparate symptoms associated with TMD/TMJ.  They are not aware that constant and/or recurrent headaches and neck/upper back/ and shoulder pain are the first and second most common symptoms of TMD/TMJ.  They are not aware that ringing in the ears, subjective hearing loss, and dizziness/vertigo are frequent symptoms of TMD/TMJ.  When a physician sees a patient with one or more of these symptoms, a referral is made to a neurologist for headaches, an orthopedic surgeon or neurosurgeon for neck pain, and ENT for ringing in the ears, subjective hearing loss, and vertigo.  These specialists, in turn, do an expensive clinical and radiographic work up which finds no reason for the symptoms.

It has been my experience that physicians do not include TMD/TMJ on the list of possible diagnosis for headaches, neck/upper back/shoulder pain/ ringing in the ears/ subjective hearing loss/ and vertigo.  A physician will only think of TMD/TMJ if the patient points directly to the jaw joint (TMJ) and says it hurts right here doctor.

If the physician specialist or PCP, does not recognize the symptoms as TMD/TMJ they will usually say they can’t find anything wrong and leave the patient without a diagnosis or solution.  In the worst-case scenario, they will misdiagnose the symptoms as migraine headaches, cervical spine problems, complications of high blood pressure or psychiatric problems and treat it accordingly.

If the patient points to the TMJ and says it hursts here, the physician tells the patient that they need to see their dentist.

The patient then makes an appointment with their dentist.

This brings us to, “What the Dentist Should Know About TMD/TMJ, But Doesn’t”, which is the title of next week’s article in this series.

If this scenario is familiar to you, I can assure you it is very familiar to us.  We hear similar stories in our practice constantly.

Our practice is limited to the non-surgical treatment of TMD/TMJ.  The good news is you do not need a referral from another doctor to be seen.

We are here to help you.