TMJ Disorder: Where Do I Begin? Part I
What Type of Doctors Treat TMJ Disorder?
This article is the first in a two part series for people who have just been diagnosed with TMJ disorder or those who still have questions about the process. Since TMJ disorder effects so many bodily systems and can produce so many different symptoms, a variety of doctors treat the disorder. Through much trial and error, we have found that a team approach is the most beneficial and produces the best results. This article will go over the type of doctors you may encounter in the course of your treatment.
These doctors will be listed chronologically, however, since each person is different, your specific treatment plan could be different as well. Some of us start with a neurologist because of the headaches brought on by TMJ disorder, others start with a surgeon because their problems were brought on by trauma. This will just attempt to summarize each doctor’s role in the treatment of this disorder.
The first stop in many patient’s treatment is their general or family dentist. The dentist will check for a number of signs that indicate TMJ disorder is present. These include tooth wear from grinding or clenching. He may also begin by listening to the jaw with a stethoscope to check for popping, grinding, or any other sounds that may not be consistent with normal jaw function. He will palpate and apply gentle pressure to your face, neck, shoulders and/or back. Depending on your dentist’s training or specialty, other tests might be done, which will explain later. If you do have any of the symptoms as explained above, your dentist may do one of several things. He may fabricate a splint which prevents further tooth wear and helps pain. Keep in mind that the splint is a trial and error process. It will require many visits to adjust the splint to get maximum benefit. You might also need to try several appliances before finding the right one for you. The dentist might also prescribe medications such as anti-inflammatories and muscle relaxants, or he may refer you to our next professional, the “TMJ specialist.”
The TMJ specialist is a dentist who has usually had extra training to help him become more familiar with TMJ disorder. It is always a good idea to ask the dentist what training he or she has had. Please refer to our article entitled “How to Choose a Doctor” for more information. The TMJ specialist will most likely do a more extensive examination than your general dentist. He might take different types of x-rays such as a panorex or tomogram, or order an MRI. You may question why to see a general dentist if you could just see a TMJ disorder specialist.
Most cases are manageable at the general or family dentist level, and do not need further intervention from a more specialized doctor. Keep in mind that these cases can be managed without invasive or irreversible treatment such as grinding your teeth down or changing your bite. If this is proposed, you may feel the need to secure a second or third opinion. The TMJ specialist will be your primary diagnostician based on results from tests, physical examination, your symptoms, how your teeth fit together, etc. Depending on what your diagnosis is, this doctor may do a multitude of things, like splint therapy, trigger point injections, iontophoresis, ultrasound,transcutaneous electric nerve stimulation. They may refer you to other doctors such as a neurologist, ear nose and throat doctor, pain specialist, or oral surgeon. This doctor will come up with a treatment plan for you which can include any of the above. Usually they refer to this treatment plan by “Phase One” and “Phase Two.” Phase one is generally reducing pain, stopping any inflammatory or degenerative processes. This part of the plan is usually conservative. When your pain has subsided, and a correct diagnosis has been established, you move on to Phase Two, which can include braces, equilibration and total reconstruction including crown work and bridges. These treatments are non-reversible and invasive. Please keep in mind that this varies from doctor to doctor. At this point of treatment, many patients see a psychologist to help deal with the pain and associated effects of TMJ disorder on their life and their family. This is a very important aspect of treatment.
Please keep in mind that there is no board certification for “TMJ Specialists.” Any doctor can call themselves a specialist, whether they have had 5 hours of education on TMJ disorder or 5000. This makes it extremely important to do research on the particular physician you choose.
If the patient has headaches, burning pain, migraines or any neurological symptoms, they can be referred to a neurologist.
The Neurologist is a doctor who specializes in nerves and diseases of the brain and spinal column. Some patients with TMJ disorder see a neurologist for a headaches or facial nerve pain. A neurologist’s examination includes checking reflexes, strength, eye movement and nerve reaction. He might listen to your jaw joints with a stethoscope.
If you haven’t had an MRI by this point, the neurologist might order one.
The next installment of this three part article will cover Ear Nose and Throat doctors, pain management specialists, and oral surgeons.
