TMJ Friends

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 and their role in the treatment of TMJ disorder.

Most patients are familiar with the fact that general or family dentists and TMJ specialists treat TMJ disorder. For more information on what these two physicians do, please see the article Dentists and TMJ Specialists.

The Neurologist is a doctor who specializes in nerves and diseases of the brain and spinal column. Most 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.

An ENT is short for Ear, Nose and Throat doctor. These are surgeons that do tonsilectomies, sinus surgeries and other, more complicated surgeries involving the face. A lot of them have otolaryngology labs onsite and do hearing tests and hearing aids.  Since some of TMJ disorder patients have facial pain, ear pain, hearing loss, or ringing in the ears, an ENT is a common team member. An ENT can determine if the problems are from sinusitis, allergies, ear issues or TMJ disorder and either address the problem or refer the patient on to the appropriate specialist.  A CT scan of the sinuses, a hearing test, endoscopy (viewing the sinuses only), and palpation of the facial, TMJ, ears and throat may performed to assist in diagnosis. Some ENT’s will suggest fixing a deviated septum or other surgery to correct breathing difficulty. As always,  multiple opinions prior to having any surgery performed is a good idea.

A pain management specialist is a key physician in the treatment of any chronic pain related disorder like TMJD. The pain management field can be practiced by anesthesiologists, neurologists, and doctors with board certification in pain medicine. Sometimes primary care physicians can take over this role as well, although it is always recommended to see someone with a specialty in this area before returning back to your primary care physician. As with any pain producing illness or disorder, it is important to manage pain in the appropriate way so that pain is not the motivating factor in your treatment, including both conservative and invasive (surgical) approaches. A pain management specialist uses different approaches to relieve a patient’s pain.

Some pain specialists are a part of large multi-disciplinary clinics, where multiple physicians are consulted with on a specific patient’s case. This can include psychologists, physical therapists, massage therapists, psychiatrists, and anesthesiologists. They may use multiple modalities when treating pain, including (but not limited to), medications, injections (both trigger point and joint injections), nerve blocks, physical therapy, stress relieving techniques, counseling, support groups, and treatment for depression and anxiety. The use of opioids for the treatment of non-cancer chronic pain has been used more frequently in the recent years. If a pain management specialist prescribes any kind of medication, you will be often be asked to sign a pain management contract, stating that you will receive medications from that doctor only, and inform him/her of any changes in your condition and treatment. This means that the other doctors in your team must work together with your pain management specialist concerning any and all medications that are prescribed, and treatment options that are presented. Your pain management specialist also needs to be contacted in any emergency situation when you require pain control. More information on the use of opioids and chronic pain is available in the Pain Management 101 article. Pain management is a very important part of any long term treatment plan, and should be approached to give the patient optimum pain control with minimum side effects and maximum function.

Oral surgeons are dentists that have studied oral surgery in dental school. They might also be  D.D.S, M.D.’s. These physicians perform procedures ranging from wisdom teeth extraction to complicated tumor removal and TMJ surgery. Sometimes, an oral surgeon will treat TMJ disorder conservatively, including splint therapy. However, most surgeons are trained in surgery, therefore, their inclination is to approach the problem from a surgical standpoint. As with all surgeries, invasive treatment should be the last resort after all conservative options have been exhausted and multiple independent opinions should be sought. With that said, there are many types of surgical treatment for TMJ disorder ranging from the least invasive, an arthrocentesis, to the most, total joint replacements. As with all surgeons, most have one procedure that they prefer and do well. If you need total joint replacements, keep in mind that this is a very rare and complicated procedure, and very few surgeons have experience with it. It may be necessary to travel to seek the best care.  More information about TMJ surgery is located on our TMJ surgery page.  This page covers the different types of surgeries, their recoveries, and other important details.

In closing, the more complicated your case, the more specialists you may need to manage your treatment plan. This will require teamwork on behalf of your specialists and you. The result is that you will be happier, feel better, and have a more positive outcome.

For more information, see our TMJ Disorder Treatment page or visit our forums.