Patients – Diagnosis
The diagnosis of TMD) , which is technically the abbreviation for TemporoMandibular Disorder, simply means …something pathological or “wrong” with the TMJ. It is an extraordinarily complex Disorder and requires significant diagnostic understanding by the treating physician or dentist. The Dysfunction or Disorder has been named the Great Imposter since it mimics so many other medical problems. Therefore the most usual and most recognized symptoms of headache, jaw clicking, and jaw pain which are generally seen when TMD exists are only basic clues to diagnosis. They may not necessarily even be present with every very real existence of a TMD in some individuals. This is one of the reasons that the American Academy of Craniofacial Pain has initiated steps to have TMJ Disorder a professional Specialty in Dentistry.
A thorough history of every new patient is imperative to finding out the cause and treatment plan. While explaining to my patients, I use the Bucket analogy.
Visualize that you have just purchased a brand new clean and shiny bucket and that you take it home placing it on your favorite couch. Each day you or a family member or a friend put something in the bucket that you do not want to get on the couch. In the bottom of the bucket is a little bit of chocolate syrup, coffee grounds, dirty automobile oil, red wine, and a variety of other “stuff” that could stain that nice couch. One day someone throws in an apple core. If the bucket is empty, you hear a bumping noise. However, if the bucket is filled to the brim, the apple core creates a splash that then stains the couch. So what caused the couch to get ruined? It’s not the apple core, it’s not the bucket. It’s a combination of everything.
An individual with TMD must be looked at and evaluated in this manner. A thorough evaluation needs to consider anything and everything that may be contributory to the one patient being diagnosed or treated. I schedule a full hour for direct, dedicated and important time for these necessary components of a more accurate diagnosis. It is very helpful when a patient brings in a written or typed list of their pharmaceuticals, all of their complaints and a chronological (time based) sequence of what happened in their life what’s going on, when their symptoms occur or when they first began to be bothersome.
A proper diagnosis must look at: why the eyes tear excessively, why pain in, around, or above the eye may be present, what causes blurry or double vision, incessant twitching of the eyelid, sensitivity to light, or why dark circles exist in the tissue just underneath the eyes.. These are Symptoms of TMD that are often not recognized as related to a TMJ problem by most physicians, dentists or chiropractors.
WHAT SHOULD BE CONSIDERED DURING A TMD EXAMINATION?
1) A proper diagnosis must look for: why there is pain in or around the ear, why buzzing or ringing of the ear occurs, why TMD sufferer can have hearing loss or be super sensitive to certain sounds, why vertigo, lightheadedness or dizziness can be present .
2) A proper diagnosis must look at : muscle tightness or spasm or irregularity of function in a large number of muscles which assist in every aspect of how our lower jaw fits to our skull and how the upper and lower jaw works when eating, talking, singing, kissing, or even when simply at rest during breathing or sleeping. TMJ muscles are not “just in the cheeks”. They are in the neck, the face, and of course also in the jaw.
3) A proper diagnosis must utilize some type of visualization of the bones in the jaw, how they look, how they come together, how they function. Various visual aids may include a variety of certain types of x-rays (the most common and acceptable tool), or MRI/or CAT scan which visualize soft tissue and bone. Magnetic Craniomandibular Scans add valuable clues to help assist in proper diagnosis and monitoring of treatment.
4) A thorough medical history of the patient which should include potential lasting consequences of any surgeries or traumas (my examination includes questioning of how the patient was born. Why? A C-Section delivery generally is quite easy …at least on the infant. A forceps delivery could cause damage to the delicate facial bones causing growth and development problems as the baby becomes an adult), other traumas as an infant or a teenager also could alter how mom’s and dad’s genes came together and created this one particular individual. A thorough review of any recent alterations in the life of this patient is an important part of diagnosis. Stress is a significant factor in pushing a delicate, perhaps injured, yet pain and symptom free, TMJ over the edge and becoming active as a disorder. A weight gain could initiate sleep disorders which then have the unfortunate side affect of pain accompanied by teeth grinding causing more pain.
5) Life. Since TMD is uniquely individual to each patient, a discussion on the patient’s life, including routine activities of daily living, diet, emotional and cognitive (how you think) are necessary components of a thorough TMD evaluation, since each very individual life encompasses so many situations that have a direct impact on TMD and its treatment success.
A thorough history of each new patient is imperative to finding out the cause and treatment plan. While explaining to my patients, I use the Bucket analogy. Visualize that you have just purchased a brand new clean and shiny bucket and that you take it home placing it on your favorite couch. Each day you or a family member or a friend put something in the bucket that you do not want to get on the couch. In the bottom of the bucket is a little bit of chocolate syrup, coffee grounds, dirty automobile oil. red wine, and a variety of other “stuff” that could stain that nice couch. One day someone throws in an apple core. If the bucket is empty, you hear a bump noise. If the bucket is filled to the brim, the apple core creates a splash that then stains the couch. So what caused the couch to get ruined? It’s not the apple core, it’s not the bucket. It’s the combination of everything. An individual with TMD must be looked at and evaluated in this manner. A thorough evaluation needs to consider anything and everything that may be contributory to the one patient being diagnosed or treated. I schedule a full hour for direct, dedicated and important time for these necessary components of a more accurate diagnosis. It is very helpful when a patient brings in a written or typed list of their pharmaceuticals, all of their complaints and a chronological (time based) sequence of what happened when their symptoms occur or when they first began