The Case of the Mismanaged and the Misinformed

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Just this past week, I have had a handful of new patients come to the practice seeking a 2nd opinion. The conclusion amazingly was either mismanaged and/or misinformed! The first part of the misinformation begins with the diagnosis phase. An MRI was never done to check the status of the articular discs. This is a very basic and a big thing to do. Just like if you had a problem with your knee (an even more simple joint than the TM joint), the doctor would ALWAYS order an MRI to see what that meniscus is doing- whether it is simply displaced or already torn/damaged. It is imperative to order an MRI to obtain the current condition or placement of the discs. In my own practice experience, I see MRIs that show perforated discs and I would want the patient to know in advance about this major problem. Most likely, with discs that are perforated, you will need surgery to fix the issue. I feel strongly that the patient should be informed well before time, effort, and money is spent.

So, dear reader, as you can see, so many people are not being fully informed about their condition. Where are the discs? Maybe instead of misinformation it is more of not enough information. Literally, in the last one hour, I have seen two new patients who never had an MRI done, and yet they have appliances in their mouths. Both were wondering why treatment was not working. The complete picture was not established. Again, where are the discs. Continuing the consult, as oftentimes happens, I found out that BOTH potential patients were wearing their appliances ONLY AT NIGHT. OOPPS. When you do an MRI and discover that the discs are slipped, it only seems logical that they are slipped out of place both night AND day. Therefore, you must treat them during both the day and the night. So, these folks are wearing their devices faithfully according to their doctor’s direction …well, sort of. Unfortunately, this is the part I call mismanaged. Not all doctors have enough continued education to understand the disc placement is part one and the angle of the jaw is another component. The mismanaging of cases occur with completely missing information! By wearing the appliances only at night, the discs might move a bit because of room now created. When the next day starts without the support, you bite down while eating and this opening and closing can damage the discs that have started movement back in place. The analogy I like to use is having a broken leg and the super nice doctor made you a cast that snaps on and off as you wish. So, you figure you will just wear the cast only at night since this is the easiest thing to do. In the morning, off it comes with you just limp around all day on a broken leg. Finally, it just never seems to heal. Gee…I wonder why?

It should be painfully obvious by now that TMJ treatment is not consistent at best. These two potential patients were both upset and disturbed when they discovered understood an MRI is a critical part of diagnosing and the “why” wearing a device(s) both day and night is necessary! I was equally disturbed at their disturbance! (You get the idea.) I do wish there was some kind of standard of treatment for TMJ disorders, but there is not. So, if you know someone who has a TMJ problem, show them this blog and help them to understand. Remember, treatment needs to make sense to you and managed treatment and informed patient is achieved. Thank you.