Don’t you just love it when a story starts out with ‘It was a dark and stormy night’. Well, not today folks. It was a bright and sunshiney morning at our office and I was looking forward to meeting the new patient on our schedule. She flew in from Canada to come see me since several people had told her she had no choice. I must admit, the visit with her was frustrating, angering, and just plain maddening at times. It truly was a conundrum! Let me explain. The moment I sat down at my bar stool, and she sat down at hers, I could tell what was wrong. Her complaint was that she had been to many practitioners and showed me her appliances. Dear readers, I tried to be nice, I really did, but on the inside I’m both laughing and disgusted with what I saw. She showed me all upper appliances, and they all were designed to let the jaw slide back into the joints. It was wrong in so many ways.
As many of you already know, you never, ever, make an upper appliance on a person who can only open to 30mm – sorry, I forgot that little tidbit earlier – she could barely open her mouth. So here she has this upper device that locks in the maxillary bone and blocks cranial motion. Not a good idea. We talked about all this and I think she understood what was going on. And then I showed her the very obvious cranial distortions- her mastoid on the left and sphenoid on the left were terribly elevated compared to her right side. And today she looked worse than her ‘before’ pictures that they did a year or so ago. In other words, wearing the appliances on her upper jaw had made things worse and more distorted.
Then to top it all off, her tongue was all scalloped, she was tongue tied, and her palate was very highly vaulted. This means she could not get good nasal breathing going so her body could not heal very well. These are the things that need to be discovered and noted in a very first initial visit folks! Needless to say, I did my best not to berate the other doctors who had seen her in the past…heck, I’m nowhere near perfect…but if you say you are going to treat these patients, at least know what you are talking about!
So in this initial 45 minute exam, I was able to give this young woman some good guidance. Maybe I over whelmed her, maybe she will never come back again because I overloaded her with information. Maybe she will return and allow me to further diagnose once the MRI has been done. A lot of maybe’s here.
As a patient, I can only imagine going to so many doctors and getting such a divergence of opinions and treatment plans. The one thing that upset me the most was that NOT ONE of them did an MRI to understand what was going on internally, and then some idiot surgeon was suggesting surgery because that is what he does! This patient (as the MRI showed later in the day) has anterior displacement of the discs in the jaw joints, so if the surgeon moved her jaw forward, this would put the jaw so forward that it would actually pinch the discs even worse and make the situation more painful. Not a great way to treat your patient, is it?
As you can tell by now, I am a bit frustrated with the various approaches toward TMJ treatment. To help out, I have just written a bill for the Virginia State legislature to have insurance companies cover this treatment more completely. TMJ disorder ruins peoples’ lives and if there was better insurance coverage, more people would be healthier and lead better lives. That’s my mission folks- stay tuned for more!