TMJ disorder treatment VA The Case of Not Knowing What You Don’t Know Until One Day You Find That You Didn’t Know It

This was sort of a frustrating one that happened the other day. A perfectly lovely woman came in for a consultation for TMJ disorder, because that’s what I do, and her comments were very interesting. She explained that she went to someone else nearby for a TMJ consult and the doctor was bragging that not one of his patients ever needed surgery! She was surprised that I told her that surgery was always a possibility and that is why I do an MRI to understand the status of the jaw bones, the joints, and the discs. She also told me this other doctor never does MRI’s because he does not feel it to be necessary. To me, this was a dangerous position to be in- not being aware of the status of the joints and just assuming all was well. You know what happens when you assume (you make an ass of u and me).

Well, dear readers, as you well know, we ALWAYS do an MRI. And as you already know, the reason for this is that we must establish a good baseline to compare how we are doing during the course of treatment. It is important to document the position of the discs in the joints so that we know if things are improving. In almost all cases, the discs do improve and this is what we want to see.

The problem with not documenting with an MRI is that if the condyles (jaw bones) are eroding away and you do not track the progression of the disease process, you are not doing well by that patient. In so many of our new patients, the MRI shows long standing degenerative arthrosis and condylar erosion. So let’s imagine you go to the dentist who does not do an MRI. Even though the patient might be feeling better over time with the appliance therapy, the erosion continues and gets worse, yet the patient does feel better overall. Without the proper tracking mechanism there could be catastrophic failure one day. What that means is that the eroded jaw bone is so damaged that if the patient fell down on the ice, slipped in the rain, got hit in the head with a soccer ball, well, you get the picture, then that already eroded jaw bone could snap or break. And this means a major surgical procedure to fix it.

It would have been so much, much easier to just do an MRI at the beginning and redo that MRI every year or two to make sure things are ‘holding their own’ and not eroding. As you all know by now, I see about 100 patients each week who have TMJ disorders. Of those, 1 person or 1% will need surgery. That’s a pretty good percentage I believe. But I do have many other patients who I am ‘tracking’ over time. They have some erosion of the condyles due to the displaced discs, yet they do not want to do surgery or simply cannot do surgery for whatever reason. My job is to keep them well informed of their situation by periodically doing the MRI and monitoring the status of the discs, the joints, and the condyles. This way, if and when we see erosion or break down occur, we can discuss the surgery option and let the patient decide what they want to do. That’s all I’m saying folks- track the progression and keep the patient informed. You never want to learn that you did not know something that you should have known.