TMJ diagnosis The Case of the Initial Exam and Consultation

The purpose of this blog is to inform our potential new patients how we do the initial examination and consultation, so you know what to expect when you come in for your visit. First of all, many of our new patients already know that they have some kind of TMJ problem- i.e. their jaw joints pop and click or get stuck open or closed. Many of them also have pain in their joints as well. This is usually what prompts a person to call and come in to see our office. And so when that first visit happens, it is a screening process to determine whether or not you really do have an underlying TMJ problem and whether or not you are in the right office.

When a patient first comes to our office, they will find the exam a bit interesting because they sit in a bar stool, not a dental chair. After a few minutes to review their symptoms, I will actually ask the patient to sit up straight and look directly at my nose to give them a focal point. I will then look at that person- I look at the eyes/eyebrows/ears/nose/shoulders/neck/etc to determine if there are any imbalances present. And in almost all cases I see that the ears and eyes are not level. This means that the bones inside the skull- the cranial bones- are not level or balanced. After the initial observations, then I will glove up and start pressing on many of the muscle groups that are attached to the TM joints. If these are a bit sore or painful, it leads me to believe that the discs are out of place. If you have popping or clicking in the jaw joints, this also means it is likely that the discs are out of place and further examination is needed to determine the extent to which those discs might be displaced.

If I suspect an underlying jaw joint problem, then I will order an MRI of the TM joints. This means that we are not ‘fixing’ anything on that first visit. Diagnosis is critical! If you follow me on Facebook I am constantly preaching that you MUST take the time to figure out the real problem and document it carefully. So, 95% of the time, I will send you to another location to get an MRI of the jaw joints. This requires that you schedule your MRI with either Novant or Inova Radiology and you will either pay them directly, or your insurance will cover this procedure.
Once the MRI is done, it takes a few days for the radiologist to review it and come up with a report. At that point, you are ready for visit #2 with our office- the next consultation and the MRI review. This is the visit where I will personally review the findings of the MRI and show you what your joints look like on the imaging that we pull up on the computer. I have direct doctor’s access to both Inova and Novant imaging services so I will be able to show you exactly what is going on. It is important that you as the patient understand your situation prior to treatment. At the MRI consultation visit we will discuss the options you have on your course of treatment and I will provide you with the information you need to make an informed decision. At that time, you will understand the appliances that are recommended and what they will do to help your condition. Again- at this appointment we are not actually ‘fixing’- we are talking and planning. If you are ready to begin treatment right away, we will take the actual impressions that day to make the appliance(s), however, most people want to know what insurance will cover. That could take weeks or even a month or so since insurance companies do not react very quickly.

As you can see, this is not simply a process of walking into my office and I get right down to fixing the problem. It takes time to diagnose the problem and to document it carefully. Now we have a baseline to work on getting you better! Ideally, we would like to have a three dimensional x-ray as well, but most patients want insurance to pay for that, so we do not take the x-ray unless they are really ready for treatment.

There you have it- two consultations visits to gather information and formulate a plan and from there we are able to begin the actual treatment.