Hey Everyone! Welcome to my first "Get Ready With Me - TMJ Edition"! I wanted to
walk us through the initial exam as well as the consultation process when I talk to my patients,
explain their condition and treatment. So let's get started! Patients come to see me
in a variety of ways - they get referred by their dentist, naturopath, acupuncturist, chiropractor,
so many different ways that they can come to my office - ENTs, neurologists, lots of people are
sending people my way lately. So when they get here, what we typically have them do
is - actually, before they get here they fill out a very very comprehensive set of forms that sort
of tell me their main symptoms. Kind of like why they're here, how long they've been having them,
where it's hurting, et cetera et cetera et cetera. So I review the forms and then we sit down and we
talk. And the first thing I do even before I do like a full exam is I actually ask for a history.
So I say, "please tell me and describe in detail the onset of your TMJ symptoms, even if it was a
long time ago". I want to hear it all, so I want to know the onset progression and sort of where we
are today. So this history can take a few minutes or it can take a full 30 minutes, depending on how
long this has been going on. Many people have been suffering from TMJ issues their entire lives or
for as long as they can remember, and other people have these issues crop up for the first time when
they're 73. So the stories can really range in kind of how long they are, how detailed they are,
etc. But typically what I do is I have the patients tell me their stories and this is
super important! Because as they're telling me their story, I will sort of ask questions. So
I'll ask if they've had any injuries to the head, neck, or jaw, if they have any concerns about
or diagnoses of Sleep Apnea or Upper Airway Resistance Syndrome. I will ask about their
orthodontic history - if they've ever had braces or Invisalign. And I sort of gather the whole
history and I'm trying to sort of piece together the different factors as to what got them here
what brought about their current condition. So the history is super super important and I never ever
ever skip over that. So once I've got a thorough history and I've got all my questions answered,
then I do the examination for the exam. I start with my patients sitting up and I basically first
check their jaw range of motion. Then I feel muscles around the head, neck, and jaw with a
certain amount of pressure and I asked for their feedback. And so I basically say I'm going to be
feeling muscles around your head, neck, and jaw with this much pressure. I give them an example
of how much pressure I'm going to use and I say if you only feel pressure - that's fine. But if you
feel tenderness or pain, I want you to interrupt me - don't be shy! And grade it on a scale of 1-3,
with 1 being a little tender, 3 is painful and 2 is just sort of somewhere in between. And then
I go through and I really take my time and I feel all the muscles around the head, neck,
and jaw starting at the temples going all the way down down here, up the neck back of the head,
and inside the mouth. Now inside the mouth those are sort of the bad boys, and I tell my
patients that those - typically one in particular -hurt the most. So I get all of that documented,
I have all that written down, and then I feel the joints with the patient still sitting up.
So I place my fingers over the jaw joints and I have them open and close a few times,
and what I'm feeling for there is I'm feeling for any clicks, any pops, any crackling noises,
and I'm watching to see how they open. So I'm watching to see if when the patient opens, they go
off to one side one way, the other way, or if there's like a "S" pattern when they
open and I'm also documenting if there's any clicks, pops, or crackling noises or snaps.
After I've done that, then I have the patient actually lie down and I say now we're going to
do a postural exam and during that part with the patient's permission I check leg length,
and then I place my hands on their head with their permission. What I'm feeling for on their head is
any cranial strain patterns -I am trained in craniosacral therapy. So I'm feeling for and
documenting any cranial strain patterns. Once I've got that down, I then ask the patient if
it's okay if I gently place my fingers in their ears again while they're lying down
and I say, "I know this sounds funny, but if I put my fingers in your ears I can actually feel
inside your jaw joints when you open and close a few times".. and so I typically place my little
pinkies in their ears and I have them bite down, and then I from there I have them open and close,
open and close. And with my fingers inside their ears, I can actually feel really well inside
the jaw joints if there's any clicking, popping, crackling, snapping. And again,
I'll document that. So I believe it's really good to feel the joints in a couple of different ways,
because then you really get a good idea of exactly what's happening inside of the jaw joints.
After I do that, I then say, "now we're going to take a look inside your mouth" and I always say,
"don't worry, I'm going to use different fingers than what just went in your ears". So then I use
my pointer fingers - of course I've got gloves on for the whole exam - so then I go inside the
mouth and I'm looking for signs of clenching and grinding. So I'm looking for the scalloping
pattern on the lateral on the side borders of the tongue, I'm looking for worn down teeth,
I'm looking for attrition, abfraction. For any dentist that might be watching, you're familiar
with those terms. But basically, I'm looking for any signs of clenching and grinding. I also look
and see how much space the tongue takes up in the mouth, because that's very important and kind of
plays into all of this as well. Then I actually have the patient bite together and I look at their
bite pattern because that can play a role. There are certain bite patterns that are very commonly
found with TMJ disorders. So I write down sort of the molar classification or relationship, I check
and see how the front teeth overlap in a couple different dimensions, I make sure that that's
documented, and then I check for any cross bites - where instead of the upper teeth overlapping
the lower teeth, the lower teeth are instead overlapping the upper teeth. So I write down
everything and by that point in the exam, I've got a pretty good idea of what's going on - based off
of the history, the patient's symptoms, what they've documented in their forms, and what I
see. After the exam is complete, we sit down and we talk about the actual diagnosis. So I pretty
much always start with: "we talk a lot about TMJ and TMD at my office. 'TMJ' is not a true
diagnosis - all it means is 'temporomandibular joints' and if there's a problem in those joints,
it will manifest as clicking, popping, or episodes of the jaw actually locking". So then if the
patient is experiencing clicking, popping, and locking - I actually explain in detail
what's happening in the jaw joint with those conditions. If they're not experiencing that and
their condition is more pain rather than actual joint dysfunction, then we sit and talk about
what's causing that. So if they're experiencing more pain than anything else, I say, "that's more
TMD -Temporomandibular Disorder or Dysfunction - and TMD recognizes that there's a group of muscles
that work together to guide and support the jaw. If or when those muscles become dysfunctional,
they get trapped in a chronic pain and spasm cycle and when they're trapped in that cycle,
it can be very painful! The number one thing it leads to is headaches, closely followed by ear
related concerns - such as ear pain, stuffy ears, ringing ears, hearing loss, and even dizziness.
Then onto jaw pain, neck pain, shoulder pain, and more". So I explain all of that and I say, "Now,
the way that we bring the muscles out of their dysfunctional state and the way that we bring
the joints back to a functional state as well - is we make custom-made mouthpieces called orthotics".
So I'll come back to that in a second because many people ask "how did the muscles get in
such a dysfunctional state? how do the joints get into such a dysfunctional state?". It's usually
due to chronic clenching, chronic grinding, any history of injury to the head, neck, or jaw or
sometimes even the way the teeth fit together. So between those four things that I just listed off,
everybody has some combination of those four things or maybe just one of those things.. and it
can explain exactly how or why they got there. So we talk about that at some length too, depending
on each patient and sort of what the cause is. Then I explain we make custom-made mouthpieces
called "orthotics" and these are very different from dental nightguards. A dental nightguard is
very very good at protecting the teeth from the forces of clenching and grinding, but it
does NOT treat the muscles and the joints! A TMJ orthotic DOES treat the muscles in the joints,
and it also protects the teeth. So I explain that at my office we have technology and software
that measures where your muscles are the most relaxed. This is a very specific position called
the "correct resting length". Every muscle in our body has a correct resting length and at my office
we have the technology and software to measure that correct resting length. Once we have those
measurements that we need, we then use those to create a daytime and a nighttime orthotic. Both of
these orthotics are worn on the bottom teeth and they literally - when worn - they guide the jaw
into a very specific position. And when the muscles are held at their correct resting length
with the help of that orthotic, good things tend to happen. We typically see pain go down pretty
drastically within a month, month and a half. The joints can go through a phase where they start to
click and pop more frequently at the beginning of treatment - that's actually a good sign. And then
once the orthotics are delivered, I have to see my patients. Some of them I have to see them once
a week, others we can stretch it out where I see them every 2-3 weeks and at those appointments we
loosen up the muscles in the head, neck, and jaw, we go inside the mouth and loosen up some muscles,
and we manipulate the jaw in a very specific way. Al of this together is called "craniofacial
therapy". It's very unique and it's very specific to treating TMJ issues - so I'm trained in doing
all of that and so is my other provider here - her name is Jan. At those appointments, in addition
to the craniofacial therapy we also check and adjust the orthotics because they cannot change,
but you can, every individual can. And as the muscles relax and everything is brought back
to health and function, we have to adjust the orthotics to keep up with the body's changes.
Then as we move through treatment and people are feeling better, we can see them every three weeks,
every four weeks, every five till we can release you from active treatment. So most patients at
my office are in treatment anywhere from four months to eight months. Sometimes it's longer,
sometimes it's shorter... it's just really hard to say how each individual is going to respond to
treatment. So because of that, it can be hard to predict exactly how long it's going to take. We
provide all of our patients with a Superbill. The Superbill has all the medical coding that is used
with the procedures that we do. Now TMJ issues - they are a medical condition. It's muscles and
joints that are causing the problem, not teeth - so we give you a Superbill so you can try to bill
your own medical insurance. Now what I've seen is that most medical insurances do NOT cover TMJ
problems unless it's a surgical treatment that's involved -and I don't do any surgery at my office
because I get really great results without having to. So what I have seen is most of the time,
this is just not covered. So the way that we make this treatment affordable and accessible
for my patients is that we basically recognize that people are in treatment for several months,
so we break up the payments. We take a certain amount down and we set up monthly, interest-free
payments until it's paid off. So I feel like I do my best to make this very affordable and
accessible. We have had college students enter into treatment with us, people that are retired
or on a fixed income enter into treatment with us. We try to be as reasonable as we can and so
that's really it my friends! I hope you found this somewhat entertaining. This is my first get ready
with me - I don't really know what I'm doing so enjoy and I will see you all soon! Thank you! Bye!