Lots of people suffer from aches and pains and jaw problems and have been told that they have TMD. For many, it is a minor irritation, like a click or a pop in their jaw when they open their mouth wide, or muscle stiffness, or occasional tooth sensitivity. For others, it can be frequent headaches. Some people suffer from severe pain. The good news is that 80% of the people with TMD have mild cases. But for those with moderate to advanced damage, it is a serious impact on their lives. So, how do you know if you have TMD?
TMD is a spectrum of disorders with different symptoms depending on the severity of the problem. It specifically affects the jaw and face bones, muscles and joints but can refer pain to other sites, involve nerve pain, or affect your speech and swallowing. It can mimic other serious medical conditions. Treatment options and success rates depend on the severity of the case. The first step is accurate diagnosis to confirm the extent of the condition and to rule out other disease. Health care providers use the Piper Score, from 1 to 5, based on the severity of the anatomical and pathological changes. The Piper Score determines the next step.
The old school approach should still be the starting point…. feeling the muscles for tenderness, putting pressure on the jaw, assessing range of motion and path of motion, and reviewing your symptoms. Some dentists will take models of your teeth and mount them on an instrument to see how they fit together. Imaging is also necessary. A panoramic x-ray or CT of your jaw is used to assess the bones. If indicated, an MRI of the TM Joint is used to look at the soft tissue. Some dentists also use newer technology for objective measurements to more accurately determine the diagnosis.
To check the TM Joint: This is the first step and is what we need to know to figure out the Piper Score. Most dentists rely on the techniques described above. The gold standard for advanced cases is an MRI. Some use a stethoscope to listen to the joint – about 12% accurate. Some use a Doppler that amplifies the sounds – about 48% accurate. We use Joint Vibration Analysis (JVA) that measures the joint vibrations. JVA is reported to be 98% accurate in objectively finding the right Piper Score. Some dentists also use a Jaw Tracker to look at how your jaw actually moves as you open and close, providing even more information about how jaw movement affects your condition. We use JVA as an inexpensive screening tool, using an MRI only for severe cases. Some dentists use an MRI for all patients. It is very expensive, often $2000 to $3000. Knowing the Piper Score is the key to knowing the treatment choices and expected outcomes.
To check the muscles: People with TMD usually have tension in the muscles in their face, jaw, neck and shoulders. Often headaches or migraines are part of this. Most dentists feel the muscles for tension or pain. Others use Electromyography (EMG) to actually measure the muscle activity. The 2 most common devices are the K7 and the BioEMG. We use the BioEMG to give us a measurable baseline of head and neck muscle tension and then to assess changes during treatment.
To check the teeth: All dentists will mark teeth with a special type of marking film to try to interpret how the teeth fit together. New studies show that 95% of dentists are correct in interpreting these marks less than 33% of the time. Yet, most dentists still rely on this technique. We use a pressure measuring system called a T-Scan to measure the pressures tooth by tooth to see exactly how they fit together and to determine if they are in balance. Improper tooth contacts and poor balance are a causative factor in TMD. Getting the teeth balanced and the timing right, refining how the teeth fit during chewing or clenching, is often the key to getting the best result, both on the teeth and with any splints.
Proper diagnosis will help you understand the nature of your TMD and the treatment options for successful outcomes. For most patients, the comprehensive diagnostic tests discussed are not too expensive and should cost $400 to $600. In more severe cases where an MRI is indicated or in offices where they don’t use new technology and do an MRI for everybody, this is the most expensive component. Imaging centers charge $2000 – $3000. Most insurance companies do not want to cover any of these costs. If your dentist is not using MRIs or any of these diagnostic tests, they are just guessing. This is why some people get better and others continue to suffer.
In a future blog, I will address Treatment Options and Success Rates.