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This has been the most entertaining thread on here in a while.
My one sentence summary:
Don't drink the koolaid.
My one sentence summary:
Don't drink the koolaid.
Dr. Phan,
As far as I know as well, there are no "TMD Specialist's" but rather individuals who have spent more time learning about it and furthering their techniques in dealing with it- and so word of mouth they start to attract those types of patients with referrals...as far as chiropractic treatment goes, I am not advocating it or stating that it is the best way to go about this condition- but rather that it is something we are trained to deal with using a hands on approach while incorporating trigger points, PT, and if a patient presents with a lockout, reduction. We are aware of the arthritic changes that can occur at the joint and how that needs to be addressed via referral. In the event of suspected TMJ, our job is to apply said techniques, but also be aware of other underlying conditions and then refer to the right practitioner.
If a certain practitioner is not effective, one cannot assume every practioner of that field lacks the ability to deal with the problem within their scope of practice. If you refer to a chiropractor that doesn't do a good job, you cannot say "chiropractic is bad", and vice versa for any other field. When people don't like their dentist or doctor, they don't just discount medicine or dentistry, they go find someone they do like that does a better job for them.
At the moment, TMD does not have a ton of research behind- and so many of the approaches are what works in practice- and yes you can get into trouble doing that if something goes wrong and then you are discovered and questioned- that I am aware of. On the same token, many types of medications and surgeries that are performed lack significant scientific evidence supporting their use- but they are still utilized because they work- the mechanism remains foggy.
I think after seeing that many dentists view TMJ as a theory and do not deal with it in practice, my energy will be focused elsewhere. I appreciate all of the input.
DC's spend a lot of time looking at the many relationships the spine has with the body- which I would advise not to underestimate. I respect the views and opinions from the dental realm as well though.
I think after seeing that many dentists view TMJ as a theory and do not deal with it in practice, my energy will be focused elsewhere. I appreciate all of the input.
You have it all figured out wrong. Every dentist believes TMD exists - when you have that PITA patient in the chair complaining of pain on opening, headaches, muscle tension, limited range of motion, funny looking condyles on the panoramic xray, etc. etc., the dentist knows this is a TMD patient. The confusion you are having is that when this seemingly complicated patient shows up in a general dentist's office, he/she will not touch this patient and almost always first refer to ANOTHER DENTIST to manage the condition. Who the dentist refers to depends on who practices in your area. In some areas, there are dentists and dental specialists who focus their practice on TMD so the patient may be sent there (these are the doctors who are likely to members of the AAOP/AACFP). In other areas, the patient maybe sent to an Oral Surgeon or an Orthodontist.
Now this secondary practitioner will treat the TMD and try to improve the patient's condition and THEN may or may not refer the TMD patient to a chiropractor for further management. If you want referrals for TMD patients, it will come from this guy. However, it will depend on that dentist's philosophy on managing TMD. Unlike other conditions in dentistry where the answer is same among all dentists (grossly carious root tip = extraction), the treatment for TMD varies greatly among dentists.
I would venture to say that there are probably a lot of patients who probably never get treatment for a TMD because they are lost somewhere in the medical world being treated for headaches and depression when the problem is related to the joint/disc/occlusion. It's not that dentists are ignoring TMD or pretending it doesn't exist, it's just a somewhat muddled field across medicine and dentistry.
Healthpartners?This is dead on. We used to manage some TMD in our practice and just realized due to multifactorial causes of TMD it just wasn't worth it. I now refer to a group of "TMJ" dentists that have a psychiatrist, neurologist, and physical therapist on staff.
If you want to get dental referrals for TMD, a pain clinic that handles TMD may be the way to do it.
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?
On the patients part, I think it would get frustrating not having any answers and the problem not going away; on the clinicians part not having the answer and having to refer them?...I also think that when you start sending a patient here and there and referral to referral they often times just give up and end up living with the condition because they are frustrated, perhaps leading to more chronic conditions that when readdressed, have gone on to cause a multitude of other related issues, and so it takes someone with the time and will power to go back and decipher the problem piece by piece. In reality, I feel like most docs don't have the time to deal with cases like that with a full head of steam...
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?
On the patients part, I think it would get frustrating not having any answers and the problem not going away; on the clinicians part not having the answer and having to refer them?...I also think that when you start sending a patient here and there and referral to referral they often times just give up and end up living with the condition because they are frustrated, perhaps leading to more chronic conditions that when readdressed, have gone on to cause a multitude of other related issues, and so it takes someone with the time and will power to go back and decipher the problem piece by piece. In reality, I feel like most docs don't have the time to deal with cases like that with a full head of steam...
Is a sham manipulation for placebo different from a "real" manipulation that doesn't do anything? There's the real question.
the TMJ can be affected by muscle and osseous structure of the neck and skull.
No one knows how a DC figures in bc you don't seem to understand what we do.
So I suppose the answer is to discover findings that may be contributing to the TMD, make a note of it and refer that patient to someone who deals with those types of patients?
...
Chiropractic discrimination and being viewed as inferior is prevalent- I know this- but TMD treatment with trigger point and muscle PIR is affective as well as activator use to level the condyles-im afraid it's true that were - an osteopath presenting OMM TMD Tx, the criticism would not have been as heavy. Anyone that disagrees knows that is the truth. There is a hierarchy, and unfortunately DC's are near the bottom-a serious inquiry about TMD, I'm glad it was entertaining. Good day.
Mr. Jones is a 79 year old male who presented to your clinic requesting treatment to the TMJ problem that he has been having. You noticed he is without any teeth. His chief complaint consists of noises on both of his TMJs during functioning and with increasing pain in the past year. He had noticed the symptoms appeared more in severity since his wife of 60 years passed away last fall. He also bought in a long list of medications that include arthritic meds.
I would like to know how you manage this patient from chiropractic point of view. DP