Stephen H. Gamerman, D.D.S. P.A.
Temporomandibular Joint Dysfunction
Baltimore Office: 107 W. Saratoga St. Baltimore, MD 21201 (410)539-1155
Billing & Correspondence: P.O. 65028 Baltimore, MD 21209
Laurel Office: 9811 Mallard Dr., Suite 112. Laurel, MD 20708 (301)523-1470
HOW TO DETERMINE IF YOUR CLIENT HAS RECEIVED A TRAUMATIC
TEMPOROMANDIBULAR JOINT DISORDER (TMD)
TMD’s are diagnosed by history, symptoms and clinical examination. TMD’s are then confirmed by a dentist experienced in treating TMD’s.
· History of TMD
TMD’s commonly occur as a result of trauma to any part of the head, face or neck (typically assault to the face or head, a fall, an automobile accident, with trauma to the temples or face, airbag deployment, contact with the steering wheel, dashboard, side or front windows, as well as whiplash injuries).
· Symptoms of TMD
Facial or jaw discomfort associated with any of the following:
Laurel Office: 13975 Mallard Dr., Suite 112. Laurel, MD 20708 (301)523-1470
· Headaches as a Symptom of TMD
Headaches are a prominent symptom of TMD. Over 90% of headaches are muscular in nature, originating in the neck, face and head muscles or both. This is why headache patients referred for CAT Scans and neurological tests frequently receive negative (normal) results. These tests look for blood vessel and/or neurological damage, and routinely miss damage to the muscles controlling the opening and closing of the mouth.
When interviewing your client ask:
1. “What hurts?”
If the client indicates headaches ask:
2. “Could you please point to where your head hurts when you have pain?”
If the patient points to the back of their head this is probably not a TMD induced headache.
If the patient points to the forehead this is most likely referred pain from the back of the head.
If the patient points to the side of their head (temples) or face this may be a TMD induced headache. Pain on the side of the head indicates damage to the temporalis muscle, (see attached picture) the large muscle completely covering the side of the head and which partially controls the closing of the mouth.
3. Give the patient the TMD Questionnaire (see attached) to fill out. Several ‘yes’ responses indicate the need for further evaluation by a dentist with extensive training in TMD evaluation and treatment.
You should:
1. Ask the patient to relate his TMD symptoms to his treating physician so that they will be included in his report.
2. Contact the patient’s physician, request a TMD consult based on the history and symptoms so the doctor includes the patient’s complaints in his findings and refers the patient out for proper evaluation.
3. Refer the patient directly to a qualified dentist for evaluation.
TMD’s are best treated through a combined effort of physician, physical therapist, and dentist.
SCREENING QUESTIONS FOR TMJ INJURIES
If you have headaches, a negative C.A.T. Scan and a normal neurological evaluation, you may have a temporomandibular disorder.
1. Do you experience headaches? (Especially in the morning when you wake up or in the evening when you go to bed?)
YES NO
[ ] [ ]
2. Do you have pain around the eyes, in the forehead, or at your temples?
3. Do you have pain in the face, neck, or shoulders?
4. Do you have pain, ringing, or buzzing in your ears?
5. Do you experience clogging, fullness, or pressure in your ears that comes and goes?
6. Do you experience dizziness?
7. Do you experience a clicking, popping, or snapping in your jaw joints when you open wide, close your mouth, or bite down?
8. Do you have pain when you open wide, close your mouth, or bite down?
9. Do you have difficulty with chewing, talking, or yawning?
**A COMBINATION OF TWO OR MORE “YES” ANSWERS TO THESE QUESTIONS IS INDICATIVE FOR A TMJ EVALUATION BYA DENTIST.**
Symptoms of temporomandibular Joint Dysfunction
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Curriculum Vitae
Education:
D.D.S. 1982 University of Maryland Dental School
Baltimore, Maryland
B.S. 1977 University of Maryland, College Park Campus
College Park, Maryland
Certifications:
NERB Licensed in MD, N.Y., R.I., PA, and Washington D.C.
Currently active in Maryland.
Professional
Memberships:
American Dental Association
Maryland State Dental Association
Experiences:
June 1982 PRIVATE DENTAL PRACTICE
to
Present Provide direct care to general dental patients and treat trauma related patients. Numerous continuing education courses in TMD treatment.
Qualified by courts in Maryland at all levels (State District, Circuit and Federal District) to provide expert testimony concerning treatment of injuries and the evaluation of permanent disabilities.
Experienced at independent medical evaluations, peer review, and consultant to managed care organizations (IWIF, HealthSouth, Ohio Casualty, Crawford & Co., etc.)
Guest lecturer at Sinai Hospital; Mercy Medical Center; University of Maryland; Anne Arundel Community College, Physical Assistants Program. Providing in-service programs on traumatic TMJ injuries and the related post-traumatic headaches.
Maryland General Hospital Grand Rounds lecturer February 24.1998.