HOW TO DETERMINE IF YOUR CLIENT HAS RECEIVED A TRAUMATIC
TEMPOROMANDIBULAR 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:
HEADACHES
DIZZINESS
LIGHT HEADEDNESS
RINGING IN THE EAR
EAR PAIN
PAIN IN THE FACIAL MUSCLES
SORE THROAT
PAIN FROM THE JAW JOINT
PAIN IN THE EYES OR VISUAL DISTURBANCE
DIFFICULTY IN OPENING AND CLOSING THE MOUTH
CLICKING SOUNDS EMANATING FROM THE JOINT
NUMBNESS OR TINGLING IN FINGERTIPS
· Headaches as a Symptom of TMD
Headaches are a prominent symptom of TMD. The vast majority of headaches are muscular in nature, originating in the neck, face and head muscles or both. This is why headache patients referred for C.A.T. 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, 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 (downloadable copy) 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?
YES NO
[ ] [ ]
3. Do you have pain in the face, neck, or shoulders?
YES NO
[ ] [ ]
4. Do you have pain, ringing, or buzzing in your ears?
YES NO
[ ] [ ]
5. Do you experience clogging, fullness, or pressure in your ears that comes and goes?
YES NO
[ ] [ ]
6. Do you experience dizziness?
YES NO
[ ] [ ]
7. Do you experience a clicking, popping, or snapping in your jaw joints when you open wide, close your mouth, or bite down?
YES NO
[ ] [ ]
8. Do you have pain when you open wide, close your mouth, or bite down?
YES NO
[ ] [ ]
9. Do you have difficulty with chewing, talking, or yawning?
YES NO
[ ] [ ]
10. Are you eating a soft diet?
YES NO
[ ] [ ]
11. Do you sleep soundly or do you wake up in pain?
YES NO
[ ] [ ]
How many times? ______
**A COMBINATION OF TWO OR MORE “YES” ANSWERS TO THESE QUESTIONS IS INDICATIVE FOR A TMD EVALUATION BY A DENTIST.**
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Stephen H. Gamerman, D.D.S. P.A.
Education: University of Maryland Dental School
Baltimore, Maryland
College Park, Maryland
B.S. 1977
Certifications: Board certified and 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
July 23, 2008
Professional
Experiences: PRIVATE DENTAL PRACTICE
Treatment of general dental and trauma related patients. Practice concentrating on TMD treatment.
June 1982
to
Present
Qualified in Maryland courts (State District, Circuit and Federal District) to provide:
disabilities.
Experienced at independent medical evaluations, and record reviews. Clients include plaintiffs and insurers. (IWIF, Ohio Casualty, Crawford & Co., CorVel, Professional Evaluation Group, Expert Medical Opinions, etc.).
Maryland General Hospital Grand Rounds Lecturer TMD Headaches and Trauma February 24, 1998.
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.
Contributing Editor, Krames Communications Publication on Temporomandibular Disorders (TMD) 2003 Edition
Maryland Association for Justice Lecturer, TMD and Worker’s Compensation Injuries November 11, 2008
Maryland Academy of Family Physicians Lecturer, TMD Headaches and Trauma June 19, 2009
Maryland Association for Justice Lecturer, Identifying and Recovering From TMJ Injuries September 11, 2009
Northwest Hospital Center Emergency Department Grand Rounds Lecturer TMD, Headaches and Trauma October 9, 2015
Maryland Association for Justice Lecturer TMD, Headaches and Trauma
October 11, 2015
