Patient Education
Questions to Consider When Choosing a TMJ Dentist
The doctor–patient relationship is about trust — and trust begins with the right questions.
A patient’s guide to what to ask, and why it matters.
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Some questions to consider are the following:
- Is the dentist you are seeing a licensed dentist in the state or country you are seeking treatment?
- How hands on would the doctor be in addressing the complex TMD case?
- Does the doctor prefer to delegate a lot of procedures and responsibilities to others, ie. his assistants, labs, etc.?
- What philosophy of thought and belief is his/her treatment and diagnostic approach?
- Does the treating doctor believe in a psychosocial perspective or biophysiologic perspective?
- How much time is the dentist willing to spend with you in adjusting your bite/orthotic? 20 minutes?, 30 minutes, 1 hour? 2-3 hours, or more?
Does the Dentist believe and practice craniomandibular pain treatment directed mainly as:
- A muscular theorist – trigger points and understand tight muscles need to be balanced (but how?).
- A psychological theorist – most of the symptoms are due to stress, tension or emotional upset leads to increased muscular activity, nocturnal bruxism, with psychological testing, etc, yes, they say muscular imbalance and eventual malocclusion, with some splint treatment (but how?).
- Or as the malocclusion theorists who use splints to prevent premature contact, attempt to relieve pain by revising occlusion.
But there are two schools of thought with the malocclusion theory:
- Occlusal disharmony believers view occlusion as the cause of muscular dysfunction.
- TMJ mechanics believers view the cause of premature contacts is due to trigger points in the muscles – Relieve muscles before splinting, prolonged dental work, stress or trauma and malocclusion can perpetuate trigger point activity, etc. and the vicious cycle continues … (but how do they treat it?).
There is also the various disciplines of chiropractics, osteopathics, physical therapists, massage therapy, cranio therapists, etc. that some doctors may coordinate with or maybe they do not include in their treatment protocol. These are things to also consider, recognize and understand as to what the doctor(s) is about.
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Philosophy Matters (The Doctor’s “Thinking Process”):
- Does the TMD/orofacial pain doctor believe in occlusion related issues, or perhaps the doctors don’t believe in occlusion related issues? Is the problem just a body alignment issue and or maybe it has nothing to do with teeth?
- Are the emotional factors involved that the clinician and patient should consider when dealing with any of the above?
- Does the dentist recognize the underlying problems presented even if the patient doesn’t tell them everything and the dentist has to figure it all out on his/her own wading through the maze of issues, concerns and history of complaints of what worked and what didn’t work as to what the patient has previously tried.
- Does the clinician believe in diagnostic instrumentation = objective data or do they disparage it because of their lack of understanding?
- Do they believe in muscle relaxation therapy or do they not believe it has any relevance to the 6 dimensions of condyle, disc and muscle alignment to the posture?
- What level of details in occlusal equilibration does the doctor understand – 100 micron adjustment level, 80, 60, 40, 30, 15, 10 microns? ….. and to what is their gnathic training, experience and understanding?
- What is their neuromuscular training, experience and understanding?
- What is their gnathological training, experience and understanding?
- What is their orthodontic or bio-physiologic training, experience and understanding?
- Are they more of a diagnostician (academic?) or is the doctor more of a hands on clinician?
- Do they understand orthodontic/orthopedic concepts and treat cases of that nature in their office?
- Do they understand complex restorative procedures and do those type of procedures?
- Do they understand airway issues?
- Do they understand just one discipline of the aforementioned, or do they understand just one: TMD, comprehensive restorative and orthodontic/orthopedics?
- Or do they understand and practice all 3 disciplines?
These are just some of the questions I would consider and there is a lot more…but as you can see…One will have to consider these factors when locating a dentist you can trust!
Skills and Ability Matters
- Is the dentist a person that takes his/her time to adjust the patient’s bite or does the dentist have his assistant do the adjustments?
- Does the dentist pay attention to details or are they fast, quick and rather abrupt in providing answers?
- Does the dentist rely heavily on the lab technician and others to make orthotics or does the dentist have skills and ability to make his own orthotics for the patient?
- Does the dentist have skill, understanding, knowledge and experience in completing a full mouth restorative case (phase 2) if and when it was appropriate?
- Does the dentist have the skill, understanding, knowledge and experience in completing an orthodontic/orthopedic case (phase 2) if and when it was appropriate?
These type of questions can further help guide you and give insights as to a dentists mindset, training, clinical abilities and experience in treating your phase 1 TMD problems.
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If you can’t trust any of them it is better not to start.
The doctor patient relationship is about trust, it’s about honesty. The relationship is about not talking behind the doctors back, gossiping to others on internet forums (ie., Facebook)….respecting who you choose regardless. And the doctors need to respect the confidentiality of their patient’s care as well. It’s a respect, honored and mutually agreed upon relationship.
If there is no trust, and or faith in what any dentist does, the case will fail no matter how good the doctor is and no matter how credentialed they are or not.
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