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Challenges with TMD Therapy from a General Dentist’s Perspective

Challenges with TMD Therapy from a General Dentist’s Perspective. Kevin D. Huff, DDS, MAGD June 19, 2019. Main Points. Interprofessional Relationships in Rural Communities Denture Patients and TMD Confusion of “TMD” Definition Underutilization of DC/TMD.

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Challenges with TMD Therapy from a General Dentist’s Perspective

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  1. Challenges with TMD Therapy from a General Dentist’s Perspective Kevin D. Huff, DDS, MAGD June 19, 2019

  2. Main Points • Interprofessional Relationships in Rural Communities • Denture Patients and TMD • Confusion of “TMD” Definition • Underutilization of DC/TMD

  3. Interprofessional Relationships in a Rural Community Misdiagnosis • “My doctor told me I have TMJ and to get a mouthguard.” • “I get migraines all the time. The nurse practitioner gave me Topamax, but it doesn’t really do anything. Then, my doctor told me to take a Maxalt that he prescribed, but when should I take it?” Lack of Respect from Medical Community • Failure to support dental diagnosis • Misunderstanding of fee structures and medical insurance coverage • Licensure and Prescription Authority

  4. Interprofessional Relationship Challenges:Case Examples • 26-year-old patient with myalgia and chronic migraines without aura who has history of stroke: Nurse practitioner failed to respect request for medical support with low dose SNRI or TCA; NP recommended OTC soft mouthguard as alternative treatment because “dentists charge too much for bite splints.” MD supported the NP during phone consultation • 32-year-old patient with TMJ pain and headaches referred by another dentist: Patient checked with her medical insurance first who told her to go to an ENT; ENT told patient he could treat her appropriately with ear surgery.

  5. Denture Patients and TMD • Correlation of headaches and TMD rarely correlated with poor denture fit and function in practice and in literature • Complete dentures rarely evaluated by physicians; denture patients do not receive regular dental examinations. • Case Examples: 1. Fractured condyle missed by ER MD 2. Myalgia caused by poor occlusion

  6. Confusion of “TMD” Definition • “TMD is not caused by occlusion!” • Temporomandibular disorders (TMD) include 30+ diagnoses • Bony • Cartilaginous • Muscular “TMD” is not a diagnosis!

  7. Underutilization of DC/TMD • Continuing Education Centers (Spear, Pankey, Kois, etc.) • ADA ??? • Accessibility and Awareness of DC/TMD Examination Protocol

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