Before I learned about TMJ and occlusion at Spear Education, managing a patient with TMJ pain was always a challenge for me. Often these patients need to be seen in the middle of an already busy schedule.
They are in pain and they want to get comfortable quick. Sometimes these patients have had a past history of unsuccessful management and are skeptical of new approaches you suggest. Dr. Steve Ratcliff discussed one such interesting case recently in “What Happened Here?”.
In the early years of my career it used to be a challenge to see certain patients. Now it's an exciting opportunity. The goals for the initial comfort appointment are simple and then we follow a simple four-step checklist to collect all the information we need.
Goals for the emergency appointment:
- Get the patient out of pain ASAP;
- Establish a working diagnosis;
- Appoint the patient to return back for more definitive exam.
TMJ assessment checklist
- The capsule
- Palpate the joint behind the condyle with jaw in open position
- Check ligament laxity
- Retrodiscal tenderness
- Stabilize/brace the joint and ask patient to move side to side
- Muscle assessment criteria
- Muscle palpation exam
- Lateral movement against resistance
- Noise on rotation
- Noise on translation
- Mouth opening
- Lateral slide in edge-to-edge position
- Protrusive movement from edge to edge- is there deviation?
- Is there deviation on opening?
- Load the joint with leaf gauge
- Load the joint with manipulation
- Load the joint with lucia jig
- Place cotton rolls over second molars and ask the patient to chomp on it.
Using this data a working diagnosis can be established. View a preview of the following videos on the Spear Digital Learning platform that explain in detail how to acquire the information mentioned above and how to interpret them.
Palliative treatment usually consists of a dental splint (I use Aqualizer), Ibuprofen and Flexeril 5mg. The patient should return for comprehensive evaluation and follow-up within the next three to five days. At the return visit you can compare the data gathered at the initial appointment with the comprehensive evaluation. Also you can evaluate the patient's response to the initial palliative treatment. These two crucial pieces of information are very helpful in establishing a diagnosis and planning long-term effective treatment.
Vivek Mehta DMD, FAGD, Visiting Faculty, Spear Education. Follow him on Twitter @Mehta_DMD.