You know that ANYTHING you can do to make your patientsâ visits to your office different from their visits to their last dentist will help them realize and expect that you may find some different things to talk about than their old dentist(s) did. Doppler auscultation of the TMJs at the examination can be one of those things that differentiates your practice, prompting that wonderful question, âWhy didnât my old dentist do that?â
In almost every case you will already have a pretty clear vision of whatâs happening in the joint because you âheardâ it with your fingers as you palpated, the Doppler simply highlights your examination of something that most patients have not experienced before. If your practice doesnât have a Doppler you can differentiate yourself by simply picking up a stethoscope and listening, not as flashy, but often equally effective in generating that magic question.
Step 1: Transmission gel. Applying the gel to the receiver of the Doppler rather then to the patientâs face is usually an easier way to get it ion the right place. Since the Doppler can emit a lot of noise anytime you do anything to the receiver I recommend keeping the volume turned to zero while applying the gel and positioning the device.
Step 2: Position receiver. Position the receiver just above the tragus, aimed straight into the patientâs head, turn the volume up and listen for the sound of the superficial temporal artery. The âwhoosh â whooshâ sound tells you youâre aimed correctly.
Step 3: Aim for the TMJ. Upon hearing the artery turn your hand to aim the receiver forward and down toward the place where the TMJ moves. Having the patient open and close quickly can confirm you have found the joint. Listen for the scratchy sound as they open and close. This is NOT an abnormal condition but the effect of quick movements interpreted by the Doppler.
Step 4: Test Rotation. Ask the patient to place their tongue in the roof their mouth and without touching teeth, open slowly and close slowly. Take about a second to open and a second to close. Quick movement produces noise as noted above. When the joint is moving on fibro-cartilage there will be no sounds, the joint will be quiet.
Step 5: Test Excursions. Ask the patient to move in excursive pathways, lateral and protrusive, without teeth touching. Again, about a second to move to the limit of the excursion and about a second to move back. When a disc is improperly positioned and is recaptured, a click will be heard. When the condyle is moving on pseudo-disc crepitus, a gravelly sound will be heard.
Use the results of Doppler auscultation to start a discussion with your patient about their TMJ health, especially if nothing is heard. Discovering health is a finding too many dentists fail to celebrate. Remember, for the patient who has never experienced Doppler, you may be the first professional with whom they are ready to have that discussion.