In previous newsletters we have covered the basics of how to diagnose and screen TMJ patients, especially subclinical cases that cause most practitioners a ton of clinical setbacks. This newsletter will summarize some of the key factors necessary to help you manage and “deal” with some of these difficult patients. Many TMJ patients do NOT show signs or symptoms of jaw problems. This is especially true of those patients who have normal occlusions and no TMJ pop, click, or crepitus. Plasticized TMJs normally do NOT exhibit any clinical symptoms, however the patient has a history of headaches and migraines. Only MRI and CTScans can be used to diagnose these patients. Clinical examination is NOT adequate.
Make sure that your Health History forms have a headache and migraine category so that you can review this with your patients. Providing dental treatment to such patients can lead to many frustrations clinically, from inadequate anesthesia to multiple post-op complaints. If you are experiencing such issues on a regular basis, go back and review your patient’s Health Histories and ask them if they suffer with headaches or migraines. These sufferers will usually have a hard time with dental treatment.
Also ask them if they chew gum on a regular basis. Gum chewing, clenching, and bruxing patients will normally have post-op clinical issues that are hard to resolve.
If you decide that the patient needs conservative treatment for clenching or bruxing: review our previous newsletter for proper orthotic fabrication. Too many splints are made with wrong designs and this can worsen a patient’s symptoms.
Simple OTC NSAIDs can help with many post-op problems but for TMJ patients it is also important to prescribe Valium (5 or 10 mg Q8H) or Flexeril (10 mg H.S.) This can help calm down the muscle dysfunction and decrease their complaints. Don’t be afraid to offer this. Keep in mind that Flexeril should not be used longer than 14 days without consulting with their physician.
If you have questions about any of your patients’ care, feel free to email or call us. We always offer a Free consultation for you and your patients.