111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
A Call for Co-operation
My life was almost destroyed by this.
—a 51-year-old lab technician
Again and again I was told there was no
reason for the pain and that it must be caused by psychological
—a 24-year-old medical student
The problem has caused me more anguish
than anything else in my life—and to think there's been
no need to suffer all this pain for so many years.
—a 33-year-old homemaker
After years of searching, I'm furious that
TMJ was missed and the diagnoses I was given were so far off.
—a 60-year-old fire fighter
Why is TMJ missed over and over again? Why
have so many people suffered needlessly? Why have TMJ sufferers
been forced to cope with little more than pain relievers,
often ineffective, and in many cases mind-altering and addictive?
These are frustrating questions that illustrate problems plaguing
the health care community today.
Almost every patient finally led to TMJ diagnosis
and treatment has had extensive work-ups and testing by members
of nearly all branches of the healing arts, from physicians
to nutrition counsellors. Many have had these work-ups more
than once, as they sought help from one practitioner then
another. And, in retrospect, many people are angry and frustrated
because their conditions remained unchanged no matter what
therapies they tried. Because they didn't understand the reasons
for their suffering many were frightened by the pain.
Unfortunately, the TMJ treatment dilemma is
complex. And the reason for the dilemma is rooted in the structure
of the current health care delivery system. The healing arts,
as we know them today, encompass various disciplines, including
acupuncture, medicine, massage therapy, naprapathy, nutrition,
physical therapy, osteopathy, dentistry, psychiatry, and psychology.
For the most part, each branch tends to operate
autonomously. Furthermore, in many cases health practitioners
refuse to call upon—or they even outright reject—some
premises of the other branches of health care. Because of
this, each field tends to develop in an inbred fashion. Practitioners
and researchers who reach outside their own fields and expand
their knowledge are rare.
There are logical reasons for this situation.
The amount of new material that must be regularly absorbed,
simply to keep up with one's own field, is enormous. This
makes it even more difficult to move outside a particular
area of expertise and interest.
In addition, each branch of the healing professions
has its own organizational structure and, regrettably, these
structures seldom get along well with each other. Organizational
structure does have its advantages. Each branch can focus
on its own developments and trends.
However, the disadvantages of the existing
structure block most interdisciplinary communication. This
leads to an atmosphere where each branch is studying and learning
independently and along its own philosophy of healing. As
a result, information from differing branches of health care
tends to be overlooked and, in many cases, even scorned.
Within each philosophical group, information
is shared and lines of communication are more open. Members
tend to refer patients to members within different specialities
of the same branch. Physicians refer to other physicians.
Osteopaths refer to other osteopaths. This kind of communication
is routine. However, there are some exceptional clinicians
who recognize the contributions other disciplines have made.
These individuals think cross-referral is often in the best
interests of the patient.
But, for the most part, there is little meaningful
and co-ordinated communication between the various healing
disciplines to work harmoniously on a patient's problems.
Co-ordinated communication would allow two or more members
of different branches of health care to come together to evaluate
a patient and reach a diagnosis and treatment plan, while
giving each appropriate approach individual and equal attention.
An unfortunate lack of respect often exists among the groups.
THE RESULT: DISASTER
This situation has proved disastrous for TMJ
sufferers. Often people wonder why TMJ was missed in the diagnostic
processes they went through with various clinicians. But "missed"
isn't exactly the way to describe it. Most physicians, for
example, were not taught to recognize TMJ. Therefore it isn't
on their lists of possible causes for headaches. You can't
really miss what you didn't know about or understand in the
first place. There is a definite need to bridge the information
gap between all clinicians.
TMJ is not currently a separate speciality
in dentistry. There are currently no comprehensive training
programs for studying it. The various approaches used in the
past have had mixed results, and the time allotted to studying
the problem in dental school is scanty or non-existent. Dental
students are usually told the condition exists, but few are
taught how to evaluate it, let alone treat it. Patients are
still surprised when a dentist asks questions about TMJ symptoms
during the course of a routine exam.
In medicine, the standard diagnostic approach
is a procedure called differential diagnosis. When evaluating
a patient, the physician lists (either mentally or in writing)the
possible problems that may cause the symptoms the patient
describes. To reach a proper diagnosis, the physician compares
the characteristics of each of the listed diseases with the
characteristics of the patient's condition. Diseases that
do not match are eliminated.
In the course of diagnosing a patient complaining
of headaches, this list will typically include, among other
things, tumor, concussion, infection, and high blood pressure.
Any one of these can cause headaches. But for the majority
of patients, the causes of headaches can be limited to vascular
headaches such as migraines or sinus disorders, and muscle-contraction
or tension headaches. Of these types, migraine, sinus-related,
and other vascular headaches make up the minority of all headaches.
The majority of all headaches are muscle-contraction headaches,
and the most frequent cause of these is TMJ. Unfortunately,
this information isn't widely known, and is not included in
training programs for clinicians.
AN ENLIGHTENED SYSTEM
If all health care practitioners were aware
of TMJ, it would be high on the list of causes for this kind
of chronic pain. If they also knew how to screen for TMJ (a
procedure taking minutes), a patient could be advised to have
this condition investigated.
In an enlightened health care system, patients
who suffer from chronic headaches and other TMJ symptoms would
be evaluated using knowledge from all the healing arts. Using
this integrated concept, practitioners could untangle and
interpret the mystery of the patient's symptoms and devise
an appropriate treatment plan by considering many ideas. This
would be the best way to avoid leaving patients in chronic
pain because the experts whose help they seek lack information.
Once open dialogue is created and information
is shared, more and more people will receive competent and
prompt treatment for TMJ. When this dialogue is established,
it may open the door to more discussion in other areas of
health care. The people who study and treat TMJ may become
pioneers in significantly integrating the knowledge and tools
of all the healing arts. We will hear fewer stories of destroyed
families, careers, and entire lives. We will reduce the number
of patients who, when they finally seek evaluation for TMJ,
consider it their last hope.