What Type of Doctor Should I See for TMJ Problems?

This is a seemingly simple question with an extremely complicated answer.  One of the reasons it is complicated is the fact that you could ask this question of 5 different dentists and get 5 different answers.  The information in this article is based on years of study and training in disorders of the TemporoMandibular Joint (TMJ) completed by both of our outstanding doctors, Dr. Jill and Dr. Cara.

Why are TMJ Problems so Difficult to Treat?

The temporomandibular joint is actually the most complicated joint in the entire human body.  It is classified as a ball-in-socket joint, similar to hips and shoulders.  The important difference is that, unlike hips and shoulders, in the TMJ the ball comes out of the socket during normal function.

In a healthy, normal TM joint, the ball (which is the condyle of the mandibular bone) moves toward the front of the face and downward out of the socket (which is part of the skull).  You can feel this by placing your fingers just in front of your ears and opening your mouth widely.  You will feel the hard, bony projection move forward and downward as you open.  In order for this movement to happen, there are many different parts of the joint anatomy that must work together.  This includes a cartilage disk, like those in your spine, muscles, tendons and ligaments.

In abnormal TMJ function, which causes popping, clicking, limited opening, and/or pain, any one of these anatomical components can be the culprit.  Often it is more than one component malfunctioning.

Why are There so many Different Opinions?

We know this can be the most frustrating part of TMJ problems.  You see one dentist who tells you one thing.  Then a second opinion tells you something completely different.  There are a few different reasons for such a wide range of philosophies on the diagnosis and treatment of TMJ disorders.

One of the reasons is a lack of information.  In the past, we were unable to get high quality three-dimensional images of the TMJ.  That led to the use of inferior x-rays and a technique that utilized the analysis of sounds in the joint to diagnose the state of the various anatomical components.  The great news is that advanced technology now allows us to gather much more comprehensive information about the jaw joints right in our own office.

Another reason for differing opinions is a lack of consensus among dental professionals regarding the exact causes of TMJ disorders.  Some strongly believe that TMJ problems result from the way the teeth come together (the occlusion).  Others believe that growth and developmental issues have the greatest impact on the jaw joints.  Some cite trauma, while others insist that airway issues are the culprit.  Each of these different opinions has great research to support it.

Yet another reason for the differing opinions about the diagnosis and treatment of TMJ problems is the human body’s ability to adapt.  This means that someone could have serious joint problems without any obvious symptoms.  We know this is true because we often find severe deterioration of jaw joints on our 3D imaging in patients who have zero complaints.  This is called an “incidental finding”.  We were not looking for problems, but they were there.  Some people can adapt to TMJ problems with very little impact on their everyday life and require no treatment at all.  Others may suffer debilitating pain with less severe damage in their joints.  This greatly complicates matters!

How Can I Tell if my Dentist Treats TMJ Problems?

As a patient, it can be tough to tell if your dentist treats this complicated joint.  Don’t trust the information you read on the website.  Often the “services” listed are a simple compilation of what most general dentists provide.  You can ask a few questions when you call an office to help you discern if this office has experience in treating complicated TMJ problems.

• What type of treatment does the dentist perform for TMJ problems?

Listen for something like, “Well, that depends on the cause of the problem” instead of something like, “We make nightguards”.  The important thing to glean from the conversation is that they do not take a one-size-fits-all approach to treating TMJ problems.  Because of the wide range of problems, a single treatment will not be appropriate for every patient.

• What type of x-rays or imaging does the dentist use to diagnose TMJ problems?

Listen for something using the term “3D”.  A three-dimensional image always provides more information than a traditional two-dimensional panoramic x-ray.  If they mention an MRI, that’s a very good sign.  An MRI is a three-dimensional imaging that shows the state of the soft tissues of the joint, including the ever-important disk.  A dentist who refers patients to an imaging center for an MRI of the TMJ has extensive knowledge and experience in diagnosing and treating TMJ disorders.

• Does the dentist refer TMJ patients to a specialist?

Trick question!  There is currently no board-certified specialty in the treatment of TMJ problems.  Those who advertise as a “TMJ Specialist” simply mean that they limit their practice to the treatment of TMJ problems instead of treating other dental problems in addition to TMJ.  That’s why you will not see us calling ourselves “TMJ Specialists”.  We treat a wide range of dental problems, including the TMJ.

More Questions about TMJ Issues?

Call 972-347-1145 today to schedule a consultation with Dr. Jill and Dr. Cara.  We will take the proper steps to arrive at a diagnosis of your TMJ problems before recommending any specific treatment.  Our years of education and training in this area show our dedication to helping patients address this complicated issue.