Frequently Asked Questions?

There are many factors that must be considered when TMJ/TMD and facial pain patients wonder when their pain will be resolved.  It is difficult to put a “realistic” time frame on things when there could be multi-layered issues involved.

Note that improvement doesn’t mean “cured” or total resolution. Most cases with chronic pain (depending on the pain problem) can improve within 24-48 hours when wearing a properly fine-tuned and adjusted lower anatomical orthotic. Other chronic pain cases (depending on their problems and conditions) may take longer.

It’s hard to predict how each individual case will respond to treatment. Not all muscles, not all joints, not all teeth/occlusal schemes and not all CNS systems function the same. Some cases have other factors such as stress factors, emotional factors, biochemical factors that play into the picture. There are no guarantees for neither the patient nor the treating dentist and other health care professional involved in the case to know how the patient will actually respond to treatment. In general, however, most cases respond well and patients experience improvement. Most patients can improve in some aspects of their condition, and need more time than others, and follow-up visits are usually scheduled in order to adjust the orthotic as the body naturally and dynamically changes as a result of the treatment.

All patients are different and may respond quicker or slower to therapy, especially when it comes to compliance.  If the appliance is not worn as prescribed, changes and improvements can be significantly slower. Alternatively, many patients can respond quickly, and as muscles adjust, and postural improvements occur, additional adjustments may be required in order to manage the bite and continue to stay on top of the changes that are happening.

How much change will occur? – there are no specifics on this.

How many visits will be required? – there is no set number; as the body adjusts and seeks a neutral position, changes occur and adjustments may need to be made.

Each case is individual and will vary depending on the conditions and various contributing combinations of problems in each case. This is what makes diagnosing and treating TMD so complex and patients need to accept the unknowns and the patience that is required in order to resolve and treat their condition.

WHAT MAKES A TMJ CASE MORE CHALLENGING TO STABILIZE:

1. Missing teeth like bicuspids (less teeth make the occlusion less stable and more challenging, but not impossible)
2. Missing upper molars or missing lower second molars
3. Clencher type, high proprioceptive detailed aware person
4. Narcotic medications or SSRI medications that contribute to clenching muscles
5. Cervical neck (atlas, axis) and occipital instability
6. Pelvis and lower back problems
7. Severe restricted mouth opening
8. Biochemical imbalances (nutritional deficiencies)

NOTE: Not all TMD problems are the same.  Just as individuals are unique and may also have a unique set of problems that are different than others individuals. Some TMD cases naturally will require certain skills, understanding, knowledge, effort and additional time.

Fees can vary greatly in TMD cases. Fees are commensurate based on time involved, effort, complexity, detail, and patient limitations. Some people require move visits than others. Some require longer appointments due to a variety of different factors. Some ask a lot of in-depth questions and want detailed answers (requiring a lot more time to discuss and explain) or require lengthy written communication or repeat follow-up or explanations. Overall, many cases are typically very complicated in nature and require a lot of time and focus to address and resolve their issues.
If treatment requires a multi-phase approach, Phase II can pose additional challenges. Treatment options for Phase II can vary and costs will highly depend on patient choice, various treatment modalities, and time needed to complete all treatment. Depending on where the patient is free of symptoms, stable, and at Optimal Physiologic Position, the treatment options may include orthodontics in order to transition to the final optimized position, while others may require restorative restorations including full mouth rehabilitation. Others may need a combination of multiple treatment modalities in order to control and maintain the ideal bite. In addition, some TMD patients are missing some teeth, or have had previous surgeries, or various forms of joint derangement problems, locked joints, discs that have not been recaptured, medication dependance, all making their problems much more complicated than those who do not have these additional challenges. Some patients are clenchers, have postural problems or have CNS issues, and all these take more time. No case is ever the same.

Generally, Insurance Companies do not cover treatment related to TMD. Please note that our office will submit treatment codes to your insurance electronically; however, your reimbursement depends on your benefit plan chosen by your employer. Please contact your employer or your insurance company for details regarding insurance coverage.

I have been practicing dentistry for many years so I have seen many Temporo-Mandibular Disorder (TMD) cases. I find that the more I learn, the more I need to learn. There is a lot of debate about TMD but not a lot of good information and, currently, dental education does not prepare dentists to treat TMD successfully. Many dentists find it arduous and frustrating and others just don’t know enough about it to help their patients resolve their issues.
TMD is multi-faceted and incredibly challenging to treat. As philosophies differ among dentists, and personality differences come into play, the limited information that is available is often misleading. To make this even more difficult, many TMD cases can be quite complex in nature, and each patient comes with their own unique challenges and limitations. Many of our patients come from all over the country, and are often referred by other health care professionals after trying and failing at many forms of therapy, modality and diagnosis. When I work with a TMD patient, it requires a whole different level of precision, patience, and skill. Many TMD patients have emotional and psychological issues as a result of being in chronic pain for many years and may have limitations, which can be extremely time consuming in a typical general practice setting.

Most cases of Temporo-Mandibular Disorder can be treated without surgery. Each case and patient is different but over 95% of patients we see are treated in office without any surgical intervention. In the few cases that are surgical, many do not need it to resolve their pain. In cases were surgery is indicated, it is usually a cosmetic rather than pain-related solution and it’s ultimately the patient’s choice whether to follow through with surgery or not.
If you are a patient where surgery would be an option, Dr. Bis will discuss that with you at the consultation prior to any treatment so that you can make decisions and ask any questions regarding your particular situation. In general, however, even if surgery is indicated, you will have the opportunity to learn about solutions that do not include surgery in the final outcome.