Dr. Shapira's Chicago Headache Blog

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Friday, January 29, 2010

What to expect at your headache or TMJ disorder consult.

When you see a doctor for the first time for a TMJ disorder you should expect to have to give lengthy and detailed history. There are usually forms to fill out. What is important is that this history should be reviewed with the patient and how the history relates to the current problem should be explored. The initial consult is usually at least 45 minutes but can last for several hours.

In most cases the doctor can provide instant relief of some of the painful conditions by deactivating muscular trigger points. This is usually done by use of a technique called Spray and Stretch that utilizes a vapocoolant spray. These techniques were developed by President Kennedy's personal physician Dr Janet Travell. In most patients it is possible to connect their symptoms to their history in an understandable fashion.

If there is a acute close-lock of the TM Joint time is of the essence and immediate reduction is best if possible. Prescribing anti-inflamatories should never take the place of attempting to reduce an acute disc dislocation.

Permanent and/or irreversible treatment should rarely be the initial treatment. Adjusting the teeth or doing equilibration of the back teeth should be avoided when there s acute muscle spasm. The exception is if a recently placed restoration is in hyperocclusion and percipitated the problem. It should be carefully evaluated because acute spasm can change the bite.

A thorough examination of the muscles and joints is usually performed before initiating treatment. A Neuromuscular Dentist will usually take impressions and a bite utilizing TENS (transcutaneous electrical neuro stimulation) as well as EMG and computerized mandibular scans. This information helps the dentist understand all aspects of the problem before initiating treatment.

Many insurance companies deny coverage of TMJ disorders and Neuromuscular diagnostic work-ups. This is done to "save money" but in reality it has a heavy toll in the quality of patients lives and their future health and welfare. Insurance companies are not in the business of caring for patients. Insurance companies are in business to make money for their shareholders. The larger the premiums they collect and the less they pay in benefits the better the bottom line. A healthy bottom line is the primary concern of insurance companies. These companies are in business to creat profit and shareholder value. The executive of insurance companies make millions of dollars in bonuses for increasing profitability. Unfortunately for patients increasing profitability usally is done by denying patients medical benefits. The more effective an insurance company is in reducing payments for care the more profitable they become.

The insurance companies often use terms such as reasonable and customary to explain why patients are not given the coverage they were promised. I have been treating sleep apnea with oral appliances for close to 30 years. In the early years I was the only dentist in the state of Illinois doing this type of treatment. I would still receive letters telling me my fees were more than "usual and customary" even though I was the only doctor doing these treatments.

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posted by Dr Shapira at 8:27 PM

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