What to expect at the first TMJ/TMD and Sleep visit

The following is a summary of the first visit in our practice. You can download the comprehensive TMD/Sleep questionnaire prior to your appointment. (download from here) or you can fill it out by arriving 20-30 minutes earlier than your set appointment time. Please try to be as detailed as possible when filling out the forms.

We will begin by gathering details of your medical and TMJ/TMD/Sleep history, including all past medical and/or dental problems and treatments and any history of trauma (especially to the head and neck regions). From the answers you write in the questionnaire, we will ask further questions about your symptoms, especially about the nature and duration of any head pain and jaw problems.

A complete clinical examination for a TMJ/TMD/Sleep problem will likely include:

1. Dental examination to evaluate the shape of the dental arches, tooth wear or fractures, missing teeth, existing dental restorations or other clues.
2. Jaw movement and jaw joint/TMJ examination to record ranges of motion of the lower jaw andwhether there is deviation or deflection of lower jaw movement. Additionally, the TM joints will be checked for internal derangement, joint inflammation, pain and the presence of joint sounds.
3. Postural exam to discover any muscular and skeletal problems that either contribute to or are the result of TMJ problems. These could include Forward Head Posture, scoliosis, lower back pain, hip misalignment and foot issues among other possibilities.
4. Functional examinations to evaluate swallowing, breathing and chewing.
5. Neurologic examination to determine neural health in relation to TMJ/TMD symptoms.
6. Sleep disorders screening to evaluate if there is upper airway resistance or sleep apnea are present and whether further diagnosis is required in collaboration with the medical doctor, an Ear Nose and Throat specialist and/or a sleep physician.

Based on the findings, further testing and referrals to allied healthcare professionals may be required. When needed, we refer for imaging or other tests.

Imaging:

Depending on the nature and severity of the TMJ/TMD/Sleep problem, referral for specific imaging for the evaluation of hard or soft tissues of the head and jaws will be given.

We refer to an Oral Radiology office for CBCT images. Cone Beam Computed Tomography, CBCT, is a compact, faster and safer version of a medical grade CT. Cone Beam CTs use a cone shaped X-Ray beam through a small scanner that has dramatically reduced radiation dosage and scanning time. The time needed for a full scan is typically under 20 seconds and the radiation dosage is up to a hundred times less than that of a regular medical CT scanner. CBCT imaging has many applications in dentistry for teeth and hard tissues such as bone, however it will not show softtissues like cartilage, ligaments and muscles.

If soft-tissue imaging is indicated, we will collaborate with an oral surgeon and/or your medical doctor for an MRI.

TMJ and Sleep Appliances:

Following the clinical examination, we will discuss with you the various Oral Orthotics that would be needed to bring the muscles of the head and neck, the postural muscles of the body and the TMJs back to optimal health. Not all people who seek relief from TMJ pain require oral appliances at the onset and it is rare that someone would only require oral appliances without addressing other causative and co-existing concerns. When needed, we refer to healthcare and allied professionals such as your medical doctor, an Ear Nose and Throat doctor, psychologist, oral surgeon, acupuncturist, physiotherapist, naturopath and even allergist, to name a few. There are many factors that co-exist and contribute to TMJ problems, which means it is a multi-factorial problem that requires a multi-disciplinary approach.