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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 problems.
—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.

INBREEDING

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.