TMJ issues should be covered by insurance, according to most experts. Many people wonder whether it’s covered by medical or dental insurance, and where the boundary is that separates the two types of coverage.
Medical insurance is usually the primary source of coverage for TMJ issues. The reason for this is that a joint, like muscle, tendons, and ligaments, can be found everywhere in the body. Physical therapy coverage is normally straightforward, although coverage conflicts are common when orthotics, appliances, or splints are created.
Blue Cross and Red Crescent Societies When used to treat a TMJ patient, Blue Shield will generally classify TENS as experimental, but will pay treatment for other purposes.
It’s worth noting that treating TMJ issues saves both patients and insurance companies money.
TMD sufferers used healthcare at 200-300 percent higher rates than non-TMJ patients, according to Shimshak et al’s findings published in Cranio.
My personal experience with saving money for insurance companies dates back to the 1980s when I worked for Chicago HMO. I had a patient who really required treatment, but her insurance didn’t cover it. I struggled for coverage and eventually met with Dr Mitchell Trubitt, the Medical Director of Chicago HMO Ltd.
I described the treatment to him, and he agreed to the non-surgical treatment, which proved to be effective. We agreed to a trial period after I assured him I could save the insurance company money while also benefitting the patients. Six patients were sent to me by a Chicago HMO, all of whom were told they needed TMJ surgery.
I handled the first six patients, and after reviewing the records, Dr. Trubitt estimated that the non-surgical approach had saved the Chicago HMO over $250,000.
Dr. Trubitt then negotiated a preferred provider agreement with Chicago HMO, under which Chicago HMO would cover 100% of phase 1 TMJ treatment with no deductible. Because of the cost savings to the corporation, he also cut the physician’s referral fee to the same level as cancer and cardiac treatment, which was the lowest available.
The end product was fantastic. Almost all of the patients who were tentatively scheduled for TMJoint surgery were able to avoid it. It was less politically acceptable because many oral surgeons objected to their surgical patients being referred to a general dentist for non-surgical treatment. Dr. Bruce Douglas, who was a Board Certified in OMS and a prior editor of their magazine, and I developed a very good relationship since he was an amazing oral surgeon who did not like TMJ surgery.
This arrangement allowed me to work with Chicago HMO and Mitch Trubitt for many years until United Health Care purchased the company. I met with their medical director and Dr. Trubitt, but they informed me that they were not interested in continuing the program because they did not pay for surgery and would not see any savings.
The Shimshak study, which found a 300 percent increase in medical utilization among individuals with TMJ issues, had not yet been published. With the sale of Chicago HMO to United Health Care, a scheme that helped patients and physicians while also saving money came to an end.
The future of health care and coverage for TMD problems is still up in the air.
I am the current chair of the American Alliance of TMD Organizations, which works to represent the majority of dentists who treat TMJ issues in obtaining insurance coverage and protecting patients’ rights to receive adequate treatment.
Is TMJ treatment medical or dental?
Patients who acquire TMJ may be unsure of who to see for therapy. Certain disorders that produce pain in the facial area or inflammation in the jaw joint itself might lead the condition to be a medical problem.
Medical conditions that cause TMJ pain
Fibromyalgia is one of the most common medical causes of TMJ pain. This illness produces discomfort all over the body as well as at a few “trigger spots,” one of which is usually in the jaw or upper neck area. Patients with fibromyalgia can have these symptoms even if they have no prior dental problems.
The temporomandibular joint can be directly affected by rheumatoid arthritis and other kinds of inflammatory arthritis. These people, like those with fibromyalgia, may not have any teeth or mouth problems; the jaw joint may simply be swollen due to an autoimmune attack on its lining.
Medical treatments for TMJ pain
Medically based therapies are frequently conservative in nature and can be prescribed by a physician or a dentist. As a first-line treatment for joint inflammation, a clinician may prescribe pain medication. Alternative treatments may be used with pharmaceuticals for holistic TMJ relief for illnesses including fibromyalgia, which sometimes respond to antidepressants, massage therapy, and body relaxation.
How much is the treatment for TMJ?
The total cost of temporomandibular joint (TMJ) surgery varies greatly depending on the severity of the case and the source of your discomfort. Patients should anticipate to pay anything from $5,000 and $50,000 in total.
Factors Affecting The Cost Of TMJ Surgery
The reason of your pain, the sort of therapy you’ll receive, and your doctor’s skill are all factors that will influence the cost of your TMJ treatment.
- The reason of your TMJ pain will determine which treatment option is best for you. Stress, a poor bite, or bruxism can all cause TMJ pain (nightly grinding and clenching).
- Treatment for TMJ pain can range from a simple sleep guard, which costs between $200 and $600, to corrective jaw surgery, which can cost upwards of $50,000.
- Another important issue that will influence your treatment costs is your doctor’s training. Specialists are usually more expensive than general practitioners, and TMJ therapy is no exception.
Why does the cost of treatment vary so widely?
Non-invasive procedures are considerably less expensive than surgical treatments. Smaller cases of TMJ pain caused by stress and/or bruxism may be managed effectively with an occlusal guard and/or medicines. A low-dose antidepressant that relaxes the muscles in the jaw and aids sleep may also be beneficial to certain people.
In more extreme situations, corrective jaw surgery and full mouth reconstruction may be required. TMJ discomfort can be caused by anatomical issues such as a poor bite. This may necessitate jaw surgery or orthodontic treatment.
What payment options are available?
Every office has its unique financial policy, so it’s vital to talk about it with them before starting treatment. You may be able to take advantage of in-house financing, or they may employ a third-party financing firm like CareCredit.
It’s worth checking your medical and dental insurance policies to determine whether they’ll cover anything. If you need jaw surgery, medical insurance might come in helpful.
Treatment for TMJ is an excellent investment in your overall health and quality of life. You may find yourself compromising to avoid discomfort if you don’t get therapy. Patients who have TMJ pain, clicking or popping at the joint, headaches, or earaches can benefit from a TMJ evaluation with their dentist.
The expense of your treatment may seem prohibitive, but your doctor may be able to work out a payment plan that works for you. Do not go untreated; at the very least, consult with your doctor about your choices.
Is TMJ an orthopedic condition?
Orthopedics is the discipline of medicine/surgery that deals with acute, chronic, traumatic, overuse, and other musculoskeletal injuries and illnesses. All of the same traumatic injuries and pathologic disorders affect the temporomandibular joint (TMJ) as they do any other bodily joint. As with those joints, TMJ and associated structures issues should be treated as a whole “Not only does it include articulating bones, discs, and cartilage, but it also has all of the other components that give it shape and allow it to operate. It is not only nonsensical, but also anatomically naive, to claim that the TMJ is unique among all other bodily joints.
The necessity of addressing all of the anatomical and functional intricacies of the TMJ within any therapeutic scheme is emphasized by the novel paradigms developed and validated for muscle pain1, neuroplasticity and central sensitization2, and pain genomics3.
Most disorders in medicine are managed rather than cured – consider diabetes, hypertension, and other conditions. Unfortunately, our dentistry education frequently teaches us that dental-related problems are curable (i.e., if there is decay on a tooth, it can be removed and replaced with a restoration, the tooth is cured). The same can be said about removing a non-restorable or periodontally compromised tooth… and so on).
The “cure” concept may induce dental professionals to believe that because temporomandibular joint disorders (TMD) are all mechanical and “dentally related,” they, too, may be treated “I have been cured.” This erroneous belief usually leads to irreversible, sometimes severe, and often unscientific consequences “options for treatment” The myriad indications and symptoms frequently associated with TMD make any practitioner’s job difficult “treat” all of them! As a result, in TMD, the key word is “management,” not “therapy.”
Despite its location in the anatomy, the TMJ articulation follows the same physical and anatomical kinematic rules as all other joints in the body. Occlusion as a cause of TMD has been debunked, with the presence of distorted ectodermal structures (tooth) associations with TMD being disproven. 4
It is now well recognized, based on imaging studies of normal TMJs, that the function of the TMJ disc is more significant than its position. Internal derangement does not cause progressive TMJ degeneration as previously thought. 57
Misguided beliefs in the past frequently led to the belief that “To avoid internal derangement problems from advancing to degenerative joint disease, treatment is required.”
8 In reality, TMD has been labeled as a self-limiting or non-progressive illness for years.
9 We now know that patients with TMD can “improve” over time without any “therapy.”
10,11
Furthermore, if TMD is a chronic, progressive, non-self-limiting illness, one would anticipate its prevalence to rise with age in the population. However, the data clearly shows that the total prevalence of TMD pain, which peaked in women during their reproductive years, has dropped to 12 percent.
So, why is there even a debate? Mohl and Ohrbach13 offer some perspective. The following are their recommendations: (1) lack of objective scientifically derived clinical evidence no good Random Clinical Trials; (2) failure to effectively communicate existing evidence to the profession practitioners don’t read the literature; (3) failure to use well-communicated scientific evidence if we read it, we must use it; (4) reliance on clinical trial and error rather than the scientific method; (5) over-reliance on subjective reports of clinical success too anxious for the magi
A mechanistic, restricted approach (e.g., occlusion, TMJ disc position) has been found to create iatrogenic harm throughout the last 150 years in the diagnosis and management of chronic orofacial pain disorders (i.e., unnecessary equilibrations, extractions, restorations, TMJ surgery, etc).
2
TMD “tunnel vision” can lead to misdiagnosis of potentially more significant conditions that resemble TMD pain distribution or jaw opening limitation, perhaps leading to needless “treatments” or other serious misdiagnosed repercussions for the patient.
The takeaway is that until practitioners and researchers adopt an orthopedic mindset of TMD management rather than a mechanical one, there will be no progress “TMD will remain a mystery in the future, notwithstanding past “cure” efforts.
When is TMJ surgery needed?
- When you open or close your mouth, you experience continuous, acute pain or soreness.
- Even with rest or other nonsurgical therapies, your discomfort or immobility gets worse.
- You have particular structural issues or disorders in your jaw joint that have been proven radiologically through imaging, such as an MRI.
- Your TMJ problems aren’t as bad as they seem. If your jaw makes a clicking or popping sound when you open it but no pain, you may not need surgery.
- Your signs and symptoms aren’t always the same. It’s possible that you’ll experience severe, agonizing symptoms one day and then none the next. This could be the result of TMJ exhaustion induced by repetitive motions or usage, such as talking more than normal on a particular day, chewing a lot of difficult food, or chewing gum constantly. Your healthcare practitioner may advise you to rest your jaw for a few hours or days in this scenario.
- You can fully open and close your jaw. Even if you have discomfort or tenderness when opening or closing your mouth, your doctor may not prescribe surgery due to the dangers. Instead of medicine, physical therapy, or lifestyle changes, they may recommend medication, physical therapy, or lifestyle modifications to alleviate symptoms.
It’s critical to seek treatment from a TMD-trained dentist or oral surgeon.
To evaluate if surgery will be beneficial for your problems, they will do a complete assessment of your symptomatic history, clinical presentation, and radiological results. If nonsurgical options have failed, surgery is considered a last resort.
What can be mistaken for TMJ?
You have two trigeminal nerves that govern your jaw, just like you have two temporomandibular joints on each side of your face. It’s simple to see why TMJ problem is frequently misdiagnosed as nerve dysfunction. Irritation of the trigeminal nerves causes intense pain in the face, teeth, and around the ear, as well as numbness or tingling on one side of the face. Trigeminal neuralgia pain, unlike TMJ discomfort, is characterized by a sensation of electric shock.
What will happen if TMJ is not treated?
TMJ Disorder (Temporomandibular Joint Disorder) is a disorder characterized by misalignment and/or tension of the joints, muscles, and teeth. This can cause pain in the joint itself, as well as in the facial muscles and teeth. TMJ problem can be caused by a variety of reasons, including a misaligned bite, tooth grinding or clenching, osteoarthritis, or trauma and injury. TMJ dysfunction, while not life threatening, can cause substantial discomfort and tension if left untreated. Chronic pain can even contribute to mental illnesses such as anxiety and despair.
Is TMJ serious?
Many of our Nashville, TN, patients wonder, “Is TMJ condition serious?” after receiving a diagnosis of temporomandibular joint disease (TMD). The answer is that, while the illness is not life-threatening, it can have serious consequences for your oral and general health. These joints, which are supported by a system of muscles and ligaments, allow your jaw to move. TMD can cause pain, ringing in the ears, and chewing issues when it is out of equilibrium. TMD side symptoms can intensify if left untreated. Effective therapy is the greatest method to avoid the unpleasant and harmful effects of TMD.
Will TMJ go away on its own?
TMJ discomfort that isn’t severe normally goes away on its own. Anyone with the following TMJ symptoms, on the other hand, should consider getting an evaluation to prevent or avoid future problems: Pain or soreness at the TMJ or in and around the ear on a regular or repetitive basis. When chewing, there is discomfort or agony.
How do you permanently cure TMJ?
Splints manufactured to fit over your lower or upper teeth are custom-made. These splints keep you from clenching or grinding your teeth by acting as a cushion between your teeth. This gives the temporomandibular joint enough rest and allows it to heal without too much difficulty.
If the pain goes away, don’t stop wearing the splints right away. Use it for another two or three days to help the joint heal completely. Live on a delicate diet for a few more days before returning to your regular routines to avoid tension on the restored joint!