TMJ Mentoring for Medical Practitioners
Place photos of ear palpation here.
As primary medical providers won’t be treating the temporomandibular joint, they need to know when to refer patients with ear, jaw, or head pain. And if the referral should be to an ENT or a TMJ dentist.
This depends on the preliminary diagnosis, which can often be done by the primary care giver.
Earache must be differentiated from TMJ pain. After first evaluating the tympanic membrane, the TMJ should be palpated from within the ear canal, preferably using the little finger and pressing very firmly forward into the TMJ. This is done with the mandible at rest, while opening and closing, and with the teeth firmly clenched. If the TMJ has been referring pain to the ear, the patient will feel pain, especially while closing to the clenched position. This is an indication of TMJ synovitis, and the patient should be referred to a dentist qualified in TMJ diagnosis and treatment.
The TMJ evaluation should be done even if the tympanic membrane shows evidence of inflammation. Middle ear inflammation does not rule out TMJ disorder. A patient can have both simultaneously. If this is the case, the provider can begin ear therapy and also refer the patient for TMJ evaluation. If the tympanic membrane is normal, just refer to the dentist.
Headache, cervicalgia, shoulder, and upper back pain are commonly associated with or caused by TMJ arthralgia. If this patient is not responding positively to conservative therapy, the TMJ must be palpated, and if pain is elicited, referral to a TMJ dentist considered.
As an aside, I have seen scores of patients referred from ENTs, after the patients had been referred to the ENTs for ear pain when the primary medical provider could not find a cause for the ear pain. I have seen hundreds of patients that had been referred for neurologic evaluation for headache when the pain could not be relieved with usual headache therapy. Many of these patients had to undergo brain MRIs before a diagnosis of TMJ synovitis had finally been made. Some of these patients suffered for years, and had repeated MRIs every year or two. Their headaches finally subsided after TMJ splint therapy was begun.
Always considering the TMJs as a source of unremitting pain of the head or neck should be part of a differential diagnosis. Almost every case of TMJ-induced pain can be diagnosed simply and efficiently by palpating from the ear canal while the jaw is functioning. Except for acute recent trauma to the jaw, blah blah blah ….
TMJ Mentoring for Medical Providers