How To Get Tmj Covered By Insurance

Q1. My husband, age 50, was recently diagnosed with periodontal disease and has just gotten a recommendation that all of his upper teeth and most of the lowers be replaced by dentures, as it looks like they cannot be saved. We're seeing a periodontist in a couple of weeks. What alternatives might be available to us?

— Beth, Washington

There are so many options available today that it would be difficult to explain them all. That said, I'll give you a brief overview that can help you get the discussion going with the periodontist.

First of all, there may be a possibility that some of the teeth your husband was told to remove can actually be saved. Periodontal surgery — including deep cleanings, bone grafting, and splinting and joining of teeth — can do a lot to help people keep their natural teeth when they have periodontal (gum) disease. To make this happen, though, your husband will need to adhere to a dental-care plan focused on improving his oral hygiene; deep cleanings will need to be performed and possibly periodontal surgery, including grafting bone that's been affected by periodontal disease. The good news is that some of his teeth — or perhaps even many of them — may be salvaged this way.

If it is determined that, in fact, some teeth cannot be saved, then I believe the best alternative would be dental implants. Dental implants are titanium screws that are inserted gently into the jawbone. The purpose of dental implants is to replace the root structures of the teeth that were removed. Then dental crowns, or tooth restoration materials, are built on top of those implants. If the dentist is able to place enough implants in your husband's mouth with proper biological engineering, then he or she can essentially restore the teeth that have been damaged due to periodontal disease. Dental implants are permanent (unlike dentures, which are removable).

Sometimes price becomes a very big issue with dental implants, though, and you may be able to afford only a few implants at a time. Also, sometimes the amount of healthy bone remaining in the mouth will be a factor in whether a patient can actually receive dental implants. The key is to see an excellent periodontist and have proper X-rays taken, including a regular set of dental X-rays, and possibly a three-dimensional X-ray, so that you can assess how much healthy bone is left, the status of the teeth that are there, how viable it is to save them, and whether implants should be placed using bone grafting. If none of these options is possible, my last recommendation would be dentures.

Q2. I have been diagnosed with localized severe chronic periodontitis and have opted for surgical therapy rather than having the tooth removed and getting an implant, as I hate the idea of losing a tooth. Have I made the right decision?

The right decision for any particular person and any particular location in the mouth depends on a good set of X-rays and a diagnosis by a competent dentist. In the case of localized periodontitis, you might also seek the advice of a periodontist in your area. There are many variables involved, and good judgment is the most important factor in weighing all options. If there is severe localized periodontitis, I always check the rest of the mouth to make sure the other areas are okay. One rarely gets periodontitis in only one spot.

Your dentist needs to collect some important information to help recommend the best method of treatment. This includes the amount of bone that is present; the length and width of the root of the tooth you are saving; the amount of looseness, or mobility, of the tooth; whether or not the tooth is in occlusion; what type of damage in terms of bone loss this tooth has caused to the adjacent teeth; and how much bone there is as far as its distance from the sinus on the upper jaw or the main nerve on the lower.

The options you were given are just a few things you must consider in deciding whether to remove a tooth or keep it. Removing the tooth may be the best option if there is already tremendous bone loss. If your dentist decides to keep this tooth via periodontal surgery (and probably bone grafting), you may not be eligible for any future implants in this area due to the possibility of further bone loss. On the other hand, being a periodontist, I do try to save teeth at all costs unless it is dangerous for the patient. This can be determined only by a competent dentist and/or periodontist.

In all fairness, implant therapy is a wonderful option, and I place many implants in my practice. It is important to try to save your natural teeth, but there comes a point when so much damage is being done to the bone around that tooth and the adjacent teeth that removing the tooth and inserting an implant makes more sense.

Q3. Do the symptoms of TMJ (or TMD) resemble or coincide with the symptoms and/or complications of multiple sclerosis (MS)? My dentist told me years ago that I had TMJ, but I couldn't afford the treatment (some kind of splint to put in my mouth). My insurance doesn't cover TMJ treatment. I've had MS for three years, but many years before that, I opened my mouth to bite into something, and my jaws had a really sharp pain. Then my jaw locked with my mouth wide open. It took several minutes before I could unlock my jaw and close my mouth — this is what prompted the TMJ diagnosis. Was my dentist right? Or could it have been an early sign of my MS?

— Juanita, Illinois

First of all, it is critical that you manage your multiple sclerosis (MS) under the advisement of an excellent neurologist who specializes in treating MS patients. I would definitely discuss this issue with that doctor since he or she would know more about your multiple sclerosis and how it might be influencing the jaw pain you feel.

I do know that it is possible for MS to attack various areas of the brain and spinal cord, and whichever nerve sheaths are attacked can then present symptoms related to that portion of the nerve. Multiple sclerosis can cause many different types of symptoms depending on where the nerves are attacked and what type of pain or numbness develops as a result. Is it certainly possible that multiple sclerosis could have attacked the nerves affecting the area where temporomandibular joint disease (TMJ) was diagnosed but for that part of your question I must defer you to your MS specialist. I suppose it is possible that your multiple sclerosis was mistaken for TMJ, though I do not know of any research that has come out about this.

The sharp pain you experienced upon opening your mouth, though, could very possibly have been unrelated to MS. Many people experience this symptom if they open their mouths too wide, and this can cause joint and musculature soreness for several days afterward. In your case, your jaw locked while it was open wide, which causes a lot of initial pain and sometimes some damage to the TM joint that can result in short- or long-term discomfort. I do not think that a locked jaw would be brought on by MS — this has more to do with your joint anatomy and the cartilage in between the bones of the joint. I would certainly have a dentist who is competent in TMJ evaluate you from a dental point of view and speak with your MS specialist. There is still so much to know about MS that I would never rule out a relationship, but I would start with the more probable causes first. The best thing you can do is to be carefully evaluated by a dentist and make sure that he and your MS specialist stay in contact with one another.

Q4. My jaw hurts when I open it wide, and this causes pain in my ear. Could I have TMJ?

— T, Oregon

The current term for TMJ is TMD, for temporomandibular disorders. And yes, while the pain you're experiencing could be caused by TMD, there are number of other conditions that can lead to jaw pain as well. These include:

Muscle spasms
Arthritic joints
Recent or previous trauma, like a blow from a fistfight
An accident, such as a car crash, bike fall, etc.
A long dental procedure in which the mouth was open for many hours
A wide yawn, causing a joint strain or crack
Grinding and clenching of teeth, particularly during sleep

To answer your question more definitively, I would need to know much more about your history. For example, how long has your jaw been hurting upon opening it wide, and do you recall any trauma or injury? If the pain started recently, and you can link it to one of the above situations, then your symptoms may not be due to TMD. If your pain is chronic and due to grinding and clenching for several years, then it may well be from TMD, and you should seek out a specialist who works with TMD patients. There are dentists who focus on this condition and have a flair for treating it.

A diagnostic workup is necessary to determine the underlying cause of your symptoms, involving a complete evaluation of your medical and dental history. Your dentist will look at your bite and the muscles that surround your jaw on opening, closing, and chewing, as well as at X-rays to visualize the joint. Once all these findings are taken into account, your dentist can determine if you really have TMD. If you do, there are a number of ways to treat it, including appliance therapy, moist heat, stress-reducing practices, bite adjustments, and orthodontics.

The most important factor now is to seek out the help of a qualified TMD dentist to eliminate or advise you on your possible TMD situation.

Learn more in the Everyday Health Dental Health Center.