Please read this whole section before you click the link to complete our online questionnaire. Your information will be secure and reviewed by Dr. Scott.
To complete the questionnaire, please work from a 12” diagonal screen or larger; use a keyboard that you like to use; and have a mouse for dragging graphic elements. Dr. Scott needs details before we can schedule the consultation appointment. Having a complete medical history and details of the current problem documented in the questionnaire will make the consultation more productive and interactive.
In thinking about your medical history and your current symptoms, keep in mind that these problems are usually slow to develop. You may have had symptoms that you did not think were related.
Ear pain, for instance, is very often associated with inflammation in the TM-joints. The jaw joints are also just behind the eyes, below the sinuses, above the throat and behind a major nerve bundle of the head and neck. As jaw joint inflammation builds-up slowly, it can cause a variety of chronic symptoms.
The symptom checklist may seem overly broad. Some issues may seem unrelated to the jaw joints. In any case, check any of the listed problems from your past and any that you have today. Check all that apply to you.
The TMJ's are the most active joints in the body in terms of movements per day. Twelve sets of muscles move and position the lower jaw. The muscles extend to the top of the head down the neck to the shoulders. Nearly any muscle in the face, head, neck, and shoulders may have pain and tension related to the TMJ. TM-joint issues are strongly associated with muscle pain.
We also have many questions about accidents and head trauma. We repeat questions because accidents are easy to forget and are often minimized. We ask that you read each question and take your time. Review your past by decade, by addresses, by schools and job. Include minor childhood accidents, falls, strikes to the jaw or face or bruising or stitches on your upper body. If you clench or grind your teeth, when did that start? If you later remember an incident, let us know so we can update our records.
Page ten of the questionnaire is very helpful for Dr. Scott to understand your symptoms. Patients often have a variety of aches and pains in the upper body.
Use page 10 to show any pain you have in the upper body.
Page ten allows you to show us not only where it hurts; but how large an area hurts and the type of pain, for instance, the letter "S" for “sharp," pain and the intensity of pain by your choice of colors from mild to severe.
Page ten will take extra time so plan on slowing down to figure it out. Read the short instructions and then play around dropping any items anywhere to see how things work and look on the screen.
All you do is repeat three steps:
1. Select an item by clicking it once and RELEASE the mouse button. The item is attached to the mouse pointer on the screen.
2. Move the mouse pointer and attached item over the person outline and the spot where you want to place it.
3. Click the mouse button once and RELEASE the button to drop the item on the person outline. Use “Undo” if you don’t like the position.
You will repeat these three steps as many times as you need.
Note the color blocks show pain intensity, the location of pain, and the total area of pain. Drop as many color blocks as needed to show the entire area of a particular pain. Rember to drop a few letters near the colors to indicate the type of pain, for instance, place a letter “P” for pressure.
As you play and practice, imagine how you will show particular pains to tell your story. When you are comfortable with the page, either click "undo” multiple times or click “clear page” once and then you can start with a clean page.
If you cannot make page 10 work for you, draw a diagram similar to the one on the screen and bring it with you to the consultation.
Go back to any page in the form to make additions or changes. Feel free to enter any text in any text box. We will move it around as needed. When you are satisfied with the entire questionnaire, go to page 11, and keep clicking until you click, "Submit Form."
After you get started, if you decide not to complete the form, close the tab or the browser. No information is kept or saved on your computer or tablet. No information is sent to Dr. Scott until you submit it by clicking, “Send Form” on page 11.
Completing your patient history in detail is important. Dr. Scott will be oriented to your story before you meet, and she will be ready to ask specific questions. The time you spend on this form will give you more time to ask questions and to have a discussion during the consultation. Plan to spend an hour on the questionnaire when you will not be interrupted. After Dr. Scott has reviewed your medical questionnaire, we will contact you to schedule within one week.
SOME ADDITIONAL THOUGHTS:
Prescription pain medication is not a solution. In a few cases, Dr. Scott may prescribe, but only with the patient already in treatment. Our office rarely prescribes pain medication.
Dental restorations and orthodontics alone are not usually considered a place to start treating TM-joint problems.
TMJ treatment has two phases. Phase One goals are jaw joint-related and include achieving a near-normal range of jaw motion; smooth and straight jaw motion; resolution of jaw and joint-related pain or significant pain reduction that is continuing to improve; a repeatable bite onto the splint, in other words, the same teeth make the first contact every time you touch your teeth to the splint and no adjustment is needed to splint for three or four months. These benchmarks are for the completion of phase one.
In Phase Two, we want to resolve the causes of the problems in some cases and the problems that were caused by ongoing TMJ issues. This may include having some adjustments to some tooth positions so that you will have a good natural bite. A good bite protects your teeth and TM-joints at the same time. You may need to learn to use the tongue more effectively for swallowing and as the natural source of facial support with the tongue pressed upward against the upper palate. Proper posture of the tongue also stimulates sinus health. Airway issues may need to be addressed in phase two. The goal is not to need or use a splint at all; to have the ease and good health that comes from a complete plan of care.
Notes about TMJ Rehabilitation with Dr. Scott:
Phase one may take 4 to 8 months. It is a complex process for Dr. Scott, but not for you, the patient. Patients wear a custom orthotic device that might be a splint or a device that provides a similar type of support. This is a minimally invasive treatment. It just requires time for the joints to adapt.
TMD or TMJ problems are not a diagnosis. TMD is a wide range of problems. Every patient is unique, but Dr. Scott adjusts the plan to fit the patient. Rehabilitation is individualized medicine that provides the right support at the right time and in the right sequence to allow rehabilitation to start and progress to a natural conclusion where the body can again keep up with ongoing adaptations as needed.
Referrals to specialized treatment providers will be needed in phase two. For instance, we recommend "OMT of Nashville.com," Alison Savic, for help with tongue function.
Although not invasive, the process to rehabilitate the jaw joints involves several systems in the upper body that only work well when working together.
Dr. Scott’s Standards of Care:
Provide a medically sound workup and treatment based on a specific diagnosis. Generally, we provide orthopedic support by using the teeth to support a temporary orthotic. We use the orthotic to create a temporary perfect bite by adjusting the orthotic. Over time the orthotic is adjusted again and again to maintain a perfectly balanced and timed bite simulation.
By maintaining this simulated perfect bite, the patient’s muscles relax and stop bracing. The joints are free to let the bones find their best alignment and adapt in a healthy fashion. We reestablish a functional set of jaw joints that work together with the jaw muscles and the other features of the chewing system and interrelated systems including our breathing system, the way we sleep, speak and sing.
We are not part of an organized medical or dental specialty because there is not one that addresses the jaw joints. We are a part of and support the standards established by the American Academy of Gnathologic Orthopedics (AAGO.com) and the American Dental Association (ADA.)
Although TM-joint rehabilitation is covered by medical insurance, it is not covered very well. Without an organized specialty, we cannot negotiate insurance coverage. We can provide detailed, printed medical receipts that you can send to your medical insurer for possible reimbursement if you have out-of-network benefits. The problem is in meeting the deductible for out-of-network coverage, which is usually twice the in-network deductible. You can apply for in-network coverage, but, at best, you can expect 20% to 25% reimbursement, and this will delay your treatment.
Medical receipts can also be used for tax deductions if you have significant other medical expenses that year.
The only in-network doctors for the TM-Joint are oral surgeons. However, very few oral surgeons actually provide a point of entry for TM-joint care except in cases of acute trauma.
As part of phase two, a surgical procedure can sometimes be helpful. Oral surgeons appreciate having patients who have completed phase one where the jaw joints are well adapted and the muscles are calm.
In today’s world, we have great opportunities to provide coordinated care. It takes a team of doctors and healthcare providers who will work together to address the needs of the patient. Dr. Scott refers and coordinates specialized care for patients when needed.