Doctor Visits - It’s All About You!

If you suffer from temporomandibular disorders,  it’s important to learn all you can about this condition. TMJ Disorders can take a long time to improve−weeks and even months.  Don't lose hope, and give conservative measures such as physical therapy, rest, heat and ice, time to work.  The National Institute of Dental and Craniofacial Research, and The TMJ Association recommend treatments that are conservative, reversible and noninvasive.

Unfortunately, TMJ Disorder treatments are based largely on beliefs that are not grounded in thorough scientific research.  Research shows many treatments do not help and may in fact do harm.  Healthcare professionals often have their own approaches or theories, which may or may not be right for you.  Sometimes, patients feel even worse when they leave the office than they did before their appointment.  You should consider seeing more than one doctor before making major decisions about treatments.

According to the National Institutes of Health brochure on TMJ Disorders, “Because there is no certified specialty for TMJ disorders in either dentistry or medicine, finding the right care can be difficult.  Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone and joints) and who is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice, particularly when pain continues over time and interferes with daily life”. Many TMJ patients see multiple health care professionals in their search for answers. This list includes primary care physicians, dentists, sleep specialists, ear, nose and throat specialists, neurologists, endocrinologists, rheumatologists, pain specialists and chiropractors.

As we learn more about the temporomandibular joint and its associated structures, many in the health care community are reassessing TMJ Disorder treatments and ways in which they were developed. Clearly, the various TMJ Disorders are far more complex than previously believed.

Here are some tips for visits with doctors, dentists, oral surgeons or any other health care professional.

Before You Go

• Learn all you can about TMJ Disorders by reading through The TMJ Association’s website,  and visiting the National Institutes of Health website section on TMJ Disorders.
• If possible, talk to others who have struggled with TMJ Disorders. Their experiences may give you insight and help you feel less alone.
• Remember that treatments should be conservative, reversible and noninvasive.
• Prepare a list of types of treatments you’ve received and your response to these treatments.
• Gather all your medical records and a list of your current mediations.
• When you are in pain, it can be hard to express how you feel. Ask someone you trust to help you prepare for the visit. This person can help you:
  • Determine what needs to be communicated to the doctor, and organize the information that will be shared with the doctor.
  • Discuss how to approach a topic. A pain-free person can be more objective and make sure the communications to the doctor are clear.
• When going to the doctor, it is in every patient’s best interest to always be accompanied by a person whom you trust and who will act as your advocate.

 At Your Visit

•  Ask to speak to your doctor in a regular office setting before the exam begins. Sitting in a dental chair, or on an examination table, can feel uncomfortable.
• Explain your situation simply and briefly. If possible, remain calm even though you may be in pain and fearful.
• Ask your doctor to explain any tests he or she wants to perform.
• Speak up for yourself. You can refuse any request, test or treatment that makes you uncomfortable or that you don’t understand.
• Make sure a compassionate family doctor is part of your treatment – aware of the suggested treatments, copied on all test results, and the physical exam.
• Learn about your health care professional’s expertise, approaches and type of practice.
• Explain any other health problems you have had. TMJ patients often suffer from conditions such as fibromyalgia, chronic headaches, irritable bowel syndrome, chronic fatigue syndrome, etc.
• Have your advocate take notes of the conversation, treatment plan, etc.

 Questions to Ask Before Consenting to Treatment

•  What is the purpose of the proposed treatment and why is it necessary in my case?
• Is the treatment reversible or irreversible?
• Will this treatment reduce my pain?
• What side effects or complications may I experience and what should be done about them?
• Are there other treatments available?
• What are the advantages of the proposed treatments over other forms of therapy with respect to benefits and risks?
• How many follow-up treatments will be necessary?
• How much will the proposed treatment cost?
• Will insurance cover the treatment costs?
• Is there a payment contract I must sign? (If so, ask to take the form home to review.)
• Is there a consent form I must sign for treatment? (If so, ask to take the form home to review.)
• If medication is recommended, the Agency for Healthcare and Quality Research suggests asking the following questions.
• Has the proposed treatment been studied in clinical trials* for safety and effectiveness?
• Is this treatment part of a clinical trial* and if so, what are my obligations and the conditions involved in participating in this trial?

 Throughout Your Treatment

•  Some people find it helpful to keep a diary of pain and other symptoms. A diary can help when you talk to your doctor.
• Write down your experiences.
• Pay attention to what makes you feel better or worse.
• Keep a record of what times of day you feel worse.
• Ask the people you live with to note changes in behavior or pain levels.  They may see things you miss.
•  If you have X-rays, MRIs or other test results, bring them with you to your appointments if possible. Your medical and dental records belong to you and you can ask for copies of these records.
• If medication is prescribed, be sure to ask about its side effects. Ask how the medication is supposed to help you.

 Tips for Talking to Your Doctor

•  Speak honestly and openly.
• Be clear about your pain and other problems.
• Don’t be afraid to discuss your pain and any urgency for pain relief.
• Ask questions if you don't understand.
• Ask about all treatment options.
• Ask your doctor to explain any treatments.
• You can say no to any test, treatment or request.
• Your health care professional’s job is to help you. Keep in mind that your doctor working for you. Make sure the visit focuses on you and your needs.
• Make your own choices about what steps to take.
• Get other opinions before making decisions.
• Be confident. If you feel uncomfortable with your doctor, change health care professionals.
• If fees seem excessive, you can ask about them and compare with other providers.
• If you think it will be a difficult discussion, ask someone you trust to accompany you to the office visit. This person can take notes, ask questions, make sure you have addressed all the points you wanted to make (sometimes during stressful office visits important things fall through the cracks). Even for routine visits it is always beneficial to have a second set of ears in the room.

 Additional Resources

 Agency for Healthcare Research and Quality
American Medical Association
Consumer Reports Health.org
Medline Plus
U.S. Department of Health and Human Services, WomensHealth.gov

* Clinical trials involve some risk on the part of the patient. Some treatments may have unforeseen side effects. By law, researchers are required to make sure volunteers understand what will happen during and after the trial, as well as the risks and benefits. The following are questions you should ask before agreeing to participate in a clinical trial:

• What makes me a candidate for the study?
• What are the risks?
• What is involved? What will I have to do?
• What checks and balances are in place to protect my safety?
• Will I be charged anything or be compensated for my participation?
• Who is paying for the study?
• How can I end my participation if I change my mind and will you continue to treat me?
• What will happen when the study is over? Will I be told the results?
• Whom do I contact to express concerns or obtain information?
• What do the researchers hope to learn?
• Who will have access to my medical information