TMJ: BENEFITS OF X-RAY AND ULTRASOUND GUIDED STEROID INJECTION

The Temporomandibular Joint (TMJ) acts like a sliding hinge that connects the jawbone to the skull. The bones intersecting with the joint are covered with cartilage, separated by a small disk, which acts as a ‘shock-absorber’ to keep the jaw moving smoothly.

Since these mechanisms are quite fragile, TMJ ‘disorders’ are common. They can include the disk eroding or moving out of alignment, cartilage degeneration (e.g. from arthritis) or the joint being damaged by impact.

TMJ disorders can be very debilitating, often causing pain/tenderness in the jaw/joint, aching pain in/around the ear, difficulty/pain/’clicking’ while chewing, facial aches/pains, locking of the joint and difficulty closing the mouth.

In many cases, symptoms are temporary and can be self-managed. However, it is important for patients to seek medical advice when pain or tenderness persists.

If your patients experience symptoms consistent with a TMJ disorder, it is important to confirm this diagnosis and/or rule out other conditions.

It is also important to determine the root cause, in order to recommend a referral/treatment pathway. Common causes include genetic factors, arthritis, injury to the jaw and clenching or grinding of the teeth (bruxism). However, it can be difficult to confirm causation.

The most accurate diagnostic tool is x-ray.

You may be surprised to know that Dentists, Orthodontists, Prosthodontists, Endodontists and Pedeodontists are able to refer for x-ray to the arms, hands, feet, legs, spine, chest and abdomen – not just the face and skull. Additionally, Oral/Maxillofacial Surgeons are also able to refer for certain CT scans, ultrasounds and interventional injections throughout the body.

This may seem strange, for Dentists to be referring for diagnostic imaging so far away from the mouth!

While it’s important to avoid over-referral for any testing/treatment involving radiology, there are benefits of looking SLIGHTLY ‘outside the box’.

Since pain is subjective, it is important (and often difficult) to determine where the problem actually originates from and if it is being referred from another area.

For example, a patient presenting with pain near the jaw may simply have bruxism; or they could have a nerve entrapment in their shoulder, with the pain referring to their jaw. Although the symptoms may appear similar on face value, the referral and treatment pathways for each condition would be very different.

If the x-ray results of the jaw area are clear, the patient may need to be referred for a nerve conduction study to confirm/rule out a nerve entrapment in their shoulder, neck or even wrist. They may then need to undergo physiotherapy treatment.

Whereas, if the x-ray showed erosion of the molars, the patient may need to be referred to an ENT specialist to confirm/rule out a diagnosis of bruxus. They may then be referred to an Orthodontist to have a mouth guard fitted for sleeping.

Accurate diagnostic imaging helps to ensure assumptions are not made. There is nothing worse than a patient undergoing the wrong course of treatment – leaving them out of pocket and with unresolved pain.

Where a TMJ diagnosis has been confirmed, the pain is chronic and the symptoms are not relieved through traditional treatment pathways, it might be worth directing your patient back to their GP to ask about getting a referral for Ultrasound Guided Steroid Injection.

This can be beneficial for a number of reasons.

Firstly, if the site of injury has been confirmed, the patient has received pain relief via steroid injection and they continue to experience pain, this indicates that there may be secondary underlying issue that requires addressing.

Secondly, ultrasound injections can provide pain relief, reduce inflammation and improve quality of life while patients wait for the injury to resolve or await surgery.

Once we have a referral which meets Medicare criteria, we can provide your patients with a prompt appointment, which we will bulk-bill (even without a Health Care or Pension Concession Card) for x-ray (injections attract a small, competitive gap fee).

Simply visit www.irisimaging.net.au for more information or contact one of our clinics:

Helensvale:

P: 07 5573 3580
E: Helensvale@irisimaging.net.au

Mount Tamborine:

P: 07 5689 3900
E: tamborine@irisimaging.net.au

Browns Plains:

P: 07 3800 4766
E: brownsplains@irisimaging.net.au