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Case Study Using the TMJ Scale in a Sports Injury

Posted by Steve Levitt Medical Doctor

Case Study: Sports Injury

Example of the role the TMJ Scale can play in evaluation and treatment.

An 18 year old male suffered a facial injury during a basketball game. Shortly after the injury he could not open his left jaw joint and had pain on both sides of his jaw, pain in his ear, and headaches. He completed a TMJ Scale to screen for the presence of a TMJ disorder. This test detects and measures physical symptom severity including pain, palpation pain, perceived malocclusion, joint dysfunction and range of motion limitation. It also screens for elevated levels of emotional distress, stress, chronicity and the presence of non-TMJ disorders that can complicate diagnosis and treatment.
The test results indicated that he probably had a TMJ disorder, with overall symptom intensity worse than 65% of TMJ disorder patients. The report indicated that he had temporomandibular joint pain, TM joint dysfunction, and limited jaw opening ability. The Non-TM scale score which screens for other non-TMJ disorder problems, was not above average. Also, his score on the Stress Scale was not elevated. He saw a local dentist who specializes in treatment of TMJ disorders and who prepared a soft splint. He wore this splint over his bottom teeth for five months. After that time he only wore the splint during sporting events, as directed by the dentist.

After five months the patient was asked to take another TMJ Scale by his dentist. The second report, according to the dentist, "displays the dramatic improvement reported by the patient." His percentile rank on the Global Scale, which measures the overall symptom intensity of a TMJ disorder, fell from 65% before treament to 8%, and all of the other scale scores were no longer elevated. The dentist also reported that the TMJ Scale demonstrated that treatment had been successful and "provided data to both the patient and insurers that Maximum Medical Improvement had been attained."

(This Case Study was published by: Steed, P.A., Clinical Application of Psychometric Analysis for Temporomandibular Dysfunction. The Functional Orthodontist, 13:32-39, Fall 1996.

To learn more about the TMJ Scale and the patient self-test click
Comments (3)
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Comment: Maximum Medical Improvement cannot be established based on TMJ Scale alone. MMI is a legal term and it states that there would be no more "improvements" of patient's TMJ symptoms and this is the time to quantify the patient's impairment.

Albert Davydov, DDS  

A TMJ Scale can be used, as I think, as a matter of medical history of a current disorder, and a basis of a referral to a psychologist, if there is an indication of high level of stress.

 I do not know how this test can be objectively used in order to measure the patient's impairment rating. TMJ Scale is the patient's subjective response to the things he / she feels having.

This is the doctor's role how to identify and show the patient's objective finding to show others, in case if questions arise, with the help of acceptable measurable objective tools. 

I studied AMA Guides 6th Edition for Impairment, and have used TMJ Scale extensively for my TMD patients. Measures taken from TMJ Scale and its connectoin to MMI based on the 6th Edition of AMA I believe is merely fractionable, and to use is as a solo tool to measure the total bodily functions impairment is incorrect.

Albert Davydov, DDS  

The TMJ Scale is not suggested to be used "as a solo tool" but rather an an adjunct to the clinician's physical exam and evaluation.  It must be pointed out however, that this assessment tool is the only one currently available that provides a scientifically documented, highly reliable and most accurate quantitative measure of the patient's "symptoms."  Patients enter the healthcare system most often because of "symptoms." Measuring and quantifying a patient's "symptoms" is an essential part of the assessment process both before, during and after treatment.  This is also a crucial aspect of determining and documenting teatment outcome.  Even when all so called "objective" measures of dysfunction do not show abnormality, a patient may still experience "symptoms" , such as pain, that cause distress and that healthcare professionals must attend to.  Accurately measuring the presence, intensity and determining the 'clinical significance' of "symptoms" using the powerful psychometric techniques built into the TMJ Scale provides the clinician with a reliable yardstick to assess this aspect of a patient's problem.  Ignoring this as part of MMI is shortsighted at best.  Clinicians do not determine the presence or severity of symptoms.  Only patients can do that.  The TMJ Scale allows the patient's report of symptoms, and in particular physical symptoms (pain, palpation pain, joint dysfunction, range of motion limitation, and perceived malocclusion) to be scientifcally measured, quantified and reported on scales that allow "subjective" reporting by the patient to be "objectively" analyzed and used as reliable measures of dysfunction and, when used post-treament, of treatment impact.  I am not aware of any other widely accepted clinical instrument that accomplishes this task in as comprehensive a manner (i.e. measures both physical and psychological symptoms associated with "TMD") combined with this level of repeatedly studied and documented accuracy, 88-94%.  This level of accuracy is unmatched in this field and no "objective" measurement tool be it MRI, CAT Scan, X-ray, etc. is 100% accurate and without false positives and negatives.  The TMJ Scale has, for a quarter century, been repeatedly and thoroughly studied in numerous University and private clinic settings by some of the most highly respected TMJ Specialists and researchers in the U.S.  This is all documented in the clincian literature of this field.  It is now widely considered one of the most "acceptable measurable objective tools" in the field of TMD practice and research. 
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