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Insurance coverage for TMJ treatment

Posted on by smiles4u.

Is a TMJ specialist covered by my insurance?  — Marcus

Marcus,
When you’re in pain, it’s unfortunate that most of us have to worry about how cost will dictate a method of treatment, or if you even decide to get specialized treatment. If it was simple, we would all just be able to see who we want and be on the road to a pain free life. But, it’s not that simple.  And, if you have seen many TMJ “specialists” in the past, it’s important to remember that while those doctors may market themselves that way, there really is not a true, recognized TMJ specialty.

There are many types of recommended treatment. Conservative methods such as relaxation techniques, medications, or night guards are more common with many dentists and much more widely accepted when it comes to insurance (night guards are covered with a report by the dentist saying it’s for Bruxism, or grinding). On the other end of the spectrum, there are dentists who call themselves “neuromuscular dentists” (usually LVI trained) who skip the night guard all together and go for Transcutaneous electrical nerve stimulation (TENS) which uses a low-level electrical current to relax facial muscles in combination with an orthotic device to find the optimal position for your jaw, by detecting your malocclusion and then making a treatment plan to correct your bite. Plan to pay out of pocket a least a few thousand dollars for this because it is not a covered benefit. Then there is bite correction. Crowns, composites, and possibly orthodontics can be recommended for that. You’ll pay at least 50% of crown work and orthodontics, if you have coverage for that.

Always check your coverage before undergoing any TMJ treatment because most insurance plans do not have TMJ coverage. Paying more doesn’t always mean that you will get better results, so first try more conservative treatments and make some changes in your diet, exercise and stress relief. All those things can make a measurable difference and you definitely don’t need insurance for that.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.

Do I Need Full-Mouth Reconstruction to Fix My TMJ Disorder?

Posted on by smiles4u.

I was visiting my hygienist and we were chatting as usual. I happened to mention that I had been suffering from a lot of headaches over the past few months. I wasn’t looking for help with them, just talking.

Well, she goes and tells the dentist what I said and, next thing I know, he’s messing with my jaw. He said he feels certain that I have a TMJ disorder and that I need full-mouth reconstruction to fix it. I was beside myself. I’ve never even heard of something like that. Then, to make matters worse, the assistant brings me in an estimate and says my insurance probably won’t cover this so-called necessary treatment and that to cure my headaches, I’ll have to pony up more than I make in a year. It sounds like snake-oil to me. Is there any truth at all to this or is he just trying to make a quick buck? —  Monica in Alabama

Monica,
In all fairness, your hygienist has a responsibility to let the doctor know any medially-relevant information that you tell her, even if it’s only in conversation. In this respect, she was no-doubt looking out for your best interests. Moreover, headaches are indeed a symptom of TMJ disorders, so they were spot-on with that as well.

It doesn’t sound like they took the time to explain why you received the diagnosis, though. A TMJ disorder occurs when the temporomandibular joint isn’t working properly. That’s your jawbone. Most commonly, people begin to experience pain in the jawbone as a result of grinding or clenching. Sometimes they do it while they sleep, so they’re not even aware of their habit. Other times, people clench while agitated and don’t realize it. Malalignment can also cause issues, too. Any of these things can affect the wear on your teeth and cause pain throughout your mouth, jaw, head and neck. If left untreated, a lot of damage can be caused, and it becomes more difficult to manage.

Typically, a full-mouth reconstruction is needed when the problem has been on-going. Doctors usually try to treat TMJ disorders conservatively at first, perhaps with a bite splint to wear overnight. However, we also don’t know the root cause of your issue, nor do we know the extent of the damage, so it’s impossible to say whether full-mouth reconstruction is warranted.

Technically, there are no TMJ specialists. Nevertheless, you can find a dentist in your area who has spent extra time studying conditions related to it. If your treatment plan and estimate sound excessive, there’s a very good chance you’re right. Find another doctor who has the additional training and experience needed to provide you with a solid second opinion.

This post is sponsored by New Orleans cosmetic dentist Dr. Duane Delaune. Read more about why many consider Dr. Delaune to be the best dentist in New Orleans.