There is a huge, specific untapped market of patients in need of the benefits of chiropractic treatment. These patients suffer from headaches, neck pain, dizziness, tinnitus and numerous other symptoms doctors of chiropractic frequently alleviate, and yet the vast majority of these people never see a chiropractor. Why?
These patients have been diagnosed with or told they have a temporomandibular disorder (TMD), and many of them seek treatment from dentists, oral surgeons and medical practitioners who are unlikely to refer them to DCs. The National Institute of Dental and Craniofacial Research estimates that 10 million people in the United States seek treatment for TMD each year. This number may represent only a fraction of the people who are told or come to suspect that their symptoms come from TMD.
Reaching into this market effectively will accomplish two goals simultaneously. Your chiropractic patient base will increase, and these patients will be afforded the benefit of chiropractic care they otherwise would not have had.
One of the reasons the chiropractic profession as a whole has not aggressively reached out to the TMD population is the misconception that TMD is a dental-only disorder. This is, quite simply, not true. Temporomandibular disorders are a sub-classification of musculoskeletal disorders, and, as such, fall within the scope of chiropractic care.
Studies in publications such as the Journal of Manipulative and Physiological Therapeutics and the Journal of Craniomandibular Practice have shown that chiropractic treatment, including spinal manipulation, physiotherapy, home-care instruction and cranio-sacral therapy, can successfully reduce TMD symptoms.
In short, chiropractic care will benefit these patients. That is not to say that the doctor of chiropractic will be the sole answer to what may well be a multi-factorial disorder. Chiropractors should, however, always be part of the treatment team. There are many proposed etiologies for TMD, including whiplash, bruxism, postural faults, cranial distortions and malocclusion. While ongoing research implicates many influences on dysfunction in the region, the treatment model remains the same. That is, examine the region, identify any dysfunction, treat within your scope of practice and refer to co-treaters as indicated. This is clearly the chiropractic model for musculoskeletal disorders, so why not for TMD?
As a profession, chiropractic has much to offer the population of TMD sufferers. This always includes the overall benefit of chiropractic care, and, specific to their local TMD complaints, benefits can range from effective diagnosis and referral to effective treatment. The key here is that by including specific examination of the region, you can open the door to chiropractic care for these patients – whether you treat the region specifically or not. If we want to effectively expand our influence in this huge market as a profession, specific treatment of this region will remain an option, but examination of the region will become routine.
Symptoms perceived to come from TMD can range from head, neck and jaw symptoms, which have nothing at all to do with cranio-mandibular tissues (e.g. pain referral from the neck and shoulder region), to profound derangements of the temporomandibular joints. The doctor of chiropractic is potentially the practitioner best-suited to identify the most probable symptom pathway. This would only require adding a thorough examination of the cranio-mandibular region to an already thorough musculoskeletal work-up. This is a valuable skill and easily incorporated into the existing diagnostic work-up.
While treatment of specific cranio-mandibular disorders remains optional in this model, many treatment options are available, and new tools are emerging. These billable treatments include physiotherapy, home-care instruction, nutritional support, TMJ manipulation, cranial adjustments, TMJ mobilization devices and distraction/bruxism orthotics.
There are a number of efforts currently under way that aim to increase public awareness about the potential benefits of chiropractic for the TMD patient, and there is a federally funded study in progress demonstrating the efficacy of chiropractic in this field.
All of these factors combine to create a great opportunity for the profession to spread into the lives of millions of people who could benefit from chiropractic care. The equation is simple. There are millions of TMD sufferers. These TMD sufferers need chiropractic care, whether for the TMD specifically or for other health issues.
All patients with head and neck symptoms deserve a thorough TMD exam, and this TMD exam should be included in every chiropractic work-up. If indicated by exam, you may opt to include treatment of the local cranio-mandibular region with your standard chiropractic care, and/or refer the patient for specific TMD co-treatment.
Reaching the Market
Once you decide you want to treat TMD in your practice, you need to get the word out about what you’re doing.
Here are some simple suggestions to bring more TMD business to your office:
- Every time you help patients with their low back, wrist, shoulder, etc., tell them about a patient with a TMD problem who improved in your care, and share your excitement about the success story. This works for any area of interest, by the way (e.g. neck, low back, etc.). If you are treating the patient for neck pain, he or she already knows you can help a friend or family member with that same problem. So spend your time telling the patient about something else you can treat.
- Post a flyer in your office, stating a simple message such as: “IF YOU HAVE TMJ, TMD OR MYOFASCIAL PAIN DISORDER, PLEASE TELL THE DOCTOR, AND IF YOU KNOW OTHERS WHO SUFFER FROM THIS PROBLEM, HAVE THEM CALL US!” (You may want to use “alternative,” inclusive terms such as “myofascial pain disorder” or “TMJ” when referring to your TMD treatment, because many patients recognize their condition by different names/buzz words.)
- Simply include the terms TMD, TMJ and/or myofascial pain disorder in any print, broadcast, or direct mail advertising you do.
- If you have a personal injury practice, let attorneys know you perform a thorough TMD exam and document your findings well. They don’t really care if you treat TMD, just that you would recognize, document and refer the case appropriately and that you would keep them informed.
- If you treat, as well as diagnose, TMD, you should educate dentists and other TMD providers in your area about the benefits associated with referrals to your office. These doctors will either be open to the suggestion or they won’t be. Don’t waste time trying to convince them if they’re not. If you become proficient with your TMD exams, you will eventually become the portal of entry doctor of choice for TMD in your area, and the patients will come looking for you.
The population of TMD sufferers is huge, and many of these patients could benefit from chiropractic care. You can expand your practice by reaching out to this market. TMD need not be a mystery; a little education can go a long way toward filling your practice with these patients.