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Experts square off on TMD diagnosis, treatment

Las Vegas—Drs. Gary Klasser and Prabu Raman sat side by side on a stage in the Mandalay Bay Convention Center, but the two dentists could not have been farther apart.

IMAGE: At the forum: Drs. Gary Klasser and Prabu Raman
At the forum: Drs. Gary Klasser and Prabu Raman at the Oct. 12 Open Clinical and Science Forum. Photo by EZ Event Photography

They and four others formed an expert panel convened Oct. 12 to explore facts and opinions on the diagnosis and treatment of temporomandibular disorders in the second and final installment of the 2011 Open Clinical and Science Forums. The first forum met Oct. 11 and looked at the safety and effectiveness of dental restorations. (See Questions in pursuit of answers.)

Dr. Klasser, an associate professor in the Division of Diagnostic Sciences at Louisiana State University, questioned the value of devices advocates use to diagnose and treat TM disorders.

The devices in question, he said, fell into three categories according to what they were expected to measure:

  • surface electromyography;
  • sonography and vibratography for detecting sounds emanating from the joint;
  • jaw tracking.

Dr. Klasser questioned whether applying “an elaborate device” would yield a more reliable diagnosis or better patient care.

Dr. Raman, immediate past president of the International Association for Comprehensive Aesthetics, advocates the use of such devices as aids to diagnosis.

Picking up on the title of the afternoon’s program, he noted that certain devices are used in health care to gather facts—taking a blood pressure reading, for example, or monitoring the heart with an electrocardiogram.

Drawing on the facts gathered with such devices, a health care professional makes a diagnosis—he or she renders an opinion.

“Devices aid in diagnosis,” Dr. Raman insisted. “They don’t do the diagnosis; the clinician does.”

The danger, said Dr. Klasser, is that what these devices measure may not relate to the patient’s underlying problem. Jaw tracking measurements, for example, can “vary enormously” and yield false positives that can lead to overtreatment, he said.

Another panelist, Dr. Norman Thomas of the Las Vegas Institute of Advanced Dental Studies where he directs neuromuscular research, countered Dr. Klasser. “It’s important that we don’t over treat patients,” he agreed, “but it’s equally important that we don’t under treat them.”

Other panelists and some of the several hundred audience members weighed into this debate on one side or the other—with the exception of Dr. Jed Jacobson. Dr. Jacobson is chief science officer and a senior vice president, Delta Dental of Michigan, Ohio and Indiana. He was on hand to explain the insurance industry on TMD coverage and reimbursement.

“It’s a mess,” he freely admitted. “I know it is.”

The cost of TMD treatments range from $12,000 to $20,000 a year and are generally covered under the medical model, not in dental plans. Coverage levels vary from plan to plan, said Dr. Jacobson, and some insurers fail to recognize that “a joint is a joint,” whether it’s a knee, a hip or the TMJ.

As the time allotted to the discussion waned, one audience member spoke for many when he asked why a mere hour and a half had been scheduled for a forum on such a timely, controversial topic as TMD.