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Medical Forum / General / Dentistry / December 2005A medical insurance glossary regarding "TMJ"
(Taken from Blue Shield of California glossary) Temporomandibular Joint (TMJ) Disorders. Disorders with any of the following characteristics: Pain in the musculature associated with the TMJ Internal derangements of the TMJ Arthritic problems with the TMJ Abnormal range of motion or limited range of motion of the TMJ. (The temporomandibular joint just ahead of the ear connects the mandible, or jawbone, to the temporal bone of the skull.) _______ Question: If a person has a problem with prosthetic TMJs (devices implanted to replace the natural TMJ), which of the above disorders and characteristics applies? The Webby In article <tmjiatroepidemic-948F8F.16425618122005@news-lb-02.socal.rr.com>, > (Taken from Blue Shield of California glossary) > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the [quoted text clipped - 15 lines] > > The Webby Or... If a person has a problem that relates to the Blue Shield glossary (above) with the natural anatomy , which of the above disorders and characteristics applies???? ... (B-63 Medical Treatment of the Teeth, Gums, or Jaw Joints and Jaw Bones Benefits) 3. medically necessary non-surgical treatment (e.g., splint and physical therapy) of Temporomandibular Joint Syndrome (TMJ); ........................ as well as items 1. - 6. ................. And we might *still* be wondering why people/patients/healthcare providers ***still*** call "it" TMJ. ......... The Webby >And we might *still* be wondering why people/patients/healthcare >providers ***still*** call "it" TMJ. ......... > >The Webby My youngest had a cat once that had a horrid cat box odor. I jokingly called him 'stinky' and the name just stuck. -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > >And we might *still* be wondering why people/patients/healthcare > >providers ***still*** call "it" TMJ. ......... [quoted text clipped - 9 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com It isn't really so different from a person saying "I have arthritis in my knee." and is then asked, "Which type of arthritis (disease) do you have?" In the case of the jaw, a person might say, "I have TMJ." If we want to know more, we might ask any of a number of questions. Here are a few possibilities: 1. What is the problem with your TMJ? (But then we've gone back to talking about anatomy rather than a disease) 2. What kind of TMJ do you have? (This is worse yet -- a well-behaved TMJ, a badly behaved TMJ, a healthy TMJ??? This is not a well worded question, IMO) 3. Is TMJ a disease? (Now we're getting somewhere) And, we have the story about how a cat got its name. With "TMJ", it's a stinky story too. Thanks for the story, W_B. You made an excellent point. Webby > > >And we might *still* be wondering why people/patients/healthcare > > >providers ***still*** call "it" TMJ. ......... [quoted text clipped - 26 lines] > > 3. Is TMJ a disease? (Now we're getting somewhere) 4) What color is your TMJ? Does the color change during the day? 5) HOW IMPORTANT IS YOUR TMJ CONDITION TO YOU? 6) Can you sing 'I Just Called...' and Tap Dance like you used to with your TMJ condition? (Notice I didn't call it a DISEASE or even a disease) To cure your TMJ condition: Thou shalt play Santana Abraxis backwards on the turn table while Thou shouldst eat raw potatoes. Thou shalt have faith: this treatment comes to Thou via the Alchemists. > And, we have the story about how a cat got its name. With "TMJ", it's a > stinky story too. > > Thanks for the story, W_B. You made an excellent point. > > Webby OK, I'll shut up now..... :-/ SP  SignatureTake out the TRAASH to reply > > > >And we might *still* be wondering why people/patients/healthcare > > > >providers ***still*** call "it" TMJ. ......... [quoted text clipped - 48 lines] > OK, I'll shut up now..... :-/ > SP SP took a fork in the road leading to very important matters: *Conditions* affecting the use of the TMJ in daily jaw function. For the purpose of this discussion, we can assume the word "condition" means: "an illness or other medical problem : a heart condition." (Dictionary v 1.0.1) If we use this definition, how does that affect our discussion? Example: An illness or other medical problem: a TMJ condition What is the medical problem you have with your TMJ? What is the illness you have with your TMJ? Our roadway seems to have turned into a round-about. We could find a way out and it is through experience coupled with aggressive yet cautious driving skills that will allow us to do so without incident. Webby > > > > >And we might *still* be wondering why people/patients/healthcare > > > > >providers ***still*** call "it" TMJ. ......... [quoted text clipped - 69 lines] > > Webby "Our roadway seems to have turned into a round-about. We could find a way out and it is through experience coupled with aggressive yet cautious driving skills that will allow us to do so without incident." Word of caution. My 1st experience with round-abouts ....was to get driven off the road by some angry English countrymen. We were driving from Oxford to Wales in a some sort of "mini" rental car (5 of us crammed in tightly). I was 20 yrs old and did not know what I was doing.... obviously. Everyone was honking and finally someone just drove me off the road. So I guess this may be an indication as to why I may not learn so quickly on Usenet forums either. Please be patient. Thank you, -Sue Apparently disease can be used in several connotations. My doctor explained that any condition is a disease translation dis ease. Does that make sense? Gail "Whamatus" <no_one@nowhere.net> > My youngest had a cat once that had a horrid cat box odor. > [quoted text clipped - 4 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com What's the BCBS code for stinky cat box? Our list ends on Zapping dogs. TIA carabelli >"Whamatus" <no_one@nowhere.net> >> My youngest had a cat once that had a horrid cat box odor. [quoted text clipped - 9 lines] > >carabelli HWA (hit with automobile) -- Whamatus Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > In article > <tmjiatroepidemic-948F8F.16425618122005@news-lb-02.socal.rr.com>, [quoted text clipped - 36 lines] > > The Webby Based upon 20 years in the medical device field: If the device therapy did not cure the TMJ symptoms, then a person is still afflicted with "TMJ syndrome." This diagnosis terminology still applies IMO. Take for example: -If a person had a mitral valve replaced and later re-developed mitral valve prolapse... the condition would still be called "mitral valve prolapse" .... whether associated with a native or a prosthetic valve. It is not called "prosthetic mitral valve prolapse" -If a person with coronary artery disease has stents placed, the person still has CAD. It is not called "coronary stent disease." Webby, please explain your position on "TMJ syndrome" diagnosis terminology a bit more. I sense you have studied this long and hard and can elaborate much more. Do you believe that much more than the TMJ is involved in this syndrome? Thank you, -Sue PS If additional problems (beyond TMJ symptoms) were experienced following device therapy, these would be considered device complications and/or adverse events that may or may not be associated with the device itself (in our business, anyway). > (Taken from Blue Shield of California glossary) > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the > following characteristics: Just thought you would like to know how thoroughly you have lost one tiny war over language. ;-) I was in an endo office (long story) last Friday filling out one of those typical "new patient" information forms. It asked the usual list of possible conditions with the typical Yes/No box next to each each. It had high blood pressure, heart problems, TMJ, diabetes... I immediately thought of Webby. I am sure that the receptionist was wondering why that guy who was so recently sentenced to see the Endo was grinning. I marked "No", knowing that was the answer they were expecting. Vaughn In article <poopf.310792$zb5.131343@bgtnsc04-news.ops.worldnet.att.net>, > > (Taken from Blue Shield of California glossary) > > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the [quoted text clipped - 13 lines] > > Vaughn My friend, ... how useful our usenet war over language has been ... Thank you for this feedback ... and I think I should be sorry to know that you were in "an endo office" ;-) hmmm. Be well and then I can :-)))) Your friend on the opposite coast, Webby In article <tmjiatroepidemic-D9B57F.17593818122005@news-lb-02.socal.rr.com>, > In article > <poopf.310792$zb5.131343@bgtnsc04-news.ops.worldnet.att.net>, [quoted text clipped - 25 lines] > Your friend on the opposite coast, > Webby It's a long way between Washington and New Jersey! Webby > (Taken from Blue Shield of California glossary) > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the [quoted text clipped - 15 lines] > > The Webby Question: If a person has a problem with prosthetic TMJs (devices implanted to replace the natural TMJ), which of the above disorders and characteristics applies? Webby, "Pain in the musculature associated with the TMJ" - applies, IMO As for the other characteristics, one must ask whether the natural TMJ was completely removed..... If yes, then: "Internal derangements of the TMJ" - would not apply If no, then: "Internal derangements of the TMJ" - may apply If yes, then: "Arthritic problems with the TMJ" - would not apply If no, then: "Arthritic problems with the TMJ" - may apply If yes, then: "Abnormal range of motion or limited range of motion of the TMJ" - may apply (with good legal representation) If no, then: "Abnormal range of motion or limited range of motion of the TMJ" - may apply (with good legal representation) Just a guess, -Sue > > (Taken from Blue Shield of California glossary) > > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the [quoted text clipped - 41 lines] > > -Sue Sue, I'm not sure what you mean by "(with good legal representation)" I can't respond until I understand what you meant. Webby > > > (Taken from Blue Shield of California glossary) > > > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the [quoted text clipped - 46 lines] > I can't respond until I understand what you meant. > Webby Hi Webby, Your post came out after I made my last post about TMJ syndrome terminology, otherwise I would have answered before moving on. I will try to explain. First off, I am only conjecturing. I do not know the true legalities involved or why you started this thread. Maybe you started this thread for conversation only, or maybe for legal advice.. or maybe far some other reason. I am not sure, but it sounded intersting ot me, so I looked at it. When I made my answer, I was guessing that you may have encountered a hassle with the insurance company (covering expenses incurred for symptomatic problems associated a the device therapy)... but I am not sure. ************************************************************************************** Re: legal representation. I was thinking that a good lawyer could help sway the interpretation of this characteristic either way, with verfication from the proper medical professionals of course. "Abnormal range of motion or limited range of motion of the TMJ" If the TMJ has been completely replaced by a device, then the literal terminology could not apply. However since the device is supposed to function the way the TMJ does, a good lawyer (and or physician or dentist) could argue this point, nullifying the exact use of TMJ in the context of this characteristic. (i.e. It could be argued that TMJ and device are synonymous terms when it comes to function) If the TMJ has not been completely replaced by a device, and still exists at least somewhat in situ, then the literal terminology could apply. However since there is more than one component involved (TMJ and device), it may remain unknown as to whether the symptoms are relate to the device or the remnant TMJ. Therefore legal consult (with professional advice of course) may be warranted. That was my thinking process. -Sue Dream a little dream for me...... Dartos However since the device is supposed to > function the way the TMJ does, > -Sue > Dream a little dream for me...... > [quoted text clipped - 4 lines] > > > -Sue Dartos, I don't think that any prosthetic joint functions as well as the real thing. In the case of TMJ syndrome, do the underlying problems need to be solved as well?(parafunction/bruxism, poor bite relations, etc.). If these are not solved, will there still be referred pain (neck, head, etc.) associated with this syndrome? (Or not) Thanks, -Sue I have never treated anyone with prosthetic TMJ's (I've only communicated with one on the internet <G>). I am not qualified to answer your question. I was just struck by that line (nothing personal). The TMJ is a much more daunting task than a hip or knee. Dartos >>Dream a little dream for me...... >> [quoted text clipped - 21 lines] > Thanks, > -Sue > I have never treated anyone with prosthetic TMJ's (I've only > communicated with one on the internet <G>). I am not qualified [quoted text clipped - 30 lines] > > Thanks, > > -Sue Dartos, I did not take it personally at all. There are limitations to all prosthetic joints. Our company is not involved in this technology, but any technological advancement in medicine interests me. I think the total TMJ prosthetic is very new (FDA approved 2005), but I would have to verify that. I remember seeing something come out in press in Sept. or Oct. I do not doubt you when you say it may be more complicated than the hip or knee. I cannot comment on that. BTW, I think I may have misinterpeted Webby's intent for posting this thread. I think she was trying to say that the current terminology used by ins cos needs to be broadened. I was not trying to be antagonistic with my questions. I was genuinely interested in learning more about the points she was trying to make about TMJ. -Sue > I have never treated anyone with prosthetic TMJ's (I've only > communicated with one on the internet <G>). I am not qualified [quoted text clipped - 19 lines] > > I don't think that any prosthetic joint functions as well as the real > > thing. The matter of prosthetic jaw joints is different from other joints. When a person has a destroyed TM joint (TMJ), the function is likely to suffer because of pain in and around the joint as well as limitation of movement within the natural joint due to various degenerative processes. Having said that, most patients who entertain the idea of replacement joints need to understand *thoroughly* what realistic expectations would mean to each individual patient. > > In the case of TMJ syndrome, do the underlying problems need to be > > solved as well?(parafunction/bruxism, poor bite relations, etc.). "TMJ Syndrome" is another catch-all term for Temporomandibular disorders and diseases. It is generally contraindicated to replace TMJs in patients who have uncontrolled parafunction. As for whether the jaw position is undesirable or acceptable for the joint replacement surgery, that would be a case by case investigation of the surgeon's. > > If these are not solved, will there still be referred pain (neck, head, > > etc.) associated with this syndrome? Parafunction is something that several of the regs here can comment upon in general. Again, "syndrome" is a term often found in insurance company definitions. I don't know how they get away with it but they do. "TMJ" isn't a real diagnostic term and neither is "TMJ Syndrome" but it doesn't stop the usage of the terminology. Finally, any surgery upon the TMJ should be a last resort. In some cases, it is the only good option. Fortunately, this is the case of very few people. > > (Or not) > > > > Thanks, > > -Sue Webby > > I have never treated anyone with prosthetic TMJ's (I've only > > communicated with one on the internet <G>). I am not qualified [quoted text clipped - 56 lines] > > Webby Webby, Thank you for the information. You have described this in a clear way that I can understand. You note TMJ syndrome refers to "Temporal Mandibular disorders and diseases." I had never fully understood what makes something a "syndrome" as opposed to a "disease." If I understand you correctly, I see that the term "syndrome" refers to a collection of symptoms that may be linked to several related, but not so well understood disease processes and/or disorders. Thanks for the clarification. This makes sense to me now. 'Night. Gotta run now. Take Care, Sue Sue, Thank you for clarifying my question. Please scroll through the old text to read my new comments. > > > > (Taken from Blue Shield of California glossary) [error] > > > > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the > > > > following characteristics: The above reference noted as Blue Shield of California glossary is incorrect. The correct reference is: http://metrokc.gov/employees/benefits/pdfs/DS910-GlossRD.pdf This was *an error on my part*. I apologize for causing any confusion because of this error. The definition below applies to this link and not to Blue Shield of California. (I am unable to locate a glossary for BS of California for the purpose of defining the language used.) The question asked (see below in text) still applies to this passage regardless of the insurance company involved. > > > > Pain in the musculature associated with the TMJ > > > > Internal derangements of the TMJ [quoted text clipped - 19 lines] > > > > > > "Pain in the musculature associated with the TMJ" - applies, IMO I agree. > > > As for the other characteristics, one must ask whether the natural TMJ > > > was completely removed..... It is also important to determine which particular prostheses have been used in prior surgeries and which particular prosthesis it currently in use. > > > If yes, then: "Internal derangements of the TMJ" - would not apply > > > If no, then: "Internal derangements of the TMJ" - may apply Internal derangement of the TMJ is not without controversy. > > > If yes, then: "Arthritic problems with the TMJ" - would not apply > > > If no, then: "Arthritic problems with the TMJ" - may apply I don't agree about the arthritic problem no longer being an issue because the joint has been completely amputated. If the arthritic process resulted in ankylosis of the joint, the condition can recur in spite of total amputation. > > > If yes, then: "Abnormal range of motion or limited range of motion of > > > the TMJ" - may apply (with good legal representation) > > > If no, then: "Abnormal range of motion or limited range of motion of > > > the TMJ" - may apply (with good legal representation) Abnormal range of motion or limited range of motion can exist with a natural joint, a partial natural joint-partially prosthetic joint, without any natural joint and with a total prosthetic joint/s. > > > Just a guess, I suppose your guess and my guess are both guesses. The "definition" seems almost useless to me. > > > -Sue > > [quoted text clipped - 8 lines] > terminology, otherwise I would have answered before moving on. I will > try to explain. I thought you may not have seen it. So I waited. No problem. > First off, I am only conjecturing. I do not know the true legalities > involved or why you started this thread. Maybe you started this thread > for conversation only, or maybe for legal advice.. or maybe far some > other reason. I am not sure, but it sounded intersting ot me, so I > looked at it. I started the thread to see if there was any interest in discussion of the subject. I wasn't looking for any legal advice for myself. If legal thoughts become part of the discussion, as it has, then that's fine and often interesting. > When I made my answer, I was guessing that you may have encountered a > hassle with the insurance company (covering expenses incurred for > symptomatic problems associated a the device therapy)... but I am not > sure. Oh yes, I have encountered many, many hassles with insurance benefits over the past nearly 23 years. Whatever my plan says about "TMJ Syndrome" and "TMJ" ... it doesn't much matter. I learned long ago that it will always be a fight even when they specifically state a particular service is a covered benefit. My most difficult challenge was getting insurance to cover total joint replacements that were considered "experimental". But, at the end of the day, they covered the devices as being medically necessary "humanitarian need". > ****************************************************************************** > ******** > Re: legal representation. I was thinking that a good lawyer could help > sway the interpretation of this characteristic either way, with > verfication from the proper medical professionals of course. Ugh. > "Abnormal range of motion or limited range of motion of the TMJ" > [quoted text clipped - 4 lines] > context of this characteristic. (i.e. It could be argued that TMJ and > device are synonymous terms when it comes to function) The TMJ, natural or prosthetic, functions because of muscles and nerves. In addition to what you've written about "TMJ" function, I would think that there is one other synonymous term: jaw function. If a person does not have any natural or prosthetic TMJ, jaw function is still a matter of mandibular function. So in the absence of a condylar head and a glenoid fossa (unilateral or bilateral) the jaw function remains an issue to the person. Measuring jaw function does not depend upon a TMJ. It depends upon muscle activity allowing for mandibular motion. > If the TMJ has not been completely replaced by a device, and still > exists at least somewhat in situ, then the literal terminology could [quoted text clipped - 6 lines] > > -Sue Interesting thought process. Thank you for your contributions to the thread. Webby > Sue, > Thank you for clarifying my question. Please scroll through the old [quoted text clipped - 162 lines] > > Webby Thanks Webby, I do not know the jaw anatomy in detail. I also do not know too much about this syndrome (other than the basic symptoms and "supposed" causes that I have picked up from online conversation). Thank you for the education. I also feel very relieved that I have not started a flaming war by interjecting my naive thoughts and questions on this subject. :-) Sincerely, Sue [cut] > Thanks Webby, > [quoted text clipped - 11 lines] > > Sue Sue, I think you have another post out asking for some explanation about "TMJ Syndrome" and I haven't gotten around to composing a reply yet. There is no need to fear that naive thoughts and questions incite flamewar activity in this newsgroup. When flames erupt, it is for other reasons. Thanks for sharing your thoughts. Webby > (Taken from Blue Shield of California glossary) > Temporomandibular Joint (TMJ) Disorders. Disorders with any of the [quoted text clipped - 13 lines] > implanted to replace the natural TMJ), which of the above disorders > and characteristics applies? Webby, How would you answer your own question? Thanks, Sue > The Webby |
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