INITIAL EXAMINATION AND CONSULTATION
from the library of Robert L. Talley, DDS

Initially, the new patients are scheduled for a complete evaluation of their present concerns. You are asked to complete a thorough medical history in advance of your appointment.

Upon arrival at the office, you will be greeted by our Treatment Coordinator who, at that time, takes a blood pressure reading and reviews your medical history. Dr. Talley is introduced and discusses your history and concerns. The Treatment Coordinator then continues with the patient gathering additional history and technical data prior to the doctor's examination.

Prior to the examination, the patient is occasionally asked to view a short video entitled, "TMJ: The Great Imposter". Subsequently, the examination is completed by Dr. Talley and a consultation follows. Our goal is to identify your specific problem(s), the cause and possible solutions. Dr. Talley completes an oral examination and checks for muscle tenderness and joint sounds. The jaw is evaluated for its range of motion, deviation to one side during opening and any discrepancy of the occlusion (bite).

The purpose of the consultation is to inform you of your condition, as it presently exists, based on all the information we have gathered about you. We will discuss treatment alternatives, length of treatment, prognosis and future needs. Recommended treatment is always subject to changes or modifications once treatment has commenced. Everyone has a different healing response. The success of your treatment is highly dependent upon good patient cooperation. If compliance is a problem, the treatment plan may need to be changed. There may be underlying problems which are not evident until after treatment is started. Additional testing or outside referrals may be required. We begin our treatment as conservative as allowed. Depending on your initial response, treatment plan changes may be indicated.

At the conclusion, scheduling and financial arrangements are discussed. Should you wish to begin treatment immediately, we do our very best to accommodate you while you are here in the office by completing all necessary records. We realize travel and time from work is often difficult. Our radiographic examination allows Dr. Talley to see actual pictures of the joint components and their relative state of health. Radiographs are usually taken with the jaw open, closed and at rest.

Dr. Talley may recommend additional medical or dental testing. Only those tests necessary to complete a diagnosis and treatment plan will be used.

At the completion of the necessary diagnostic records and testing, the patient's treatment plan is scheduled accordingly. A narrative report is also completed and forwarded to the referring doctor.

Dental Stress

Dental Stress does not refer to cavities or gum disease, but to the manner in which the upper and lower teeth and jaws relate together. If your teeeth do not function or mesh properly, there can be a great deal of stress and strain placed upon the joints, muscles and ligaments of the entire head and neck region. Therefore, part of your treatment may involve correcting the misalignment of the teeth or jaws for a more harmonious function.

Structural Stress

There are three types of structural stress. The first has to do with previous traumatic injuries which occur to your head, neck or jaw. Even if these injuries occurred years ago, they could have left the ligaments or joints damaged enough that they can not carry out normal function. These injuries can also lead to arthritic deformities within the joints which take years to develop sufficiently to be noticeable.

The second form of structural stress concerns the way in which you use your body. Posture, work habits and even sleeping habits can all have a significant impact on muscles, joints and ligaments of this region. In order to correct some of these problems, it may require a change in your postural habits.

The third type of structural stress concerns changes that occur in the spine, most noticeably the cervical (neck) spine, due to problems associated with the jaws. Abnormal jaw position, which may be due to improper development, trauma or injury, or tooth loss can ultimately affect the position of the head on the spine and, eventually, lead to changes in the neck. These changes are responsible for a variety of symptoms, most noticeably, head and neck pain, shoulder and arm pain and, possibly, sensory loss and tingling down the arm, even into the fingertips. In addition to correcting the jaw problem in these cases, therapy on the neck may also be required.

Nutritional Stress

Nutritional stress is a very significant factor for about 1/4 of our patients. Chronic pain of the head and neck is often due to muscle irritability. One of the factors which can produce muscle irritability and add to existing irritability caused by other forms of stress, is the inability of the muscle to obtain necessary oxygen, proteins, vitamins and minerals. Also, it is a proven scientific fact that substances like caffeine, nicotine and sugar significantly increase muscle tension. In addition, some people may be eating "good food", but their body is not digestimg it properly. Therefore, their body is starved of essential elements in the same manner as someone who is not eating properly. Obviously, this is another area which may require a change.

External Stress

External stress, often referred to as emotional stress, affects the body in the same way as does caffeine, nicotine and sugar. With these substances, there is a very significant increase in the levels of adrenalin and steroids in the blood stream. Over a prolonged period, these changes in body chemistry can have a great number of undesireable side effects, including muscle irritability. Chronic emotional stress is a primary factor and a leading cause of death. The three best-selling prescription drugs in the country are an ulcer medication, a high blood pressure drug and a tranquilizer. Here we have a problem which may only be corrected with a change in lifestyle. Unfortunately, it is often difficult to change the cause of our emotional stress (occupation, family difficulties, finances, etc.)

The success of your treatment may be dependent on correcting or reducing one or more of these areas of stress. Each of us has a different level or capacity of stress which our body will tolerate before symptoms become apparent. We call this the stress threshold. If our stress level is kept below our stress threshold, we do not notice any pain or dysfunction. However, if our stress "score" rises above our threshold capacity, symptoms begin to appear. Our concern is to identify which types of stress are most significant in producing your particular symptoms.

ULTIMATELY, YOU ARE THE ONE WHO IS RESPONSIBLE FOR GETTING WELL AND STAYING WELL!!