Medical/Legal - David B. Miller D.D.S.

However, their explanations of the nature and treatment of the condition known as TMJ, which are essentially unchallenged by Blue Cross, consistently and clearly describe the focus of a TMJ disorder and its treatment as a joint that happens to be connected to the teeth, not the teeth themselves.

The Connecticut Society of Oral and Maxillofacial Surgeons (the Maxillofacial Surgeons), appearing as amicus curiae, also describe TMJ and its treatment as focused on a disorder of the jaw rather than of the teeth, and refer us to a substantial number of state court insurance cases so holding. (Citations omitted.)

RESULTS OF COURT CASES FOR HEAD, NECK AND TMJ DISORDERS

1 - Ponder v. Blue Cross of Southern California, 193: Rptr. 632, Cal App. 1983: The health insurance policy had an exclusion denying payment for dental care including "treatment for or prevention of temporomandibular joint syndrome" The Appellate Court held that this was not an effective exclusion.

2 - Jowers v. Nationwide No. CV 85-, 2 December 1986 Terrolyn Jowers recovered $703.00 medical expenses, $175.75 Bad Faith Penalties, $5,000 attorney's fees and $1,000,000 punitive damages for her TMJ treatment which was originally denied by the insurance company.

3 - Goss v. Medical Service of the District of Columbia et al, District of Columbia Court of Appeals, No. 81 - 1276, 13 June 1983 Blue Cross/Blue Shield's position was that putting crowns on the teeth is considered dentistry. The Patient's position was that the crowns were medically necessary to correct a malpositioned jaw. Court results: "There was no need for the crown and bridge work independent of the TMJ. In fact the crowns were directly related to, and required by, the medical condition of Mrs. Goss' jaw. The treatment was not required to, and did not treat any condition of Mrs. Goss' teeth or tooth relationship as Mrs. Goss' teeth were used to support the devices required to stabilize the position of her jaw." Blue Cross Blue Shield was ordered to pay for the treatment.

4 - Robinett v Metropolitan Life Insurance Company, 404 So. 2d 1344 1981 (Louisiana): "The appliance used to treat the patients condition was not an end in itself but rather was intended to relieve pain from her mandibular joint rather than to correct her dental problems. Reasonable minds would not inevitably conclude that, as a matter of law, procedures performed on her were "dental services" excluded from coverage under health policy."

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MOTOR VEHICLE TRAUMA

Must my head or face strike the inside of my car in a motor vehicle accident (MVA) for me to have a dislocated jaw joint or TMJ symptoms?

YOUR HEAD NEED NOT STRIKE ANYTHING TO DISLOCATE YOUR JAW

An overwhelming majority of patients that sustain whiplash injuries in motor vehicle accidents (MVA) also dislocated one or both temporomandibular joints at the same time without having impacting their face or head against the steering wheel, door column, windshield, or, other parts of their car. The lack of head/face impact and the absence of bruises, cuts, stitches, etc., is frequently used by insurance companies to deny claims from patients for TMJ treatment.

A recent study by Garcia, DDS and Arrington, MD performed MRI's on 164 TMJ's of 87 consecutive motor vehicle cervical whiplash patients "who had sustained no direct trauma to the face, head or mandible and had no TMJ complaints prior to the MVA" documented that 95% of the joints (156/194) showed TMJ abnormalities after the MVA, "significantly illustrating the proximate relationship between cervical whiplash and TMJ injuries".

A similar MRI study by P. D. Pressman, MD, et.al. on 33 consecutive symptomatic patients who had suffered whiplash from rear-end collisions with "no direct trauma to the jaw, mouth, head or face, due to the accident and no prior history of TMJ dysfunction" showed that 88% (29/33) "had some type of TMJ abnormality related to whiplash injury..."

The medical and dental professional literature, published in peer reviewed journals, supports the position that your head or face does not have to be struck for you to sustain a TMJ injury in a motor vehicle accident.

Contact us by the Contact the Doctor page or reach us by e-mail: info@davidmillerdds.com

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Jawlash

In the 1970s the term "jawlash" began appearing on dental reports as part of the sequelae of whiplash injuries. Because the jaw is attached to the skull and shoulder girdle through numerous muscle attachments, it easily becomes misaligned when the involved muscles go into spasm.

In a study conducted by the Preventive Dental Research Foundation, 500 whiplash injury cases were reviewed and considered "closed" after conventional treatment. The unfortunate victims, however, did not consider themselves cured, for they still suffered from a multitude of symptoms. According to the president of the research group, Dr. Harold Ravins of Los Angeles, the chief complaints included:

1. Pains of the head
2. Burning sensations of the forehead and scalp
3. Facial pains
4. Clicking, popping, or cracking sounds in the jaw
5. Buzzing, ringing, and roaring sounds in the ear
6. Stuffiness or itchy feeling in the ears
7. Balance problems
8. Difficulty in swallowing
9. Pain in the roof of the mouth
10. Blurred vision
11. Sensation of pressure around and behind the eyes
12. Sensitivity of the eyes to light
13. Reduction of arm and shoulder movement
14. Tingling sensations in the arms and fingers

Dr. Ravins and the other members of the Foundation traced these symptoms back to the violent, uncontrolled forces that had snapped the patients’ heads around and misaligned their jaws.

The actual mechanism of whiplash involves a very complex, dynamic series of stretching, compressive and twisting forces dissipated throughout the skeletal structure and living soft tissue. A simplistic view portrays the event as a forward hyperfiexion, and backward hyperextension with a corkscrew effect on the spine, sacrum, and pelvic complex. The sudden pulling and jerking motions created by the impact have the potential to cause ruptures and micro-tears within the muscle tissue. The microscopic changes within the muscle serve to exacerbate the pain. They include:

1. Decreased circulation of blood to the area
2. Decreased oxygen supply
3. Decreased ability of the lymphatic system to clear the traumatized area
4. Reduced nutrient supply
5. Increased metabolism of the involved tissue
6. Increased build-up of waste products
7. Increased muscle fatigue
8. Inflammation
9. Swelling

These changes account for the prolonged symptoms of muscle soreness and pain. The aftermath of the trauma also is characterized by latent secondary effects such as pressure on nerves and blood vessels from spastic muscles Neurologic pressure will produce clinical symptoms of muscle weakness and tenderness, numbness, hypersensitivity, burning sensations, heaviness, paresthesia and shooting pains. Vascular pressure, on the other hand, will lead to decreased blood to an area, discoloration (such as in cyanosis), swelling and nutritional changes.

Whiplash injuries are not always the result of motor vehicle accidents but can result from falls, direct traumas to the skull, or moving forces applied to various parts of the body such as those which occur in contact sports. Whiplash should not be thought of as a typical syndrome, nor any particular injury but should be looked upon only as the mechanism of the injury. From a total structural perspective, other common symptoms include:

1. Restriction of neck motion
2. Blackouts
3. Chronic fatigue
4. Heaviness of the head
5. Mental fogginess, light-headedness, poor memory and inability to concentrate
6. Nausea and other gastrointestinal problems
7. Low back pains
8. Pain between the shoulder blades
9. Cold hands and feet, numbness of the arms, hands, feet and shoulders
10. Stress-related symptoms of extreme nervousness, palpitation, insomnia, excessive sweating, anxiety, depression, tremors, and pallor

Recent clinical experience indicates that as many as 80 per cent of whiplash injuries induced by rear-end motor vehicle collisions will also include associated TMJ trauma. These jaw joint problems do not necessarily appear immediately after the accident. In fact, some patients may not be plagued until months later. The primary trauma comes from the forces generated by the hyperextension phase. As the head is forced backward, the lower jaw is pulled forward and open. The TM joint ligaments and chewing muscles become overextended inducing micro-tearing within the tissue; then spasm and disc derangement occur within the temporomandibular joint.

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For Attorneys – When Your Client Needs a Treatment Program

Your clients who have been injured deserve excellent treatment and just compensation for their head and facial injuries. For too long, injuries that produce pain have been shrugged off with such unsympathetic statements as, "Learn to live with it." Too many people have spent years in pain, because they were thought to be malingerers, when all along their dysfunctions could have been
documented by an OBJECTIVE evaluation. A surprising number of people are even discovered to have undiagnosed fractures. Evaluation is always appropriate if there is pain in any area of the head, face, or jaw.

You have probably wondered why so many clients who have suffered cervical injuries also complain of significant headaches and facial pain. Reports in the medical literature indicate that this is true for MOST cervical injury patients, even where there is no direct trauma involved. Although the related TM joint injuries are, in most cases, permanent, the associated pain can often be abated with
appropriate therapy.

We can offer the following:

Medically accepted treatment for head and facial pain with a success rate in excess of 90% (based on a review of the discharge records of approximately 3,000 patients).
Documentation, in most cases, of the permanency of structural damage, the probability of "permanent loss of use," as well as "permanent consequential and significant limitations of use of body functions or systems."
OBJECTIVE evaluation to determine whether there are significant injuries to the joints and muscles of the face, as well as to the swallow mechanism (an essential function of the digestive system). Each of these results simultaneously with most cervical injuries. Impairment of these systems is separate and distinct. Of course, not every patient complaining of pain has an injury to the structures which are within our area of expertise. In those cases, we will advise you and the patient.

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Print out the curriculum vitae listed below. By selecting "print out" a new window will appear that only contains the information below.

DAVID B. MILLER D.D.S.

2648 Del Paso Boulevard
Sacramento, California 95815
(916) 925-2264
FAX (916) 922-6045

CURRICULUM VITAE

BIOGRAPHICAL:

B.A., WASHINGTON UNIVERSITY St. Louis, Missouri 1973
Biology, Chemistry

B.S., NIVERSITY OF ILLINOIS Chicago, Illinois 1978
Dentistry

D.D.S., UNIVERSITY OF ILLINOIS COLLEGE OF DENTISTRY Chicago, Illinois 1980

National Dental Board Examination 1978

National Dental Board Examination 1980

Northeast Regional Dental Licensing Examination 1980

California Dental Licensing Examination 1980

Instructor: University of Illinois College of Dentistry 1980

Completed Course work at the L. D. Pankey Institute for Advanced Dental Education; Key Biscayne, Florida 1988

Licensed in California and Nevada

Certificate in Orofacial Pain, University of New Jersey School of Medicine and Dentistry in 2000

Practiced General Dentistry in California since 1980, and have maintained a private general dental practice in Sacramento, California since 1981

EXPERT DENTAL CONSULTANT: California State Board of Dental Examiners for General Dentistry, Temporomandibular Disorders, Orofacial Pain

EXPERT DENTAL CONSULTANT: Nevada State Board of Dental Examiners for General Dentistry, Temporomandibular Disorders, Orofacial Pain

MEMBER:

SACRAMENTO DISTRICT DENTAL SOCIETY
(Peer Review Committee 1996-97, 1999- )

CALIFORNIA DENTAL ASSOCIATION

AMERICAN DENTAL ASSOCIATION

ACADEMY OF GENERAL DENTISTRY

SLEEP DISORDER DENTAL SOCIETY

AMERICAN ORTHODONTIC SOCIETY
(Achievement Award, 1996 )

AMERICAN ASSOCIATION FOR FUNCTIONAL ORTHODONTICS

FUNCTIONAL FREEDOM CORPORATION
(Founding Member)

AMERICAN BACK SOCIETY

AMERICAN ACADEMY OF PAIN MANAGEMENT
Board Certified - Pain Management
Listed in the National Registry of Pain Management Practitioners

AMERICAN ACADEMY OF EXPERTS IN TRAUMATIC STRESS
Board Certified – Traumatic Stress
Listed in the National Registry of Experts in Traumatic Stress

AMERICAN ACADEMY OF HEAD, NECK, FACIAL PAIN AND TMJ

ORTHOPEDICS

INTERNATIONAL COLLEGE OF CRANIO-MANDIBULAR ORTHOPEDICS

THE COLLEGE OF FORENSIC ORTHOPEDICS
(Founding Member; Vice-President: Board of Directors)

THE AMERICAN COLLEGE OF FORENSIC EXAMINERS
(Life Fellow)

THE AMERICAN BOARD OF FORENSIC EXAMINERS
Board Certified – Forensic Examination
Listed in the National Registry of Forensic Examiners:
Forensic Analysis and Objective Documentation of Trauma-induced Injuries to th
Craniomandibular/ Temporomandibular/ Cervical Complex

THE AMERICAN BOARD OF FORENSIC MEDICINE
Board Certified - Forensic Medicine

THE AMERICAN BOARD OF FORENSIC DENTISTRY
Member-Executive Board of Dental Advisors
Chairman- Committee for Continuing Education
Board Certified - Forensic Dentistry

RECIPIENT: 1997 Dr. "O’WOW" Award for Clinical Excellence in the Fields of TMJ Orthopedics, Pain Management and Forensic Examination

FELLOW:

ACADEMY OF GENERAL DENTISTRY (F.A.G.D.)
AMERICAN BACK SOCIETY (F.A.B.S.)
AMERICAN COLLEGE OF FORENSIC EXAMINERS (F.A.C.F.E.)
INTERNATIONAL COLLEGE OF CRANIO-MANDIBULAR
ORTHOPEDICS (F.I.C.C.M.O.)
AMERICAN ORTHODONTIC SOCIETY (F.A.O.S.)
AMERICAN ACADEMY OF HEAD, NECK, AND FACIAL PAIN (F.A.A.H.N.F.P.)

DIPLOMATE:

AMERICAN ACADEMY OF PAIN MANAGEMENT (Dpl. A.A.P.M.)
AMERICAN BOARD OF FORENSIC EXAMINERS (Dpl. A.B.F.E.)
AMERICAN BOARD OF FORENSIC MEDICINE (Dpl. A.B.F.M.)
AMERICAN BOARD OF FORENSIC DENTISTRY (Dpl. A.B.F.D.)
THE COLLEGE OF FORENSIC ORTHOPEDICS (Dpl. C.F.O.)
AMERICAN BOARD OF OROFACIAL PAIN (Dpl. A.B.O.P)

RESEARCH:

National TMJ Treatment Outcome Study. One of 66 doctors nationwide participating in the first large-scale treatment efficacy trials.

PUBLICATIONS:

Eagle’s Syndrome and the Trauma Patient in "The Functional Orthodontist, A Journal of Functional Jaw Orthopedics" Vol. 14, 2, March-April 1997.

Yesterday’s Dentistry, Today’s Chronic Pain in "The Functional Orthodontist, A Journal of Functional Jaw Orthopedics" Vol. 14, 3, May-June 1997.

Objective Documentation of Injuries to the Craniomandibular/ Temporomandibular/ Cervical Complex in "The Forensic Examiner, The Journal of the American College of Forensic Examiners" Vol. 6, 9-10, September-October 1997.

Clinical Management of Chronic TMD Pain "The Functional Orthodontist, A Journal of Functional Jaw Orthopedics" Vol. 15,3, September 1998

Low Velocity Accidents, Vehicular Damage and Passenger Injury "Cranio, The Journal of Craniomandibular Practice" Vol. 16,4, October 1998.

EDITORIAL ADVISORY BOARD:

The Forensic Examiner, The Journal of the American College of Forensic Examiners

EDITOR:

The Forensic Orthopedist, The Newsletter of The College of Forensic Orthopedics

PUBLISHING EDITOR:

The Journal of The College of Forensic Orthopedics

PROFESSIONAL LECTURES:

"The Neuromuscular Approach to Treating Temporomandibular Disorders."
Guest Speaker: Dr. Brock Rondeau’s Orthodontic Seminar Series
Phoenix, AZ January, 1997.

"Using Computerized Instrumentation in Treating Chronic Pain."
Guest Speaker: Dr. Brock Rondeau’s Orthodontic Seminar Series
Phoenix, AZ March, 1997.

Featured Speaker: Fifth Annual Scientific Session of The American College of Forensic Examiners

"OBJECTIVE DOCUMENTATION OF INJURIES TO THE CRANIOMANDIBULAR/ TEMPOROMANDIBULAR/ CERVICAL COMPLEX."

San Diego, CA. December 11, 1997.

Featured Speaker: The American Association for Functional Orthodontics Annual Scientific Conference

"THE PLASTIC BRAIN: A NEW MODEL FOR TMD DYSFUNCTION BASED ON NEUROPLASTICITY."

San Francisco, CA March 27-29, 1998.

Featured Speaker: BioResearch Annual Scientific Symposium

" TMJ STORY – RESOLVING DIFFERENCES BETWEEN THE PSYCHO-SOCIAL AND MUSCULO-SKELETAL SCHOOLS OF THOUGHT (THE PLASTIC BRAIN)"

Milwaukee, WI April 25-26, 1998

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