MISOGYNY and Denial of Medical Coverage for TMJ &TMD:You do not really have pain, it is all in your head or you’re just crazy.

I just received this e-mail (see below) from Prabu the president of IACA, the International Association of Comprehensive Aesthetics. I am also an ICCMO representative to the TMD Alliance, The Organization of TMD organizations. Prabu is also one of the top practitioners in the world utilizing Neuromuscular Dentistry to improve the quality of TMD patients lives. In the Midwest there is Prabu in Kansas City, I (Dr Ira Shapira) am in the Chicago area, Dr Kevin Ladesic in LaCrosse, Wisconsin, and Dr Roger Roubal in Omaha, Nebraska. There are many other excellent practitioners in the midwest and across the U.S. and the world. TMD patients are being written off as crazy and having psychosocial issues. This is not the opinion of the patients or their treating doctors, it is the opinion on a small group of doctors who “choose” not to treat TMJ disorders or treat them as a mental disorder.

This opinion comes from a small group of psychologists and dentists who do not treat TMJ disorders. Dr Charles Greene has not treated TMJ patients for years but he has worked for insurance companies to deny their legitimate medical claims. In spite of the fact that he does not, or is incable of treating patients successfully he does consider himself to be the single authority in the field (based on court testimony). He is certainly not an expert on Neuromuscular Dentistry though he may be an expert on seeing that patients medical claims are denied by insurance companies. I am sure one can make a very good living by denying coverage for legitimate medical claims.

Patients with TMJ problems are being harmed by the inordinate influence of a handful of doctors many of whom do not believe that there are actual physical disorders. They basically believe these patients are merely “crazy” i.e. have a psychosocial issue.

TMJ patients are not “psychosomatic” translated as “I hurt because I’m crazy!” but rather have somatopsychic issues, i.e. “My pain is driving me crazy!”. Unfortunately this small group of doctors that are incapable of treating the physical problems do have the ability to destroy patients lives. They have the power to deny patients with physical problems access to medically necesary medical care coverage by insurance companies.

TMD is primarily a women’s disease (approximately 80% of patients are female). This blatant discrimination against women is not surprising as all of the major proponents are male.

Wikipedia defines “Misogyny (pronounced /mɪˈsɒdʒɪni/) is the hatred of women. Misogyny comes from Greek misogunia (μισογυνία) from misos (μῖσος, HATRED) and gynē (γυνή, woman).”

“Freedom is Not Free”
Dear Ira,

The freedoms we enjoy in this country – freedom of speech, freedom of religion etc. are often taken for granted. I have seen the point made that “FREEDOM IS NOT FREE” in thanking the brave young men and women of the armed forces.

The freedom to practice Neuromuscular dentistry that we enjoy is not free either. The freedom to utilize NMD to help alleviate years of pain and other symptoms may not always be there unless we act.

“The price of freedom is eternal vigilance.” – Thomas Jefferson

Our patients assume that their mouth conditions will remain the same for the next 10 years as they were for the last 10 years. Then there is a crisis of a fractured tooth, closed lock, etc. We as Neuromuscular dentists are no different. Most of us take our freedom to practice NMD for granted while there are powerful forces such as insurance companies aiding those that will take that freedom away.

Dr. Charles Greene’s report calling for a “standard of care” for TMD was published in the Journal of the American Dental Association’s September 2010 issue. If you are unaware of its publication, we know that insurance companies and trial lawyers certainly are. The following are excerpts from his report:

It is recommended that the differential diagnosis of TMDs or related orofacial pain conditions should be based primarily on information obtained from the patient’s history, clinical examination, and when indicated TMJ radiology or other imaging procedures.

…the consensus of recent scientific literature about currently available technological diagnostic devices for TMDs is that, except for various imaging modalities, none of them shows the sensitivity and specificity required to separate normal subjects from TMD patients or to distinguish among TMD subgroups. (This statement entirely invalidates use of any bio-instrumentation such as the K7 system)

Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time.

It has become accepted widely among pain experts in the medical and dental professions that these types of pain conditions must be managed within a biopsychosocial framework, in which behavioral approaches supplement conservative medical care.

Therefore, the publication of this new TMD statement could be regarded as the closest thing to date to a true standard of care in this contentious field.

The Canadian dental journal, OOOOE, Japanese, and other prosthodontic journals have also published basically the same reports. Some Canadian provinces are restricting NMD. This “report” has already been quoted by a liability insurance carrier cautioning an LVI dentist about practicing NMD. One TMD pain organization has already accepted it as their standard of care. It has also been referenced in a malpractice case in California. Is all this just a coincidence?

Do you still want to take your “freedom” for granted?

IACA Editor, Dr. Dan Jenkins and I met with ADA leaders – President, President – Elect, Senior VP Scientific Affairs and Director Council on Dental Practice – a few days back for over an hour to convey theIACA’s views on TMD and even showed a video testimonial of a severe case successfully treated with NMD. There are many occlusion and TMD organizations but the IACA is the new kid on the block – yet, it was the IACA which stepped up to the plate as Neuromuscular dentistry’s voice to ADA.

Some will be perfectly happy with the IACA carrying the burden for NMD and enjoy the benefits of any of our efforts without actually contributing to it. The world is full of such mentality.

I hope that the NM dentists are of such high ethics and character that they would hate the idea of getting something for nothing…and step up to share the burden through their IACA membership and participation.

“The only thing necessary for the triumph of evil is for good men to do nothing.” — Edmund Burke

Stand up for your Freedom to practice NMD. Tell your friends that practice Neuromuscular dentistry to join the IACA. Register for the annual meeting at www.TheIACA.com. Come join our ranks as the IACA fights for everyone’s Freedom to practice NMD.


Dr. Prabu Raman
IACA President

All of my comments are personal opinions and not the views of Sleep and Health Journal. Many are supported by court documents. Dr Ira L Shapira