Bruxism and/or TMJ

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Bruxism and/or TMJ

Post by Dove96 on Sat 16 Feb 2013, 10:20

I am diagnosed with Bruxism. I am pensioned for Bruxism and it shows on my file I have dental.
I put in a claim for dental work done on a tooth that cracked due to bruxing. It was denied, I appealed - it was denied. That was when I found out that the only "dental" covered for Bruxism is a Bruxism guard.
I went as far as the Ombudsman but was told it was "policy" and they don't have sufficient evidence to change policy.
When I asked DVA what I could do I was told I would have to put in a new claim for "teeth conditions" and have it related to specific teeth.
My opinion: If you are pensioned for Bruxism, teeth problems caused by bruxism and dental work required to prevent further damage from bruxism, should be covered.

There is a lot more to the story but I am wondering if there are others out there that have run in to this problem?

Bruxism is consequential to PTSD and chronic pain sufferers.

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Re: Bruxism and/or TMJ

Post by puddleduk2 on Sun 17 Feb 2013, 08:18

Couple of questions,

Do you have CF dental coverage after release? As they cover 80% first as the first provider,

second question,

Are you an 'A' or 'B' client of VAC?

'A' clients are covered only for their pensioned conditions,

'B' clients are covered at 100% of any allowed procedure or coverage under those items listed on the back of your VAC health services card.

I was provided a dental guard for TMJ ($500+) as one side of my jaw was broken, further in not being treated for the broken jaw with cartilage ripped out of place, and Having an OSI on top of this, it has lead to further jaw and face pain, wear of the teeth, grinding, which leads to bruxism.

So far I haven't cracked or worn down my teeth enough to be denied services, but it odd that they would deny it once it has gone as far as resulting in bruxism.

From what I've read, bruxism is the result of untreated TMJ, and having the further issue of an OSI doesn't help.

I haven't submitted a claim to VAC for my jaw yet, it is too difficult for me to do so on my own, I have prior paperwork started prior to the NVC but it is not completed in whole.
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Re: Bruxism and/or TMJ

Post by Dove96 on Sun 17 Feb 2013, 11:51

The broken tooth was first a root canal then would require a crown a cost of over $3000. This was recommended instead of pulling because of my bruxism. (A good bite plane is needed to prevent damage to the surrounding teeth and this was a large load bearing tooth.)
The maximum in a year for dental plan is $1500. I used my dental plan for the other bruxism damage and routine dental services so I put in my first claim against my pensioned Bruxism. That is when I found out Bruxism only pays for a guard.
My bruxism is caused by chronic pain that cannot be controlled...so far.
I am an "A" client with VIP and pensions for Bruxism, plus ...

NOTE: I read in our Sunlife coverage that our Dental insurance does not cover anything relating to TMJ.

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Re: Bruxism and/or TMJ

Post by puddleduk2 on Sun 17 Feb 2013, 12:34

I went with the mouth guard/plane as it was the only way I could control some of the discomfort and pain associated with my injury, it was covered at the time, but havent looked into getting another since that time..

This is the first day I have heard of bruxism, so forgive my misunderstanding about this particular matter as I don't know what is or isnt offered either our Sunlife or VAC for coverages having not dealt with it with them as of yet.

I am a 'A' client for my pensioned conditions, and for everything else under my 'B' coverage..

I had a tooth shatter after my jaw injury, and while in the CF they put in a temporary filling after the root canal to dull the pain, stayed put for many years was finally replaced with a crown 15 years later (long time for a temporary filling eh).
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Re: Bruxism and/or TMJ

Post by puddleduk2 on Sun 17 Feb 2013, 12:37

I don't have to wear my guard/plane during the day, and find that if I preplan on wearing it on stressful days and nights it give me much relief.
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Re: Bruxism and/or TMJ

Post by Dove96 on Sun 17 Feb 2013, 13:05

I wear the guard every night and sometimes during the day when the breakthrough pain is too bad.
The years of bruxism developed TMJ which misaligned my jaw.
The dentist submitted a $7200 treatment plan to correct the problem which has bounced around the DVA since last May awaiting a decision.
PDSP booklet page 32 Charges not covered: "charges for a periodontal appliance, occlusal equilibration, and other related service as a result of a temporo-mandibular joint dysfunction (TMJ dysfunction)"
Of course it may be that it is covered under PSHP. Either way as you are pensioned DVA should offer assistance also.

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Update

Post by Dove96 on Wed 14 Sep 2016, 16:47

Update:
I was approved for the "Teeth Condition" claim.
I was approved for braces to re-align my teeth/jaw.
After the jaw was put back in place I put in a claim for a implant to replace the tooth that was removed. It was approved also.
I always wear an upper and lower mouth guard at night. I still clench and have jaw pain but it is way better.

Just a reminder:
IF YOU HAVE BRUXISM, PTSD, TMJ. Get your teeth checked and if the condition warrants, start a claim for teeth conditions. Mine was listed as "Posterier Gingival recession with Abfractions/Abrasions" and "Parafunctional tooth Wear" and the teeth were listed.


Last edited by Dove96 on Wed 14 Sep 2016, 16:53; edited 1 time in total (Reason for editing : Added info)

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Re: Bruxism and/or TMJ

Post by Trooper on Wed 14 Sep 2016, 17:16

Good info Dove, could you give us more details on the claim? Is it done through Medavie Blue Cross?
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Re: Bruxism and/or TMJ

Post by Dove96 on Wed 14 Sep 2016, 17:47

The claim is a regular VA claim for "Dental and Oral Impairment".
Mine was consequential to Bruxism.
You jump through the regular VA hoops of every other claim. The award is not monetary but dental coverage for things like dental appliances, implants, root canals etc. It really helps once it is in place.
http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities/ch-11-2006#t01

People with PTSD and chronic pain often don't realize there is damage happening.
When you see your dentist - ask if there are visible signs of bruxism.
If your jaw hurts or has signs of TMJ - get it looked at before the joint becomes damaged or misaligned.
Get in a claim for Bruxism or TMJ and wear a mouth guard! Teeth are expensive to replace.
Note: Any teeth that were damaged before diagnosed and granted a Bruxism claim will not be covered for repair/replacement.

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Re: Bruxism and/or TMJ

Post by Trooper on Wed 14 Sep 2016, 18:33

Dove, that is clear and concise, I have learn't something new, thank you so much!
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