Restorative procedures are necessary to complete orthopedic stability of the mandible and maintain the current jaw position. A specific court ruling regarding insurance cases states:
Goss v. Medical Service of the District of Columbia, DC Court of Appeals, No. 81 1276, 13 June 1983.
The medical insurer’s position was that restorative bridge work 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 jaw. In fact the crowns were directly related to and required by the medical condition affecting the jaw. The treatment did not treat the teeth or tooth relationship as the patient’s teeth were used only to support the devices required to stabilize the jaw position.”
A Medical Necessity
Clinical examination revealed: articular disk disorder, muscle spasm, and cephalgia.
An orthopedic jaw stabilization orthotic was placed to position the condyles in the fossa in a more true anatomical position, reduce stress to the jaw joint, increase joint space, allow remodeling of the condyle, heal retrodiscal tissue, capture the dislocated articular disc, provide proper alignment of the mandible to the skull, reduce myospasm and pain, and maintain the muscles of mastication in proper physiologic resting length.
This appliance is orthopedic and neuromuscular treatment and should be considered as a medical necessity by the insurer.
