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I call out the results which are recorded by Table 3: Considerations for Determining
a second note taker. Medication Induced Caries
1. Demonstrate the dental condition at the
The use of these techniques for the detec- time medication began.
tion of malingering is no without critics. 2. Demonstrate the dental condition prior
And basing any final conclusion requires to the date of injury (including the oral
careful consideration of a complete under- hygiene).
standing of the claimed injury as possible. 3. Demonstrate the deterioration rate his-
torically.
Some investigators may choose to use elec- 4. Test the current saliva production (com-
tromyography, sonography, jaw tracking pare historically if possible).
(kinesiography) or TENS (low frequency 5. Examine current oral hygiene.
electrical stimulation) to detect TMJ dys- 6. Look at Decayed, Missing and Filled
function. However, the profession has not rate (DMF) historically.
reached consensus on the efficacy of these 7. Develop a new score for DMF which in-
modalities to identify healthy versus in- cludes the transition to higher forms of
jured TMJ. Going forward the investigator dental care- so that as the tooth is transi-
needs to utilize a deep understanding of the tioned into endo = 5, or as it is replaced
symptomatology and a careful investiga- with implant or denture causes higher
tive technique. score.

The dental IME is a controversial activity, Table 4: Motives to make injury claims:
albeit a fundamental reality of our medi- 1. Drug seeking behavior
co-legal system and it behooves us to un- 2. Vacate conditions (escape work)
derstand how it works. Further, knowing 3. Escape responsibilities
the system can be adversarial, we should 4. Financial gain
practice good technique and install safe- 5. Personal attention (Munchausen, by
guards for both our patients and ourselves. proxy)

Table 1: Initial Review of the Case References:
Establish a timeline of the incident 1. Kevin J. Bianchini, et. al. (2001) Symptom
Review the records, radiographs and Validity Testing: A Critical Review, The Clinical
photographs Neuropsychologist, 15:1, 19-45, DOI: 10.1076/
Understand the claim(s) clin.15.1.19.1907.
2. Scott R. Millis & Conference Participants
Established the mechanism for the injury as (2009) American Academy of Clinical
claimed Neuropsychology Consensus Conference
Understand the known etiology Statement on the Neuropsychological Assessment
Fit the injury to the established facts of Effort, Response Bias, and Malingering, The
Consider any irregularities Clinical Neuropsychologist, 23:7, 1093-1129,
Are there plausible explanations DOI: 10.1080/13854040903155063.
Arrive at a conclusion 3. Fishbain, David; et. al. (November–
December 2004). “Is There a Relationship
Table 2: The Role of the Investigating Between Nonorganic Physical Findings
Clinician (Waddell Signs) and Secondary Gain/
Malingering?”. Clinical Journal of Pain.
An investigating clinician is obliged to American Academy of Pain Medicine. 20 (6):
consider many aspects of a reported injury. 399–408. doi:10.1097/00002508-200411000-
For instance; 00004.
1. Is a financial gain to be made by a
plaintiff for an injury?
2. Are the symptoms reported outside the
usual symptoms described for the in- Joseph DiDonato, III,
jury? DDS, MBA, FAGD is
3. Does the mechanism for the injury in private practice in
provide no clear force in vectors that Rochester, NY. He has
can be justified as having caused the been doing dental IME’s
injury? and answering ques-
4. Is the plaintiff guarded during the exam tions for third parties
while prior behavior was normal? related to TMJ injuries,
5. Are there are ample examples of facial and dental injuries for years.
pre-existing conditions to explain the
symptoms rather than an acute inci-
dent?
6. Is the plaintiff an inconsistent historian
about the injury?

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