Re: treatment in tmj disorders

Treatment plans for TMD are as varied as the patients that present with it. Each patient must be treated differently depending on the uniqueness of their problems and the contributing factors. Pain Relief Info.

It is very important to realize that the goal of TMD treatment is to minimize pain and establish a return to function. TMD conditions are not “cured” but are managed instead. The basic goal is to allow the muscles and joints to heal through rest and care. Often damage to the joint itself can not be reversed, but the body can often heal it enough to return to function without pain. We also want to teach you to recognize the symptoms early and manage them yourself once we give you the tools to do so. This condition can often recur later on but early care can minimize the severity.

The basic philosophy of treatment is to do the conservative and reversible treatments first. Irreversible treatments , such as surgery or orthodontics, are only considered if conservative steps have failed to bring lasting relief. These more radical treatments are rarely used. Most patients respond well to simpler care.

The following treatment modalities may be used in each case..

Occlusal Splint – Also called a night guard, or the new FDA approved NTI Device, are is designed to protect the teeth from further wear. These also will reduce the severity of grinding at night and allow the muscles to rest. In more severe cases it needs to be worn all day as well to allow the TMJs and muscles to rest.

The NTI Device is much easier to wear than traditional night guards and is fit to your teeth in only one appointment. It attaches to your front two teeth only and does not allow the posterior teeth to touch at all. This alignment suppresses clenching over ninety per cent, giving the jaw muscles a break. Also, since the teeth are out of contact no wear occurs. The NTI has also received FDA clearance as an adjunct for the treatment of medically diagnosed migraine pain

Jaw Rest – You must rest your jaw for it to heal. The occlusal splint will help somewhat but other steps should be taken. You should not chew gum at all, bite your nails, clench your teeth together while awake, or any other non functional jaw habits (pencil chewing, etc.). Your diet should be fairly soft, avoid chewy and crunchy foods during treatment.

Medication – Pain medication can be prescribed. Often over the counter analgesics such as ibuprofen are enough. Sometimes we will prescribe medicine similar to Ibuprofen but a bit stronger. These medications not only relieve pain but reduce inflammation as well to aid in the healing process. Occasionally a mild muscle relaxant may be prescribed. Narcotic medications are not very helpful in treating TMD and are rarely prescribed.

Moist Heat – Moist heat is very helpful for the sore muscles of TMD. The penetrating moist heat promotes blood flow into the muscle which aids in healing and relaxation of the muscle as well. This increased blood flow also helps analgesic/ anti inflammatory medications into the muscles. A wet washcloth with a hot water bottle will do, or you can purchase moist heating pads if you wish.

Exercises – Some simple jaw and neck exercises which will help the muscles stretch. A good time to do some of these is in the warm, moist environment of the shower or bath, particularly in the morning and/or before bedtime.

Occlusal Adjustment – We evaluate all TMD patient’s bite with the T-Scan computerized bite analyzer. This device shows exact bite forces on each tooth in the mouth during various motions. It allows conservative, effective adjustments to be performed when needed. Bite discrepancies that aggravate TMD symptoms may be corrected through a minor reshaping of the teeth. These usually are diagnosed after wearing the NTI device for several weeks or more. They are discovered when the muscles relax after consistent NTI splint wear.

Physical Therapy – Physical therapy can help relax the muscles, increase joint flexibility, and the like. We can do some simple stretching therapy in the office if needed. If you need more involved therapy you will be referred to a physical therapist.

Stress Management – Emotion and stress plays an important role in TMD. TMD may be a sign that the patient is under stress that they are not quite aware of. Anything that helps you relieve stress is helpful, such as reading, exercising, listening to music, and the like. If the stress is getting to be a bit much, counseling is often helpful to learn stress management. Counseling is also recommended if you feel you need help with any emotional problem. It is almost impossible to get relief from TMD if the underlying emotional issues are not addressed.

Referral – Specialists may be needed to optimally treat your case. Opinions and/or treatment may be sought from physicians, oral surgeons, orthodontists, psychotherapists, physical therapists, or prosthodontists. Very severe cases may be referred from the start to a pain center or a dentist whose main focus is the treatment of temporomandibular disorders.