treatment in tmj disorders

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There are a few different treatment methods with regard to treating TMJ. These methods combine both medical and dental resolutions. The patient may be given anti-inflammatory medications for their TMJ. Along with the medications, the patient may be advised to apply hot compresses to the location of the TMJ and told to remain on a soft-food diet for a certain period of time.

Once the medications and compresses have done their duties, the next step is to visit a dental professional to have the jaw-related issues resolved. At the dental professional’s office, the patient may have to have permanent dental corrections performed in order to ensure that the TMJ does not come back again. There are a few different dental treatments for TMJ which include orthodontics work, construction of a removable prosthesis or dental reconstruction. The treatment method which is applied will depend on the diagnosed cause of the TMJ.

        

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Treatments range from simple self-care practices and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, non-surgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.

Basic Treatments
Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw (as instructed by your dentist or physical therapist). After exercising, apply a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.

Eat soft foods. Eat soft foods such as yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods (like hard rolls, pretzels, raw carrots), chewy foods (like caramels and taffy) and thick and large foods that require your mouth to open wide to fit.

Take medications. To relieve muscle pain and swelling, try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin), which can be bought over-the-counter. Your dentist can prescribe higher doses of these or other NSAIDs or other drugs for pain such as narcotic analgesics. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti-anxiety medications can help relieve stress that is sometimes thought to aggravate TMD. Antidepressants, when used in low doses, can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs and antidepressants are available by prescription only.

Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, lessening the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn full time (24 hours a day for 7 days). Your dentist will discuss with you what type of mouth guard appliance you may need.
Undergo corrective dental treatments. Replace missing teeth; use crowns, bridges or braces to balance the biting surfaces of your teeth or to correct a bite problem.

Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.

Don’t rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.

Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.

Learn relaxation techniques to help control muscle tension in the jaw. Ask your dentist about the need for physical therapy or massage. Consider stress reduction therapy, including biofeedback.

More Controversial Treatments
When the basic treatments listed above prove unsuccessful, your dentist may suggest one or more of the following:

Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles. This treatment can be done at the dentist’s office or at home.

Ultrasound . Ultrasound treatment is applied to the TMJ to relieve soreness or improve mobility.
Trigger-point injections. Pain medication is injected into tender facial muscles called “trigger points”” to relieve pain.

Radio wave therapy. Radio waves create a low level electrical stimulation to the joint, which increases blood flow. The patient experiences relief of pain in the joint.

Surgery for TMD

Surgery should only be considered after all other treatment options have been tried and you are still experiencing severe, persistent pain. Because surgery is irreversible, it is wise to get a second or even third opinion from other dentists.

There are three types of surgery for TMD: arthrocentesis, arthroscopy and open-joint surgery. The type of surgery needed depends on the TMD problem.

Arthrocentesis. This is a minor procedure performed in the office under general anesthesia. It is performed for sudden-onset, closed lock cases (restricted jaw opening) in patients with no significant prior history of TMJ problems. The surgery involves inserting needles inside the affected joint and washing out the joint with sterile fluids. Occasionally, the procedure may involve inserting a blunt instrument inside of the joint. The instrument is used in a sweeping motion to remove tissue adhesion bands and to dislodge a disc that is stuck in front of the condyle (the part of your TMJ consisting of the “ball” portion of the “ball and socket”)

Arthroscopy. Patients undergoing arthroscopic surgery first are given general anesthesia. The surgeon then makes a small incision in front of the ear and inserts a small, thin instrument that contains a lens and light. This instrument is hooked up to a video screen, allowing the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove inflamed tissue or realign the disc or condyle. Compared with open surgery, this surgery is less invasive, leaves less scarring, and is associated with minimal complications and a shorter recovery time. Depending on the cause of the TMD, arthroscopy may not be possible, and open-joint surgery will need to be considered.

Open-joint surgery. Patients undergoing open-joint surgery also are first given a general anesthesia. Unlike arthroscopy, the entire area around the TMJ is opened so that the surgeon can get a full view and better access. There are many types of open-joint surgeries. This approach is used if:
The bony structures that comprise the jaw joint are deteriorating
There are tumors in or around your TMJ
There is severe scarring or chips of bone in the joint
Compared with arthroscopy, open-joint surgery results in a longer healing time and there is a greater chance of scarring and nerve injury.

        

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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.

        

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