Treatment Of Temporomandibular Disorder

Deciding on the Right Treatment

Just as there are no established guidelines for diagnosing temporomandibular disorder, there also is no single best treatment. Most experts agree, however, that conservative, nonsurgical therapy is the right way to begin. Surgery and other invasive treatments, such as injections, can create more problems and are best left as a last resort.

Most people with TMD have symptoms that are temporary and do not worsen into a more serious condition. For these people, symptoms can usually be relieved with simple treatment done at home. Sometimes symptoms go away without any treatment at all. They also can come back without any warning.

If you have TMD, your dentist may suggest the treatments listed below. Most dentists agree that these treatments work best when they are used in combination. You may not get relief using only one.

Soft foods — By eating food that doesn't require a lot of chewing, you give your jaw, including your temporomandibular joint and chewing muscles, a chance to rest and heal. This means you shouldn't eat food that is:

  • Thick or large, requiring you to open your mouth wide
  • Chewy, like a caramel apple
  • Hard or crunchy, like a hard roll, pretzel or raw carrot

When possible, cut food into very small pieces so it's easier to chew. The best food, however, is soft and require little or no chewing. Examples include:

  • Yogurt
  • Mashed potatoes
  • Cottage cheese
  • Soup
  • Scrambled eggs
  • Fruit smoothies
  • Cooked vegetables or fruits
  • Fish
  • Grains
  • Beans

Some people's symptoms go away after about two or three weeks on a soft-food diet. Other people need to stick to this diet for a longer time.

Ice packs, exercise and moist heat — Some people find that a routine of ice, exercise and moist heat helps TMD symptoms. Start by applying an ice pack to the side of your face and temple. This relaxes tight muscles that may be causing spasms. Try to do this for about 10 minutes. Then do a few simple stretching exercises, like this one:

  • Put your left thumb under your upper front teeth.
  • Put your right index and middle fingers on top of your lower front teeth.
  • Gently pull the jaw apart using your hands, not your jaw muscles.

Your dentist may recommend other exercises, too. In fact, he or she may suggest that you see a physical therapist to help with some of these exercises. End the routine by applying a warm towel or washcloth to the side of your face for about five minutes. Try doing this several times a day.

Medicine — This can include:

  • Nonsteroidal antiinflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Motrin), help relieve muscle pain and swelling. Most can be bought over-the-counter at pharmacies and drug stores.
  • Muscle relaxants help relax tight jaw muscles. These can be useful to people who grind or clench their teeth. You will need a prescription.
  • Antianxiety medicines help relieve the stress that is sometimes thought to aggravate TMD. These medicines are available only with a prescription.
  • Antidepressants used in low doses to reduce or control pain. In these doses, however, the drugs do nothing for depression.

Splints — Splints are designed to fit over the teeth. They prevent the upper and lower teeth from coming together, making it impossible for a person to grind or clench his or her teeth. These devices work by taking pressure off the jaw joints and muscles, which gives them a chance to relax and heal. If your dentist thinks a splint would be helpful for you, he or she will determine when you should wear it (during the day or at night) and for how long. A splint should never be worn so long that it changes your bite.

None of these treatments is a cure, but they may relieve the symptoms of TMD. If symptoms continue or return, be sure to see your dentist.

Tips for Relief

Here are some more suggestions that may help relieve your TMD pain or discomfort: Yawn and chew (especially gum or ice) as little as possible and avoid extreme jaw movements, like yelling or singing.

  • When you need to yawn, place a fist under your chin and press up to keep your mouth from opening too wide.
  • Try to remember to keep your teeth slightly apart as often as you can. Keep in mind that it is natural for your jaw to open a little if your lips are closed.
  • Sleep on your back, not on your stomach.
  • Don't rest your chin on your hand or hold the telephone between your shoulder and ear.

Other Treatment Choices

There are many different types of treatments for TMD. Some are more controversial than others. If your TMD is not better after trying the basic treatments listed above, your dentist may suggest one or more of the following:

  • Transcutaneous electrical nerve stimulation (TENS) — This therapy uses low-level electrical currents to relax the jaw joint and facial muscles. For some people, this relieves pain. This noninvasive treatment can be done at the dentist's office or at home.
  • Ultrasound — Ultrasound treatment is deep heat that is usually applied to the joint if it is sore or lacks mobility.
  • Trigger-point injections — For this therapy, a dentist injects pain medicine or an anesthetic into tender facial muscles to relieve pain. While the pain medicine is working, it is good for the person to stretch the jaw muscles with simple exercises.

Surgery: The Last Resort

Surgery should be considered only if you still are experiencing severe, persistent pain and all other treatment options are exhausted. Your dentist and oral surgeon also must have determined that the cause of your TMD is connected to a structural problem within the jaw joint. For instance, you may have limited jaw movement or lockjaw due to disc displacement.

Before undergoing any surgery, be sure to get a second and third opinion from other dentists. Remember, surgery is irreversible. While it has been successful in some cases, it sometimes results in more pain and jaw damage. Be sure your dentist clearly explains why you should have surgery, the risks and benefits of the proposed surgery and other possible treatment options.

The temporomandibular joint (TMJ) is a small ball-and-socket joint. It consists of the following parts:

  • The ball, called the condyle
  • The socket, called the glenoid fossa
  • A small, fibrous disk, which acts as a shock absorber between the ball and socket

There are two main types of surgery for TMD: arthroscopy and open joint surgery.

Arthroscopy

Like many types of surgery, arthroscopy requires general anesthesia. While the patient is unconscious, the surgeon makes a small incision in front of the ear. A small, thin instrument equipped with a lens and light is inserted through the cut. This instrument is connected to a video screen and monitor, which allows the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove tissue or realign the disc or the condyle.

Open Joint Surgery

There are many types of open joint surgeries. In all of them, the surgeon operates on the TMJ without the use of special equipment like video monitors. Instead, he or she opens up the area around the TMJ to get a full view. This provides better access and allows the surgeon to move around more easily. Your oral surgeon may suggest this type of surgery if:

  • Your TMJ is degenerating
  • There are tumors in or around your TMJ
  • There is severe scarring or chips of bone in the joint

It takes longer to heal from this type of surgery than it does from arthroscopy. There is also a greater chance of scarring and nerve injury.


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