tmj_diagramAfter the diagnosis of temporomandibular joint disorder (TMD) is established, contributing factors are identified and all effective options of therapy and treatment will be explained.

Typically, symptoms develop over several years, often starting with mild non-painful clicking of the jaws or tightness in the jaw, head, or neck muscles. Treatment may range from avoiding specific activities like chewing gum or bagels, to alternative therapies. These may include:

  • Exercises
  • Behavior modification/biofeedback
  • Counseling
  • Stress management
  • Diet counseling
  • Physical therapy
  • Oral appliances
  • TMJ injections/arthrocentesis
  • Surgery

Managing Your TMJ Disorder

The purpose of managing TMD symptoms is to decrease pain, adverse pressure or loading on the jaw joints, and restore normal jaw function. This can be achieved by identifying contributing elements and following a program to treat physical, emotional, and psychological factors.

There are several conservative management techniques proven to be safe and effective in many TMD cases. In fact, research shows that over 50 percent of TMD patients have fewer or no ongoing symptoms after conservative management. Techniques may include:

  • Behavior modification
  • Physical therapy
  • Medication
  • Jaw exercise
  • Orthopedic appliances (orthotics)

Effective Ways to Treat TMD

Behavioral Intervention

Behavioral intervention is often necessary for long-term control of maladaptive behavior and persistent habits like tooth clenching or nail biting. Behavior modification programs facilitated by a trained clinician can be very effective. Clinical behavior modification programs may include:

  • Habit reversal programs
  • Life-style counseling
  • Progressive relaxation
  • Autogenic training
  • Hypnosis
  • Biofeedback

TMD Medication

Medication can be very effective to reduce pain and inflammation. The extended use of the following medications may lead to depression, drug tolerance, and addiction.

  1. Narcotic (opioid) medications – Codeine, Hydrocodone, Propoxyphene
  2. Sedative psychotropic drugs – Valium, Xanax, and Ativan

Use of these medications that often give temporary relief from pain, are discouraged for long-term pain management.

Oral Orthopedic Appliances

Oral orthopedic appliances are routinely used in TMD management and are usually made from hard acrylic, are removable and cover the upper or lower teeth. They should be periodically checked and adjusted by an experienced dentist as the potential exists for harmful changes to the teeth and jaws if improperly used. TMD appliances are designed to:

  • Redistribute the occlusal forces
  • Prevent wear
  • Reduce mobility of teeth
  • Reduce bruxism/clenching
  • Reduce jaw muscle pain
  • Alter structural relationships within the TMJ

Physical Therapy

Physical therapy performed by a licensed physical therapist is a well-recognized, effective, and conservative treatment for TMJ disorder. Certain techniques may include spinal-head-jaw and tongue posture training. Physical therapy aids in:

  • Reducing factors contributing to TMD
  • Reduces inflammation
  • Restores function
  • Promotes repair and regeneration of injured tissues

Methods for TMD Management

TMJ mobilization techniques are often indicated for decreased range of motion and pain related to jaw muscle contracture, disc displacement, and adhesion in the joints. Pain reduction and muscle relaxation is usually required before mobilization of the jaw. Physical agents for TMD management include:

  • Electrotherapy (EGS, TENS, etc.)
  • Ultrasound
  • Anesthetic agents (Vapocoolant spray or topical anesthetic)
  • Stretching
  • Massage

TMJ Arthrocentesis

TMJ arthrocentesis consists of anesthetizing the affected TMJ with local anesthetic followed by flushing the joint with a sterile solution such as Lacated Ringers Solution. This is meant to lubricate the joint surfaces and reduce inflammation.

Anti-inflammatory agents (corticosteroids) can be injected into the joint following arthocentesis. Gentle manipulation of the jaw is often utilized following arthrocentesis to improve the jaw range of motion and in some cases, lysis or break fibrous adhesions that limit normal jaw opening.

TMJ Surgery

TMJ surgery can be effective treatment for specific joint disorders. However, it's typically used on very select cases because of the complexity of techniques, potential for complications, and frequency of behavioral and psychological contributing factors. Surgical procedures include:

  1. Closed surgical techniques (arthroscopy) may have limitations related to the limited size of the arthroscopic instruments and limited space within the joint.
  2. Open surgical techniques (arthrotomy) used to treat painful joint hypomobility secondary to displaced discs, fibrous adhesions, and arthritis.

Frequently Asked Questions

What are effective medications for managing TMD?

The most effective drugs for TMD management include:

  • Non-narcotic analgesic drugs such as Acetaminophen (Tylenol)
  • Non-steroidal anti-inflammatory drugs (NSAIDS) like Aspirin, Trilisate, Ibuprofen, Naproxen and prescription strength NSAIDS
  • Muscle relaxant drugs such as Carisoprodol (Soma) and Cyclobenzaprine (Flexeril)
  • Tricyclic antidepressant medications including Amitriptyline (Elavil), Nortriptyline (Pamelor), and Doxepin (Sinequan)

All medications have specific benefits and side effects. Long term use of medications should be directed and supervised by your dentist or physician to reduce the potential side effects.

Are there alternative ways to relieve TMD symptoms?

To help relieve TMD symptoms, patient self-care includes:

  1. Limit jaw opening (yawning, etc.) to no more than 2 fingers widths
  2. Rest of the jaw by avoiding heavy chewing (gum, bagel, tough meats)
  3. Avoid grinding and clenching teeth by keeping them slightly apart and the jaw relaxed
  4. Try not to lean or sleep on the jaw
  5. Keep clear of wind, brass and string instruments that stress, retrude or strain the jaw
  6. Apply a cold or moist heat compress as directed by your doctor or therapist
  7. Massage the affected muscles
  8. Use over-the-counter medications such as Aspirin, Ibuprofen, Naproxen, or Tylenol

Is occlusal therapy effective in treating TMD?

Occlusal therapy has little support in the scientific literature for routine use in the treatment of TMD. Several recent scientific studies on occlusion and TMD conclude that treatment of occlusion for TMD is infrequently necessary. Limited occlusal adjustment following stabilization of the TMD symptoms may be beneficial. In general, irreversible occlusal changes should be discouraged.

Are there any possible complications with oral orthopedic appliances?

Oral orthopedic appliances are commonly referred to as occlusal splints, orthotics, night guards, and bruxism appliances. Complications can occur with excessive or incorrect use of these appliances. These may include:

  • Dental caries
  • Gingival inflammation
  • Mouth odors
  • Speech difficulties
  • Tooth movement
  • Psychological dependence on the appliance

Why are physical therapy exercises important?

Exercises prescribed by the physical therapist or doctor are important to:

  • Maintain normal muscle/joint function and comfort
  • Improve joint range of motion
  • Increase muscle strength
  • Develop normal coordination and stabilize the TMJs

Exercises should be specifically prescribed and monitored by the therapist or doctor as improper or excessive exercise therapy can aggravate TMD symptoms.

What is TMJ arthrotomy?

TMJ arthrotomy, or open joint surgery may range from simple removal of adhesions, disc repair or replacement to total joint replacement utilizing cartilage and bone grafts or vitallium metal implants. The TMD patient should be aware that there is no guarantee for successful surgical outcome and should routinely get several opinions prior to accepting TMJ surgery.

When would TMJ arthrotomy be required?

TMJ arthrotomy (open joint surgery) may be required in:

  • Severe fibrous adhesion removal
  • Ankylosis (bony or fibrous)
  • Tumor removal
  • Chronic dislocation
  • Painful non-reducing disc dislocation
  • Severe osteoarthritis that have not been responsive to reversible treatment modalities

Schedule Your Consultation

Are you suffering from TMJ disorder? Dr. Kaspo can help relieve your pain and create a personalized treatment plan to help manage your TMD.

To learn more, give us a call today at (248) 519-1100 or fill out a contact form to schedule your no-obligation consultation today.