Treatment of Temporomandibular Disorders
Temporomandibular disorders (TMD) involve a broad variety of symptoms that have been known to have common characteristics, including:
- Muscles that are associated with jaw movements;
- Facial pain, especially near the TMJ; and
- Trouble with the jaw joint
Therefore, diagnosis and therapy can be difficult. Many TMJ problems will get better with time, thus many experts are very conservative when it comes to treatment(s). This is why the more invasive type treatments are used if no other options available or if your dentist feels that surgery if your only hope for treatment. Most individuals with TMD only have symptoms that are temporary, and don't get more serious. They can be prescribed home treatments, and there are those whose symptoms go away and then return again. Your dentist may recommend the following treatments to help you with your TMD. You probably have to use a few of these, as one may not do the trick.
Eating Soft foods: Eat foods that do not require much chewing, and give your jaws a rest. Stay away from foods that: require you to stretch your mouth open; are chewy and sticky; and, are crunchy and/or hard. Also, try to cut your foods into very small pieces. Several good food are: mashed potatoes; yogurt; soups; cottage cheese; scrambled eggs; fish; fruits and cooked vegetables; smoothies; beans; and some grains that are not hard. Symptoms usually diminish or disappear after several weeks when eating only soft foods.
Moist heat, ice packs, and exercises: Some individuals feel that these help relieve their TMD problems. First apply to heat to your joint area, temple, and sides of your face for about ten minutes, to loosen up your muscles and perform some jaw stretching exercises:
- Place the thumb of one hand under your front teeth of your upper dental arch.
- Next place the index and middle fingers of your opposite hand on top of the front teeth of your opposite dental arch.
- Then, don't us your jaw muscles, but pull your jaw apart gently using your thumb and fingers.
Other exercises may be suggested by your dentist. Next, follow this up this ice on both sides of your face for five minutes. Due this several times a day. Your dentist may also refer you to a physical therapist to help treat your TMD.
Medications: Your dentist may prescribe one or several medications to help you with the pain associated with TMD. These may include: Nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter ibuprofen or aspirin; prescription muscle relaxants to help relax your muscles; and, low doses of antidepressants which may help with pain. Splints: You dentist will fabricate a splint to be worn over your teeth to prevent your teeth from hitting each other. These are usually made of orthodontic acrylic. If properly designed, the splint will keep you from grinding and clenching your teeth and reduce pressure to your TMJ and its associated muscle groups. Your splint should be worn as prescribed by your dentist. The above recommendations and treatments are not cures; however they should relieve some of your symptoms.
Some Recommendations: These recommendations should help you to relieve some discomfort and/or pain:
- Don't chew gum or ice, and try not to yawn.
- Minimize your jaw movements, i.e., no singing or yelling.
- If you have to yawn, try to keep your mouth from over-opening.
- Try not to touch your teeth together as much as possible. It is normal for your teeth to be separated when your lips are together.
- Try to sleep on your back.
- Don't put any undue pressure on your jaw.
Other Treatments: If the above recommendations and treatments don't work for you, your dentist may suggest the following treatment(s).
Transcutaneous electrical nerve stimulation (TENS) . TENS units sometimes relieves pain associated with TMD. Your dentist can perform this treatment, or there are small portable units can you can use at home.
Ultrasound : Deep heat is applied using ultrasound treatments if the TMJ is very sore or is resistant to movement.
Trigger-point injections : Your dentist can inject either pain medication or anaesthetic solution into the associated muscles that are tender to relive pain. After the injections, you should move and stretch your jaw muscles using simple exercises that your dentist will show you.
Acupuncture : Acupuncture and acupressure has been helpful for some individuals with TMD.
When Should Surgery Be Considered: If all of the above treatments fail, and constant pain is still present, you dentist may speak with you about surgery. Additional tests may be required to determine if structural damage exists in your TMJ that keeps it from responding to other type therapies. You may have a torn or displaced disc that needs repair or properly placement to resolve your problem. Also, some individuals who have severe degenerative disease may not respond at all to other therapies, and surgery may be recommended as a first choice. Always make sure that you get a second opinion before agreeing to surgery, as it cannot be reversed easily and sometimes not at all. If successful, it works; however, if not successful, it can cause much more pain. Make sure that all of your questions are answered, and that your oral surgeon points out the benefit to risk ratio, and all other therapeutic options. The two main types of oral surgery for TMD are arthroscopy and open joint surgery.
Arthroscopy requires general anaesthesia. The oral surgeon will make a small incision in front of the ear, and using a small, thin instrument containing a light source and lens, the instrument is inserted and guided by the oral surgeon's hand using a video screen and monitor. The surgeon then performs their work and an additional incision is made to insert small instruments.
Open joint surgery is more invasive and takes longer to heal, and may be suggested if arthroscopy will not work, the TMJ problem is degenerative. A very low percentage of individuals with TMD may require total replacement of the TMJ.
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