Treatment Options for TMD / TMJ

The temporomandibular joint (TMJ) is the most active joint in your body. It is responsible for all your jaw movements while eating and talking and more importantly, controls, along with the tongue and pharyngeal muscles, your ability to maintain an airway and breathe. It is constantly active every day all day long and takes a lot of wear and tear. In addition, it is a major contributor to balance.

Some studies show that approximately 75% of the population experiences some signs and symptoms of temporomandibular joint disorder (TMD) at some point in their lives. In most cases, there is little or no intervention necessary to treat the symptoms and the body recovers quickly.  Many of the patients not treated may have continuing underlying pathology that decreases the quality of their lives in subtle ways. Approximately five to ten percent of the population does require some sort of medical treatment to alleviate the symptoms of TMD/TMJ. Patients who do not require treatment will sometimes opt to use neuromuscular techniques to improve appearance and reduce signs of aging.  Professionals and amateur athletes now utilize neuromuscular dentistry to improve athletic performance, and a recent study at Rutgers confirmed the efficacy of the PPM (Pure Power Mouthguard).

Signs and symptoms of TMD include:

  • Headache
  • Migraine
  • TM joint clicking, popping and locking
  • Tinnitus, ringing of the ears
  • Jaw pain or achiness
  • Muscle pain or MPD
  • Sinus pain and stuffiness
  • Retro-orbital pain or pain behind the eye
  • Otalgia (or ear pain)
  • Cervicalgia (or neck pain)
  • Dizziness
  • Facial pain
  • Snoring
  • Sleep apnea
  • Morning headaches
  • Abfraction (or grooves on roots of teeth)
  • Severe tooth wear
  • Tightness in the neck
  • Atlas adjustments that do not hold
  • Scalp pain
  • Occipital pain
  • Pain in the temples
  • Tooth pain without cause
  • According to the National Heart Lung and Blood Institute (NHLBI) of the NIH (National Institutes of Health), there are cardiovascular consequences of TMJ disorders. Cognitive brain function and the autonomic nervous system secondary to TMJ disorders. The report is titled “Cardiovascular and Sleep Related Consequences of TMJ Disorders.”

Types of TMD

  • Muscle related – This usually results from overwork, fatigue, or tension of the jaw and related structures.
  • Joint related – Problems with the joint itself, degeneration, of the hard or soft tissues, or inflammation, including arthritis, are common joint problems
  • Occlusion related.  Muscles and joints must accommodate to existing occlusion.  In reality, there is never only one problem but a interrelate group of problems

Treatment Types

Depending on the type and severity of your particular condition, the neuromuscular dentist will create a headache treatment plan with the goal of getting your jaw back into proper alignment.  Proper alignment would be healthy muscles, joints, occlusion and posture of not just the jaw but the entire craniomandibular and cervical complex.

Simple, conservative treatments are usually reversible, are not invasive and do not permanently change the structure or shape of your jaw. These treatments usually work best if there is an underlying healthy relation of the jaws.  Some patients become symptomatic due to habits such as hours of chewing gum seen in teenagers and also in patients who recently quit smoking and are using nicotine gum incessantly.

A second example would be a “cheerleader” joint where hours of yelling and shouting lead to overuse and delayed muscle and/or joint pain. 

This is also sometimes the case after trauma such as wisdom tooth extraction or a motor vehicle accident.  Patients whose underlying structure is neuromuscularly correct will usually heal following trauma.  Patients with compromised neuromuscular jaw and teeth relations may never heal even though they never experience problems before the trauma they were predisposed to problems.

  • Eating soft foods
  • Alternating heat and ice packs
  • Avoiding large jaw movements when possible
  • Physical therapy
  • Medication
  • Massage
  • Acupuncture or acupressure
  • Topical medicaments and anti-inflammatories

Other treatment types include:

  • Orthotics—Often mistakenly referred to as splints. These oral appliances, also called bite plates and bruxism appliances are plastic guards that fit over your upper and/or lower teeth. These can help reduce damage from tooth grinding (bruxism), which places a lot of stress on the TM Joints. These appliances are meant to be worn on a temporary basis and should not cause a permanent change in the patient’s bite. Whenever an oral appliance is worn, it always changes the orthopedic functioning of the entire system. Long-term use of orthotics will create permanent bite changes and/or postural changes.

The use of bruxism appliances at night protects the teeth and muscles and joints from being damaged by grinding and clenching. All oral appliances are not the same, and they can create problems as well as prevent them.

The NTI-tss (Nociceptive Trigeminal Inhibition-tension suppressing system) appliance has been approved for treatment of migraines by the FDA, and it has some uses but is not a neuromuscular appliance. It works by sending nociceptive inputs into the trigeminal system to suppress clenching. While it may be helpful for some patients, it can also be harmful for others, and regular monitoring of the patient should be continued.

The fact that the FDA has approved this appliance for treating migraines should forever put to rest the question as to whether migraines can be caused by or treated with oral appliances.

***Neuromuscular Orthotics are designed to create a three dimensional repositioning of the mandible to a physiologically healthy and stable position that allows postural corrections throughout the body.

  • Invasive – Injections and surgery are both considered invasive procedures since they break the integrity of the skin. Injections are typically reversible, as the effects will eventually fade. Surgery is often irreversible and is not usually resorted to unless and until other more conservative treatments are tried.

Trigger point injections into muscles and prolotherapy injections into tendons and ligaments can have incredibly positive effects for some patients, often speeding recovery time. There is always some degree of risk associated with invasive procedures.

Prolotherapy (Proliferation Therapy) uses proliferating agents (such as dextrose) injected into muscles, tendons, and ligaments to strengthen them by inducing new collagen formation without surgical intervention.

Diagnostic blocks are often helpful in discovering underlying pathology, and autonomic blocks can be both diagnostic and curative. An excellent example is the sphenopalatine block that can relieve pain and other autonomic symptoms. When it is effective, repetitive use can speed healing in the patient   Neuromuscular dentists will frequently block the auricular-temporal nerve or the occipital nerves. Neurosurgeons can do diagnostic or long acting blocks of Stellate Ganglions and other structures.

  • Irreversible treatments that are meant to permanently change your bite include implants, orthodontia, orthognathic surgery and restorative and reconstructive dentistry.

Unless major facial trauma is involved or is shown to be the main factor in your continued TMD, your neuromuscular dentist will attempt to use conservative diagnostic treatment options initially, and delay any invasive or irreversible type treatments until a substantial improvement in symptoms, function and quality of life has been obtained.  CR dentists will often start their treatments with major equilibration (grinding of the teeth to change the bite).  Neuromuscular dentists usually avoid this because of the danger of making the symptoms worse.  If permanent changes are used initially and the condition worsens, there is no way to “ungrind” the teeth.

If you suffer from TMJ headaches or TMD headaches, contact us for a neuromuscular dentistry consultation and see how our TMD/TMJ treatment options can help you.

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