Treatment of Temporomandibular Disorders
Deciding on the Right Treatment
This variety makes diagnosis and treatment challenging. An accurate diagnosis is critical for successful treatment. For instance, patients with a muscle problem that is causing pain will most likely not benefit from surgery on the temporomandibular joint.
Most problems, whether muscular or within the joint, get better over time. For this reason, most experts agree that it's best to use conservative treatment at first. But in some instances, surgery or other procedures, such as injections, may be recommended as a first treatment.
Most people with TMD have temporary symptoms that are not serious and do not get worse. They usually can get better with simple treatments done at home. Sometimes symptoms go away without any treatment at all. They also can come back without warning.
If you have TMD, your dentist may suggest the treatments listed below. Most dentists agree that these treatments work best in combination. You may not get relief using only one.
Soft foods — If you eat food that doesn't require a lot of chewing, your jaw gets a chance to rest and heal. This means you shouldn't eat food that is:
When possible, cut food into very small pieces so it's easier to chew. The best food to eat, however, is soft and requires little or no chewing. Examples include:
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 moist heat, exercise and ice helps TMD symptoms. Start by applying moist heat 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:
Your dentist may recommend other exercises, too. End the routine by applying ice to the side of your face for about five minutes. Try doing this several times a day. Physical therapy often plays an important role in treating patients with TMD. Your doctor may decide to refer you to a physical therapist.
Medicine — This can include:
Splints — Splints are designed to fit over the teeth. They prevent the upper and lower teeth from coming together. This makes it difficult for you to grind or clench your teeth. These devices take pressure off the jaw joints and muscles so they can relax and heal. If your dentist thinks a splint would help 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
Other Treatment Choices
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 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's sore or doesn't move. It is often used along with physical therapy.
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, you should stretch your jaw muscles with simple exercises.
Acupuncture — For some people with TMD, acupuncture can be helpful.
In some instances, surgery is the first option. Patients who have severe degenerative disease may not respond to more conservative measures.
Before having any surgery, be sure to get a second opinion from another surgeon. Remember, surgery can't be reversed. It has been successful in most cases, but it sometimes results in more pain and jaw damage. Be sure your surgeon clearly explains why you should have surgery, the risks and benefits, and other treatment options. You should have a clear understanding about what you can expect from surgery.
The temporomandibular joint (TMJ) is a small ball-and-socket joint. It consists of the following parts:
There are two main types of surgery for TMD: arthroscopy and open joint surgery.
Arthroscopy Like many types of surgery, arthroscopy usually requires general anesthesia. While the patient is unconscious, the surgeon makes a very small incision in front of the ear. A small, thin instrument equipped with a lens and light is inserted. The instrument is connected to a video screen and monitor. This allows the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove tissue or adjust the disk or the condyle. A second incision is then made. The surgeon uses this incision to place small instruments.
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, an incision is made just in front of the ear and the joint is operated on under direct vision. Your oral surgeon may suggest this type of surgery if:
It takes longer to heal from this type of surgery than it does from arthroscopy. Although there is a chance of scarring, the incision usually heals very well and is difficult to notice. Your surgeon will discuss other risks of surgery.
A very small percentage of patients require total joint replacement to correct the underlying problem.
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