Treating Temporomandibular Disorder or TMD
How can you decide on the right treatment for TMD?
You must keep in mind that there are no established guidelines for diagnosing temporomandibular disorder and there are also no single best treatments for such disorder. Most experts agree that nonsurgical therapy is always the right way to begin. Surgery and other invasive treatments like injections may create more problems and should be left as a last resort.
Most people with TMD have symptoms that are temporary. They do not worsen into more serious conditions. For these people, symptoms are usually relieved with a simple treatment done at home. In some cases, symptoms go away without any treatment whatsoever. The symptoms can also come back without any warning at all.
If you have TMD then your dentist may recommend some of the treatment listed below. Most dentists agree that these treatments will work optimally when done in combination rather than only using one
- eat soft foods that do not require a lot of chewing. This will allow your jaw, temporomandibular joints, and chewing muscles a chance to heal. You should avoid foods that are thick or large and may require you to open your mouth wide, foods that are chewy like caramel apples, and foods that are hard or crunchy like hard rolls, pretzels, or raw carrots
- cut your food into small pieces so that they are easier to chew
- if you can get food that requires little or no chewing then that would be even better. Some of the foods you may want to consider are yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fruit smoothies, cooked vegetables or fruits, fish, grains, and beans. Take note that some people's symptoms will go away on this kind of soft food diet while others may need to stick to this diet for a longer time
- use ice packs, exercise, and moist heat. People find that a routine of ice, exercise, and moist heat can help most TMD symptoms. You can start by applying an ice pack to the side of your face and temple. This will relax the tight muscles that may be causing spasms on your face. Do this for about ten minutes and then do some simple stretching exercises. You can put your left thumb under your upper front teeth. Then, put your right index finger and middle finger on top of your lower front teeth. Finally, gently pull the jaw apart using your hands and not your jaw muscles. Your dentist may recommend other exercises too and in fact, you may even want to get a physical therapist to help with some of the exercises. You can end the routine by applying a warm towel or washcloth to the side of your face for a couple of minutes. Do this several times everyday
- use medications. Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen will help relieve muscle pain and swelling. Most of them can be bought at over-the-counter pharmacies and drug stores. Some muscle relaxants help you relieve tight jaw muscles. These relaxants can be useful especially for people who grind and clench their teeth. You may need a prescription for these. You can use anti-anxiety medications to help relieve the stress that can cause aggravation of the TMD. These medicines also need prescriptions. Antidepressants used in low doses can reduce or control your pain. In these doses, the drugs will not do anything about depression
- use splints that are designed to fit over the teeth. They will prevent the upper and the lower teeth from meeting. This will make it impossible for a person to grind or clench their teeth. These devices work by taking pressure off the jaw joints and muscles. They will give these muscles a chance to relax and to heal. If your dentist thinks that a splint is best for you then they will determine the way you should wear it. You may have to wear it during the day, night, twenty four hours, or whatever your dentist prescribes.
Keep in mind that none of these treatments will guarantee a cure. They may be able to relieve the symptoms of TMD. If the symptoms keep coming back and refuse to go away then you must see your dentist.
Here are some tips that you may want to keep in mind so that you can relieve yourself of some of the TMD pain and discomfort
- yawn and chew as little as possible. Avoid extreme jaw movements like yelling or singing
- when you need to yawn, you must place your chin and press up in order to keep your mouth from opening too wide
- make sure you keep your teeth slightly apart as often as you can. Remember that it is normal for your jaw to open a little even if your lips are still closed
- try sleeping on your back and not on your stomach
- do not rest your chin on your hand
- do not hold the telephone between your shoulder and your ear
What are some of the other treatment choices for TMD?
There are several types of treatments for TMD and some are more controversial than the others. If your TMD is not getting better after the basic treatments aforementioned then your dentist may suggest one or more of the following procedures
- transcutaneous electrical nerve stimulation or TENS. This therapy uses low level electrical currents to relax the jaw joints and the facial muscles. In some people, this will relieve pain. This non-invasive treatment can be done at the dentist's office or can be administered at home
- ultrasound treatment uses deep heat that is applied to the joint if it is sore or if it lacks mobility
- trigger-point injections is a therapy where a dentist injects pain medicine or anaesthetic into tender facial muscles. This will relieve pain in some patients. While the pain medication is working, it is good practice to stretch the jaw muscles using simple exercises
What are some of the surgeries used to treat TMD?
Surgery should be considered as a last resort to resolve TMD. You should go through surgery only if you are experiencing severe pain and if you have gone through all the other treatment options. Your dentist or your oral surgeon must have determined the cause of your TMD and it must be related to structural problems with your jaw joint. For example, you may have limited jaw movement or lockjaw because of disc displacement.
Before you go through any surgery, you should get a second and third opinion from other dentists. Remember that surgery is irreversible and it may be successful or not. In some cases, TMD is resolved while in other cases, there is simply more pain and more damage done on the jaw. You must be sure about your surgery. Your dentist must be able to explain why you should have your surgery, the risks and the benefits from the surgery, and other treatment options available aside from surgery.
The temporomandibular joint or the TMJ is a small ball-and-socket joint that consists of the following parts
- the ball is also known as the condyle
- the socket which is also known as the glenoid fossa
- a small, fibrous disk that acts as a shock absorber between the ball and the socket
There are two main types of surgery for the TMD and they are
- Arthoscopy is a type of surgery that requires general anaesthesia. When the patient is unconscious, the surgeon will make a small incision right in front of the ear. A small, thin instrument equipped with a lens and light is inserted through the cut and through this instrument, the surgeon will be able to examine the TMJ and the surrounding area through a video screen or monitor. Depending on the cause of the TMD, the surgeon will remove tissue, realign the disc, or realign the condyle
- Open joint surgery is when the surgeon operates on the TMJ without the use of any special equipment like video monitors. Instead, the surgeon opens up the area around the TMJ to get a full view. This will provide better access and it will allow the surgeon to move around more easily. Your oral surgeon will suggest this type of surgery if your TMJ is degenerating, if there are tumours around your TMJ, and if there is scarring or chips of bone in the joint
You need more time to heal with open joint surgery than arthoscopy. There is also a greater chance of scarring and nerve injury with open joint surgery.