What If I Am Diagnosed with TMD (Temporomandibular disorder)—How Can It Be Treated?
When you discuss your jaw pain with your dentist, he or she may diagnose it as TMD, or temporomandibular disorder. TMD is not one condition, but a group of several conditions, often painful, that can affect the jaw joint (the temporomandibular joint, or TMJ) and the muscles that control chewing. The good news is that most TMJ disorders can be treated conservatively and easily and will not require surgery. A sequence of TMD treatments can isolate and address your particular condition, and your continuing routine dental visits during your TMD treatment will allow your dentist to monitor your TMJ symptoms.
Temporary TMD Pain Relief
Many home and drugstore remedies can temporarily alleviate the pain of TMD symptoms. The less aggressive of these include heat and cold packs, physical therapy, biofeedback, massage, and NSAID medications, such as ibuprofen. For a temporary solution, you might avoid foods that require repetitive chewing, or avoid extreme movements of the jaw, such as the wide opening of the mouth required in singing or yawning. What is important to remember is that, although these approaches can sometimes provide temporary pain relief, they do not treat the cause of your disorder. TMD treatment administered by the proper dentist will often be less costly and less time intensive. What’s more important, it can produce longer-lasting results.
Traditional Treatments for TMJ: Appliance Therapy, Occlusal Equilibration, Surgery
Before your dentist can select a specific treatment for your TMD symptoms, it is critical that she make a careful examination of the affected joints and occlusion. If an improper bite is the cause, one solution might be orthodontics or restorations, but often appliance therapy or occlusal equilibration is needed. In a small percentage of TMD cases, surgical intervention is required.
Appliance Therapy (Splint or Mouth Guard)
Typically, the first line of treatment prescribed by your TMD dentist will be the wearing of a TMJ splint to reposition the lower jaw into the socket. This will allow the muscles to function optimally, reduce stress on the jaw, and/or cover the deflective interferences affecting the bite. Your TMD dentist has experience in fabricating many different types of splints and appliances, and, based on clinical findings, symptoms, and diagnostic tests, he or she will decide which appliance is best for you. If a splint helps to relieve the pain, it is possible that it was your bite or parafunction that was causing the problem. (Parafunction is a dental term that refers to unconscious activities of your central nervous system, such as grinding of the teeth during sleep, that might be harmful.)
If your dentist determines that no structural disorder exists in the joint, you might have deflective interferences (teeth that do not line up properly when you bite or chew) that are affecting your bite and causing an improper jaw closure. If that is the case, your dentist may suggest you undergo occlusal equilibration. Occlusal equilibration involves selective reshaping of the biting surfaces of the teeth. Often, the TMJ can be corrected with occlusal equilibration performed by a dentist experienced in TMD diagnosis. If the lower jaw has previously been unable to close properly into position within the temporomandibular socket, occlusal equilibration can allow the muscles to function properly again and offer immediate pain relief.
Typically, only after all the conservative TMD treatment options have been exhausted, is oral surgery considered: arthrocentesis (a procedure in which fluid is drained from the joint), arthroscopy, or open-joint surgery. These procedures are performed under general anesthesia.
What Other Options Do I Have?
Unfortunately, there are some TMD issues that are not resolved even by surgery. If you have sought and received proper diagnosis and treatment early, you will probably not need more aggressive alternative medical treatments, such as transcutaneous electrical nerve stimulation (TENS), ultrasound, trigger-point injections, or radio-wave therapy. Like the self-help or drugstore treatments mentioned above, however, these treatment alternatives are only palliative; that is, they may provide limited, temporary symptomatic relief, but do not treat or “cure” the causes of TMD.