Because the exact causes
and symptoms of TMD/TMJ are not clear, diagnosing these disorders can be
confusing. At present, there is no widely accepted, standard test to
correctly identify TMD/TMJ. In about 90 percent of cases, however, the
patient's description of symptoms, combined with a simple physical examination
of the face and jaw, provides information useful for diagnosing these disorders.
It is estimated that as much as
20% of the population suffers from pain associated with TMJ dysfunction*
Examination of joints
Checking dental and medical history.
Regular dental X-rays are NOT generally used.
Before undergoing any expensive
diagnostic test, it is always wise to get another independent opinion.
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key words to keep in mind about TMD/TMJ treatment are:
Conservative is to keep it as
simple as possible and these treatments do not invade the tissues of
the face, jaw or joint. Treatment should be non-invasive and ......
so as not to cause
permanent, or irreversible, changes in the structure or position of the jaw
TMD/TMJ problems are temporary and do not get worse, simple treatment
is all that is usually needed to relieve discomfort.
Simple self-care practices
are often effective in easing TMJ/TMD symptoms.
Acute pain following
trauma can be treated and cured. Chronic
pain, where tissue damage occurred long ago, can
Self Care Management Techniques are:
foods like baby food, soups, milkshakes,
eggs. This is to relieve the load on the TM
joint to cause less muscle activity. Severe
cases may need a liquid
Avoid hard foods like French bread or
bagels. Avoid chewy foods like steak or candy. Cut fruits into
small pieces and steam vegetables.
Chew with our back teeth rather than biting
with your front teeth. Don't take big bites or open your mouth too wider
than 1-2 inches. Don't eat any foods that require
DO NOT CHEW GUM! Chewing
gum much of the day increases the wear and tear on the
joint giving little opportunity for your jaw to recover between meals.
letter N throughout the day can remind you to unclench
or discontinue grinding your teeth.
Repair teeth that have been damaged from
, chew habitually only on one side of your
mouth you concentrate all
the pressure on one side rather than equally on both sides of your mouth so
you need to learn to chew evenly, left vs. right.
Applying heat for
5-10 minutes 2 to 4
times daily. Microwave a wet towel for approximately 1 minute or until
towel is warm. You can also wrap the moist hot towel around a hot
water bottle to keep it warm longer. This will increase circulation
and relax involved muscles,
For cold compresses, use ice wrapped in a
thing washcloth for 5-10 minutes, 4 times daily. Ice should only be
applied to the painful area until numbness is experienced. Heat or ice
can reduce joint or muscle pain and relax the muscles. For acute
injuries cold is recommended.
Keep your tongue up and teeth
The teeth should never be touching (Except occasionally during swallowing).
Remember to keep the joints
moving in order to produce synovial fulid, don't immobilize this
Closely monitor your jaw position
during the day in order to maintain a relaxed and comfortable
position. This involves placing the tongue lightly on the top of your upper
front teeth, allowing the teeth to come apart and relax the jaw muscles.
Avoiding extreme jaw movements (such as wide
yawning, loud singing and gum chewing).
to reduce pain and heal
sore muscles. Use
your fingers to massage in a circular motion, the tender
muscles, usually the masseter or temporalis for 5-10
Massage stops and then stretch
the mouth open to the point where it is comfortable and not
painful and it is held stretched open for 5-10 seconds. Do not
massage while stretching. This helps to stretch the masticatory
muscles to their full length. Do this for technique for
5-10 repetitions and than return to hot or cold packs.
Repeat this regimen frequently throughout the day.**
Learning special techniques
by reading a book about relaxation, listen to a relaxation tape
or try yoga for relaxing and
reducing stress. Advanced problems may need to be referred to a psychologist
for biofeedback and stress reduction skills.
Physical therapy you can do at home, which
focuses on gentle muscle stretching and relaxing exercises. When
muscle pain is widespread down to through the shoulders try
physical therapy or massage. some commonly used exercised
to treat TMJ are:
(placing the tip of the tongue on the roof
of the mouth and stretching the jaw)
exercised (gently pulling the head
forward, bringing the chin toward the
(truing the head to one side and then
tilting it posteriorly)
exercise are most effective if done
regularly 4-6 times per day. In
addition, moist heat application for 10-15
minutes followed by ethyl chloride or
fluoromethane spray prior to stretching
the muscles is helpful. ***
Short-term use of
muscle-relaxing and anti-inflammatory drugs. Over the counter
ibuprofen may be useful for short-term use. Or ask your doctor/dentist
about using prescription anti-inflammatory (rofecoxib, 25 mg per day for pain
and inflammation) to reduce gastrointestinal toxicity. Nonsteroidal anti-inflammatory agents (Ibuprofen, Naprosyn, Tylenol,
Alleve) even aspirin are very effective for reducing inflammation in joints
and are recommended before bed and upon waking. NSAIDs (Motrin,
Naprosyn) are indicated for mild to moderate
acute inflammatory conditions. They may
be used for a minimum of 2 weeks. Long
term NSAID use is not recommended.
spray provides a temporary anesthesia effect
to the muscles. A commonly used muscles
relaxant is cyclobenzaprine (Flexeril)***
Ultrasound sound waves
that are applied to the joint and muscles to reduce pain
and swelling and promote healing.
Avoid oral habits that put strain on the
jaw muscles and joints. These include clenching, grinding, touching,
biting cheeks, jaw tensing, biting objects, popping your jaw joint, leaning
on the palm of your hands while reading or watching TV or other habits.
Lips together teeth apart is a technique to keep the jaw in neutral
relaxed position. Practice this technique during the day
and before falling asleep.
Avoid activities that involve wide or
prolonged opening of jaw, long dental treatment until the pain has been
Do not thrust your lower jaw
forward, such as biting off a piece of thread, smoking, applying
lipstick or while under stress.
Avoid stomach sleeping or leaning on the
jaw since this puts adverse forces on the jaw and neck muscles.
Don't bite any food with your
like Elavil and medications like it, will put the suffer
Delta 4 sleep. Delta 4 sleep helps you not
to grind your teeth so the muscles get a rest and the pain is decreased. *
If more treatment is needed,
it should be conservative and reversible.
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Visit your dentist for an oral appliance
called a splint or bite plate.
This is a plastic guard that fits over the upper or lower teeth. The splint
can help reduce clenching or grinding, which eases muscle tension. .
Surgical treatments are often irreversible and should be avoided
where possible. Scientists have learned that certain irreversible
treatments, such as surgical replacement of jaw joints with artificial
implants, may cause severe pain and permanent jaw damage. Some of these
devices may fail to function properly or may break apart in the jaw over
At our office we only take the conservative approach for
the treatment for TMJ/TMD. If this condition is not effectively
treated with self care techniques and the use of a bite splint we will refer
you to the appropriate specialists.
undergoing any surgery on the jaw joint, it is very important to get other
reliable independent opinions.
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In most people, discomfort from TMD/TMJ will eventually
go away whether treated or not.
Simple self-care practices are often effective in easing
If more treatment is needed, it should be conservative
Avoid, if at all possible, treatments that cause
permanent changes in the bite or jaw.
If irreversible treatments are recommended, be sure to
get a reliable second opinion.
The conservative, reversible treatments
described here are useful for temporary relief of pain and muscle spasm --
they are not
"cures" for TMD/TMJ.
If symptoms continue over time
or come back often, check with your doctor.
TMD News Updates
Open Wide For a Quick Fix
Typically, arthritis of the temporomandibular
joint (TMJ or jaw joint) is treated with therapies like
relaxation exercises, nonsteroidal anti-inflammatory drugs or
dental appliances to discourage grinding of teeth. When such
treatments fail, some people resort to invasive surgery.
However, a recent Israeli study suggests something much
simpler and safer might work: arthrocentesis, or removal of
fluid from the joint.
Besides being a diagnostic tool, it turns out
that, in most cases, withdrawing the fluid itself brought
relief. Of the 38 joints that underwent arthrocentesis, 26
became less painful, and opening wide became a lot easier.
What's more, the improvement lasted through an average
year-and-a-half follow up.
The researchers say that arthrocentesis is a
safe and quick procedure, which in many cases, can ease pain
and return function to arthritic jaw joints without the need
for invasive surgical procedures.
Source: Journal of Oral and Maxillofacial
Surgery, Vol. 59, No. 10
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Academy of Head Neck and Facial Pain
Headache NTI-tss Directory
of Washington Department of Radiology
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This information has been obtained
of TMD, Dr.
American Dental Association
Academy of General Dentistry
National Oral Health Information Clearinghouse
Practical Periodontics and Aesthetic Dentistry.
X Forum, Jeffrey
*AGD Impact, March 2001
TMD; Dr. Syrop; Dentistry
Today pg 52-57;
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February 06, 2008
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