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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
                                                             
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TMJ/TMD

DIAGNOSIS AND TREATMENT

   

Diagnosis TMD News Update
Examination Involves Resources
Treatment Guidelines TMD Medication Treatment
Self Care Techniques Pain Disorders
Other Techniques Bite Splint
Remember Bite Splint Home Care

Diagnosis:

     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*

Joint examination by dentist

The examination includes:

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Examination of joints

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Checking  dental and medical history.

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Regular dental X-rays are NOT generally used.

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Before undergoing any expensive diagnostic test, it is always wise to get another independent opinion.

TMJD Self Test

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Treatment:

     The key words to keep in mind about TMD/TMJ treatment are:

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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 ......

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Reversible so as not to cause permanent, or irreversible, changes in the structure or position of the jaw or teeth.

      Because most 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 be managed.

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 Simple Self Care Management Techniques are:

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Eating soft 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

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Avoid hard foods like French bread or bagels.  Avoid chewy foods like steak or candy.  Cut fruits into small pieces and steam vegetables.

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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 prolonged chewing.

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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.

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Posture training.

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Saying the letter N throughout the day can remind you to unclench or discontinue grinding your teeth.

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Repair teeth that have been damaged from grinding.

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If you , 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.

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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,

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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.

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Keep your tongue up and teeth apart.  The teeth should never be touching (Except occasionally during swallowing).  

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Remember to keep the joints moving in order to produce synovial fulid, don't immobilize this area .**

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 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.

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Avoiding extreme jaw movements (such as wide yawning, loud singing and gum chewing).

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Massage 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 seconds.  

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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.**

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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.

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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:
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N-stretching (placing the tip of the tongue on the roof of the mouth and stretching the jaw)

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chin-to-chin exercised (gently pulling the head forward, bringing the chin toward the chest.

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head tilts (truing the head to one side and then tilting it posteriorly)

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These 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. ***

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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.

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Vapo-coolant spray provides a temporary anesthesia effect to the muscles.  A commonly used muscles relaxant is cyclobenzaprine (Flexeril)***

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Ultrasound  sound waves that are applied to the joint and muscles to reduce pain and swelling and promote healing.

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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.

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Avoid activities that involve wide or prolonged opening of jaw, long dental treatment until the pain has been reduced.

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Do not thrust your lower jaw forward, such as biting off a piece of thread, smoking, applying lipstick or while under stress.

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Avoid stomach sleeping or leaning on the jaw since this puts adverse forces on the jaw and neck muscles.

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Don't bite any food with your front teeth.

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Antidepressants like Elavil and medications like it, will put the suffer 
into 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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Bite Splint can help relieve symptoms of TMJ

 Other techniques:

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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. .

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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 time.

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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.

 Before undergoing any surgery on the jaw joint, it is very important to get other reliable independent opinions.

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Remember:

  1. In most people, discomfort from TMD/TMJ will eventually go away whether treated or not. 

  2. Simple self-care practices are often effective in easing TMD/TMJ symptoms. 

  3. If more treatment is needed, it should be conservative and reversible. 

  4. Avoid, if at all possible, treatments that cause permanent changes in the bite or jaw. 

  5. 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.

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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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Additional Resources
American Academy of Head Neck and Facial Pain
Migraine Headache NTI-tss Directory
University of Washington Department of Radiology
Anatomy Modules

TMJ Anatomy
 

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This information has been obtained from:

***Evaluation and Management of TMD, Dr. Uyanik, Dentistry Today 11/03 pg 108-116. 
American Dental Association
Academy of General Dentistry
National Oral Health Information Clearinghouse
Practical Periodontics and Aesthetic Dentistry.
*Generation X Forum, Jeffrey Hoos DMD
*AGD Impact, March 2001
**
*Initial Management of TMD; Dr. Syrop; Dentistry Today pg 52-57; August 2002

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February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
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