TMJ/TMD: Treatment plans for TMD are as varied as the patients that present with it. Each patient must be treated differently depending on the uniqueness of their problems and the contributing factors.
It is very important to realize that the goal of TMD treatment is to minimize pain and establish a return to function. TMD conditions are not “cured” but are managed instead. The basic goal is to allow the muscles and joints to heal through rest and care. Often damage to the joint itself cannot be reversed, but the body can often heal it enough to return to function without pain. We also want to teach you to recognize the symptoms early and manage them yourself once we give you the tools to do so. This condition can often recur later on but early care can minimize the severity.
The basic philosophy of treatment is to do the conservative and reversible treatments first. Irreversible treatments , such as surgery or orthodontics, are only considered if conservative steps have failed to bring lasting relief. These more radical treatments are rarely used. Most patients respond well to simpler care.
The following treatment modalities may be used in each case:
Botox: Botox can be injected into the very large muscles that are the powerhouse behind clenching and grinding. The Botox will weaken the muscles and reduce the risks of continuing damage to the joints and teeth.
Occlusal Splints – These devices are is designed to protect the teeth from further wear. These also will reduce the severity of grinding at night and allow the muscles to rest. In more severe cases it needs to be worn all day as well to allow the TMJs and muscles to rest. There exist many types of TMJ splints and which type is best depends on each patient’s situatiuon.
Full coverage traditional splints are useful, particularily in patients with mostly joint dificulties. They protect the teeth from the wear and tear of grinding and help stabilize inflamed and damged TM joints.
The NTI Device is easier to wear than traditional night guards for many patients. They are smaller than traditional splints and are designed not to allow the posterior teeth to touch at all. This alignment suppresses clenching over ninety per cent, giving the jaw muscles a break. Also, since the teeth are out of contact no wear occurs. The NTI has also received FDA clearance as an adjunct for the treatment of medically diagnosed migraine pain. Customized NTIs on traditional orthodontic retainers can be made as well. Patients often prefer this design as it has a more stable fit and eliminates any risk of swallowing the device.
NTI-tss: Using the body’s natural reflex protection
The NTI-tss system takes advantage of the naturally protective nociceptive trigeminal inhibition reflex which prevents the powerful temporalis muscles from contracting with full intensity. It is the protective reflex experienced when biting down, expecting something soft, but encountering something hard. In addition to preventing occluding of the canine and molar teeth (which is required to generated significant muscle contraction intensity and joint strain) this jaw-opening reflex – triggered by the NTI-tss device – protects incisors, posterior molars, surrounding tissues and the TM joints. Helps prevent associated headaches, stiff, sore joints and muscles, and tooth sensitivity.
Jaw Rest – You must rest your jaw for it to heal. The occlusal splint will help somewhat but other steps should be taken. You should not chew gum at all, bite your nails, clench your teeth together while awake, or any other non functional jaw habits (pencil chewing, etc.). Your diet should be fairly soft, avoid chewy and crunchy foods during treatment.
Medication – Pain medication can be prescribed. Often over the counter analgesics such as ibuprofen are enough. Sometimes we will prescribe medicine similar to Ibuprofen but a bit stronger. These medications not only relieve pain but reduce inflammation as well to aid in the healing process. Occasionally a mild muscle relaxant may be prescribed. Narcotic medications are not very helpful in treating TMD and are rarely prescribed.
Moist Heat – Moist heat is very helpful for the sore muscles of TMD. The penetrating moist heat promotes blood flow into the muscle which aids in healing and relaxation of the muscle as well. This increased blood flow also helps analgesic/ anti inflammatory medications into the muscles. A wet washcloth with a hot water bottle will do, or you can purchase moist heating pads if you wish.
Physical Therapy – Physical therapy can help relax the muscles, increase joint flexibility, and the like. It also is very useful in training the patient proper posture and bad habit avoidance.We refer many patients for physical therapy with a provider who has experience and training in managing TMD.
Exercises – Some simple jaw and neck exercises which will help the muscles stretch. A good time to do some of these is in the warm, moist environment of the shower or bath, particularly in the morning and/or before bedtime. Click here for some simple exercises.
Occlusal Adjustment – We evaluate all TMD patient’s bite with the T-Scan computerized bite analyzer. This device shows exact bite forces on each tooth in the mouth during various motions. It allows conservative, effective adjustments to be performed when needed. Bite discrepancies that aggravate TMD symptoms may be corrected through a minor reshaping of the teeth. These usually are diagnosed after wearing the NTI device for several weeks or more. They are discovered when the muscles relax after consistent NTI splint wear.
Stress Management – Emotion and stress plays an important role in TMD. TMD may be a sign that the patient is under stress that they are not quite aware of. Anything that helps you relieve stress is helpful, such as reading, exercising, listening to music, and the like. If the stress is getting to be a bit much, counseling is often helpful to learn stress management. Counseling is also recommended if you feel you need help with any emotional problem. It is almost impossible to get relief from TMD if the underlying emotional issues are not addressed.