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Conservative Approach for Tempromandibular Dysfunction

Posted in Family Health.

     Approximately 15 percent of people in the United States experience pain associated with tempromandibular dysfunction (TMD), however only 1 percent have pain severe enough to seek treatment.  In many cases TMD can be alleviated with nonsurgical treatment or self managed care. Nonaggressive therapy can be both helpful and economical Some common signs and symptoms of TMD may include tenderness or pain of the jaw, aching pain in and around the ear without infection, aching facial pain, frequent headaches, tooth pain or sensitivity, inability to open jaw smoothly or evenly, clicking or popping jaw joints, and an uneven or uncomfortable bite.

 What is TMJ?

      The tempromandibular joint, also know as TMJ, is the joint where your lower jawbone meets your skull.  This joint is located just in front of your ears and is used constantly during everyday functions such as talking, chewing, and yawning.  The TMJ is one of the most complex and unique joints in the human body because it combines sliding motions with a hinge action.  Cartilage covers the parts of the bones that interact in the joint and they are separated by a small shock-absorbing disk, which allows the movements to be smooth.

 What causes TMJ?

     TMD can occur due to various reasons.  TMD is a major source of face, head and neck pain.  People who habitually grind or clench their teeth often develop TMJ disorders because they overwork and fatigue the muscles that stabilize the joint.  Others may have TMJ pain due to worn or damaged cartilage in the joint, which is seen in those with arthritis.  In other instances of TMJ disorder, the disk in the new joint was moved out of its proper alignment or becomes eroded. 


What are conservative self care techniques?

      If one suspects he or she is suffering from TMJ disorder, they can utilize some of the following self care techniques: one should avoid eating chewy foods (gum, bagels), large foods which require excessive mouth opening, and hard and crunchy foods.  After eating crunchy foods, the symptoms of TMD usually become evident after a couple of hours.      


    One can also try applying moist heating packs to loosen muscles around the TMJ.  According to Dr. Robert N. Arm, Director of the General Practice Residency of Dentistry at Christiana Care, hot water bottles, warm to hot packs, or electric heating pads should be used for about 1 ½ hours; there should be at least 1 ½ hours of rest before the initiation of a second cycle of moist heat therapy.  The body heals itself.  The objective is to allow the patient to be comfortable while healing continues.  


     One can take over the counter nonsteroidal anti-inflammatory drugs (NSAIDS) such as Ibuprofen or Naproxen, which may provide temporary relief.  Some patients find their TMJ disorder symptoms intensify in times of stress or emotional unrest due to increased bruxism (grinding of the teeth) or tension of the facial muscles.  These patients may benefit from meditation or yoga to help relax the mind and body and from limiting stressful situations.  Progressive relaxation techniques can also help the patient.  Successful early treatment is best to avoid the development of chronicity. 

 When one seeks help from a specialist, what kind of experience is expected?

      When self management of TMD is insufficient, one should consider seeing their dentist or physician. Due to the complexity of tempromandibular disorder, many patients have to see several health professionals or specialists for complete evaluation and diagnosis.   

      Certain imaging techniques including CT scans, MRIs, or panoramic xrays may all be used to visual pathologic changes of the TMJ.  Physical examination including listening and feeling for clicking, popping, or cracking (crepitus) in the joint along with examination of the dentition should also be performed. 

      Passive stretch exercises for the muscles of mastication should be used to regain muscle length and coordination and may prove to be helpful under the supervision of a physical therapist.  Dr. Arm notes that vapocoolant spray and stretch is a noninvasive technique  for both diagnoses and therapy of myofacial pain and can be readily accomplished as an office procedure.  The passive stretch itself is thought to be therapeutic action. 

      Your dentist may recommend wearing a nightguard (occlusal guard) if there is evidence of bruxism.   


     Severe cases may require invasive procedures such as injections into the joint or surgery.  For muscle  trigger points that persist, injection with local anesthesia without vasoconstrictor and Botox injection may be considered. 

      Electrotherapeutic management of myofacial pain includes Tens, iontophoresis, and high voltage stimulation.  These modalities may enhance patient comfort and reduce treatment time and are used most often in combination with other forms of myofacial pain treatment. 


    In summary, various non-aggressive therapys such as moist heat, inflammation reducing drugs and muscle relaxers, muscle massage, physical therapy, soft diet, and stress reduction such as yoga and meditation can aid in alleviation of TMD pain.  In order to restore balance to the joint and reduce clenching and grinding, it may be necessary to use a custom bite guard, replace missing teeth, adjust the bite, or move teeth (orthodontics).

Dr. Amit Dua, DMD, 2007 University of Pennsylvania graduate, former resident at Christiana Care Health Service & Dr. Linda Le Nguyen, DDS 1985 UCLA graduate, member of Medical/Dental staff at Christiana Care Health Service 



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