TMJ is one of the hardest conditions to get successfully treated. Many people with the condition spend years searching for successful TMJ treatment, and some find that the treatments they try can make the condition worse.
So how do you find the best treatment for this hard-to-treat condition? Understanding your options can help you follow a path through noninvasive and reversible treatments first before trying more aggressive therapies that have higher risk. Our guide will help you understand this process so you can navigate its twists, turns, and pitfalls.
What Is TMJ/TMD?
First, it’s important to understand that temporomandibular joint disorders, commonly called TMJ or TMD, is not a singular condition, but an unknown number of conditions that result in overlapping symptoms. These conditions all affect the temporomandibular joints, which connect the temporal bones of the skull with the mandible (lower jaw bone).
This joint sits at a complex and vulnerable intersection in human anatomy. When it has problems, these problems can affect nearby systems, which can lead to a wide array of symptoms (see TMJ symptoms under How Is TMJ Diagnosed?).
Which Is the Right Name?
Some people are confused about whether temporomandibular joint disorders should be called TMJ or TMD. The condition has had many names in the approximately 85 years it’s been a recognized disorder. It was known as TMJ for over a decade before some people decided to start calling it TMD, preferring to use TMJ to refer to the jaw joint. Since then, the condition has had about a dozen names.
Two large organizations of doctors and dentists got together in the late 1990s to try to resolve the naming issue. They agreed that the condition should be called TMD, so this has become its “official” name. However, by this time, so many people were accustomed to calling it TMJ, that the official declaration has made little difference.
Types of TMJ
There are at least three commonly recognized types of TMJ: myofascial pain disorder (MPD), disc displacement (DD), and degenerative joint disease (DJD).
MPD is the most common form of TMJ. It occurs when the jaw muscles are tense or strained, leading to muscle pain and dysfunction. DD is when the cushioning disc between the two bones comes out of place, causing jaw popping and clicking, as well as irregular jaw motion. DJD is when the joint begins to break down as a result of arthritis. The symptoms of these conditions often overlap, and people can have more than one of them at a time.
How Is TMJ Diagnosed?
Successful treatment of TMJ depends on a proper diagnosis of the condition. While in the past there was no standard process for diagnosis, in recent years, doctors and dentists have adopted a procedure that uses a detailed sequence to achieve more reliable diagnosis. First, your doctor will talk about your symptoms. Then they will ask about your medical history. Third, you will get a detailed exam, which will include palpitating (touching) the joint and muscles of the head and neck. Finally, your doctor or dentist may use different technologies to image the joint and measure its dysfunction.
One of the things that has stymied diagnosis of TMJ in the past is that it has so many symptoms that are so widespread. These can lead to misdiagnosis in part because patients often don’t report all related symptoms, since they might not recognize them as being related to TMJ. By focusing on just the most bothersome symptoms (such as headache or tinnitus), it can lead a doctor to consider just a few incorrect possibilities, such as salivary gland infection.
Here is a list of common symptoms that people with TMJ might experience:
- Jaw pain
- Irregular jaw motion
- Limited jaw motion (including locked jaw)
- Popping or clicking in the jaw
- Clenching or grinding teeth (bruxism)
- Damaged or worn teeth
- Ringing ears (tinnitus)
- Congested ears
- Ear pain
- Vertigo or dizziness
- Headaches (including migraines)
- Shoulder, neck, or back pain
- Facial pain
- Numbness in hands and fingers
In addition, sleep apnea and TMJ commonly occur together, so people with sleep apnea or its symptoms should consider themselves at risk for TMJ.
Next, your doctor will talk to you about your medical history. This will include potential injuries that might contribute to TMJ, other conditions that are linked with TMJ, and medications or other treatments that can sometimes occur with TMJ, such as rheumatoid arthritis, lupus, fibromyalgia, vulvodynia, or irritable bowel syndrome (IBS).
The more complete your medical history, the better your odds of a successful diagnosis.
After taking your medical history, your doctor will conduct a physical exam. You will be asked to move your jaw and report symptoms as they occur. The more symptoms that can be demonstrated, the better the diagnosis.
Your doctor will feel your jaw joint and muscles, including head and neck muscles, and muscles inside the mouth. Your doctor may press on certain muscles in an attempt to elicit discomfort.
Imaging and Other Objective Measurements
Based on the results of the previous steps, your doctor may recommend objective measurements of the jaw joints and their function. This may include imaging techniques like panoramic x-ray, MRI, ultrasound, or CT (computed tomography) scans.
Neuromuscular dentists, like Dr. Ken Siegel in Blue Bell, PA, also use a number of tools that can measure aspects of your bite we can’t otherwise measure effectively. This includes a suite of tools called the K-7, which can measure jaw motion, jaw sounds, and jaw muscle tension. Neuromuscular dentists also use a T-Scan bite measurement tool to identify the strength and balance of your bite.
How Is TMJ Treated?
In the past, doctors were quick to jump to invasive treatment for TMJ. However, less invasive treatments are often best, especially when the condition is detected early. With early treatment, you might be able to stop the progress of TMJ so you don’t need more invasive treatments later.
TMJ Home Care
Everyone should start with home care for TMJ. Here are some home care strategies for TMJ:
Avoid overuse: Limit the amount of chewing and talking you do. Stop habits like chewing gum, breaking ice, or chewing nonfoods. Check your exercise regimen and make sure it’s not causing spillover tension or joint damage. Weightlifters often clench their jaws with effort, and the repeated shock of running can also strain the jaw joints.
Stretching: Consider specific exercises that can stretch out the jaw joint to improve function. There are many lists online for these exercises that you can try.
Hot or cold packs: Applying hot or cold packs to the jaw can help relieve discomfort. People are often confused about which to use. Cold packs are best for problems in the joint itself, while heat is best for sore muscles.
OTC medication: Go ahead and take over-the-counter pain relievers and anti-inflammatory medications. Don’t exceed the recommended dosage unless instructed by your doctor.
While home care is a great place to start with TMJ treatment, stop home care and seek professional care if it doesn’t provide any relief, it makes symptoms worse, symptoms persist for more than a week, or if symptoms recur.
Your doctor might prescribe different medications to try to stop discomfort. First, they might prescribe medications that are just stronger versions of what you had at home: pain relievers and anti-inflammatories. They might also recommend oral or injectable muscle relaxants (such as Botox). Steroid injections might also be used. In some cases, tricyclic antidepressants have been used to successfully treat the condition.
There are many therapies used now for TMJ. The most common therapy for TMJ is the use of a bite splint. This mouthpiece, also called an occlusal appliance, is used to hold your jaw in a position that relaxes the muscles and puts the jaw joint in a healthy position. Initially, this might be worn all day, but eventually it is worn only at night. It can provide immediate relief of some symptoms and relief of most symptoms within a few weeks.
Another therapy that some find effective is TENS (transcutaneous electrical nerve stimulation), a kind of electric massage that can relax your jaw muscles.
Physical therapy can help some people relax their muscles and keep their joint in place.
For many people, TMJ has a strong psychological component, so counseling can be very effective. It can help with stress relief, give healthy coping mechanisms, and teach avoidance of habits that contribute to TMJ.
MLS (multiwave locked system) laser therapy uses precise laser wavelengths to stimulate joint healing. This new treatment hasn’t received as much research as others, but its results seem promising so far.
Surgical and Invasive TMJ Treatment
If other treatments don’t give relief, we might have to recommend surgical treatments.
Bite adjustment isn’t surgery, but it is an invasive and irreversible treatment. It modifies your teeth to put your joint into the same position as a bite splint, so you don’t need to continue using the splint.
Arthrocentesis uses needles to inject fluid into the joint to clean it out.
Arthroscopy uses small incisions to insert tools that can operate on the jaw joint. It can be used to clean out scar tissue and modify the structure of the joint to improve function.
Condylotomy changes the relationship between the part of the jawbone that touches the skull and the part that holds the teeth. The goal is for the jaw to be in a healthier position when at rest or in use.
Open jaw surgery is used for the same purposes as arthroscopy, but it’s a more invasive and risky procedure.
Jaw joint replacement replaces the natural jaw joint with a TMJ implant.This procedure has been fraught with some of the most serious complications, so it is considered a method of last resort, after literally all other treatments have been tried and failed.
Many people like that alternative medicine can potentially achieve good results without invasive treatment. Although the record of success of these approaches is slight, there seem to be few risks associated with them, which makes them reasonable treatment options for people who aren’t getting results from other noninvasive treatments.
The traditional approach of acupuncture has been reported to be successful for some people, although it is not currently recognized as an effective treatment in most medical circles.
Relaxation works well for people whose TMJ is linked with stress, which is very common. Although some people find that self-relaxation works well, others find that it works better with a counselor.
An exciting variation on relaxation is biofeedback, in which a person looks at a reading of the tension in their jaw joint and consciously wills the muscles to relax. The evidence of its effectiveness is promising, but slight.
Seeking TMJ Treatment in Blue Bell?
If you think TMJ might be responsible for your symptoms, or if you’ve been diagnosed with TMJ but haven’t been able to get successful treatment, we can help. Please call (610) 272-0828 today for an appointment with neuromuscular dentist Dr. Ken Siegel at Dental Excellence of Blue Bell.