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TMJ Disorders

Temporomandibular Joint Disease (TMJ) & Myofascial Pain Syndrome

Although the exact nature of temporomandibular joint disease and myofascial pain syndrome are different, the causes and treatment can be similar.  There are a number of basic things that all patients can do to minimize their pain and disability and to facilitate their treatment.

Your symptoms are similar to those of any other orthopedic injury, in which there is injury to the joint itself or the related ligaments, tendons and other soft tissues.  Treatment is directed toward allowing the body to repair the injury by its own natural healing process.  Surgery is always the last resort and is avoided whenever possible.  Remember, like all other injuries, it will take time for your symptoms to improve and to evaluate your response to treatment.  This is especially true if your pain and limitation has existed for some time.  Do not expect to get better overnight.

  • The most basic treatment is resting the jaw joint and muscles.  This is done by avoiding crunchy (e.g.:  carrots, pretzels) and chewy (e.g.:  bagels, steaks, chewing gum) foods, which put a lot of stress on the joint and require the muscles to exert considerable force.  You should cut your food into smaller pieces or put it into a blender in order to minimize the work of eating.
  • Try to relax your jaw and keep your teeth apart when not eating.  This will take the stress off the joint and soft tissues.  Try to become aware of when you clench or grind your teeth, such as when you are under stress, and try to break yourself of the habit.
  • Good back, neck and head posture help maintain good jaw posture.  Try to hold your head up straight and avoid leaning on your hand when reading or watching television.  You may use a lumbar support for your lower back.
  • Moist heat over the affected muscles and ligaments helps to relax them.  This can be done up to 3 or 4 times per day for 20 minutes.  If there is acute inflammation, alternating with ice directly over the painful area for 20-30 minutes may give relief.  This can also be done 3 or 4 times per day.
  • Relaxation techniques, such as deep breathing, yoga, relaxation tapes, biofeedback, etc. may be useful in reducing stress.  Some patients may also benefit from professional counseling to help deal with life or job stress, which is contributing to the TMJ problem.
  • Anti-inflammatory medications are frequently prescribed (e.g.:  Ibuprofen 800 mg three times per day).  They are most effective when taken on a regular schedule, rather than just as needed.  You should take the medication every day, whether you need it or not during the initial treatment period.  After the pain and symptoms have resolved, you will be taken off the medication.  You may also be prescribed a muscle relaxant, if it appears that it will be helpful for your situation.  All muscle relaxants may cause drowsiness or difficulty concentrating.  Some must be taken for a few days before the effect is noticed.  If you have any problems or questions about your medications, please call our office.
  • If you have limited mobility of your jaw, you may practice jaw-opening exercises in front of the mirror.  Try to open and close your mouth straight up and down.  This will help loosen ligaments and strengthen muscles.  You can do this in the morning and evening, only when pain is not flaring up.
  • An occlusal orthotic (night guard or splint) is an important part of therapy in many patients.  This allows the jaw and muscles to find the most relaxed position, to allow the joint to rest.  It also helps to stop you from clenching and grinding your teeth unconsciously when awake and asleep.  You may need to wear it 24 hours per day, or just at night, depending on your particular case.  Your general dentist or orthodontist can fabricate these appliances if they are needed to treat your condition.
  • Physical therapy may be indicated in your treatment.  Some techniques can be performed in the office as part of your regular follow-up visit, but it may be necessary to have a physical therapist involved in your care for specialized treatments.
  • Dietary supplements, such as chondroitin and glucosamine have been recently shown to be important in joint function.  Taken in therapeutic doses, they may help reduce joint pain and inflammation.  Recommended doses are Chondroitin sulfate 600 mg twice per day, and Glucosamine sulfate 750 mg twice per day.  These supplements can be purchased at most pharmacy and health food stores.

Other treatments, such as orthodontics, restorative dentistry or surgery may be indicated in your case, and will be discussed with you when appropriate.

A very small percentage of TMJ patients will benefit from surgical procedures relative to the temporo-mandibular joint.  Surgery is considered when there is loss of joint function to the point of daily incapacity and when less invasive treatment options have been exhausted

If you have any questions regarding your treatment, medications or home care, do not hesitate to call the office.