docTMJ disorders cause a variety of symptoms ranging from jaw stiffness, limited range of motion, and ringing in the ears to outright pain. These symptoms take a toll on the patient’s quality of life. So it’s no surprise that patients go to great lengths to get treatment. From YouTube videos to visiting doctors and surgeons, patients can be often overwhelmed and not know what to do. So what are the treatment options for TMJ disorders?
TMJ Treatment Options
For TMJ disorders, treatment options can be broken down into 2 broad categories: home self-care and professional care by a dentist or a surgeon. There are also some therapies that should be avoided at all costs. We’ll discuss all, but first, let’s start with self-care by the patient.
TMJ Home Remedies
Our body is a great machine as it can perform many complicated tasks and functions seamlessly. It can even heal itself when it’s damaged or diseased. Of course, there are limits. And once these limits are reached, then no amount of self-care or home remedies can help it. For TMJ pain, there are some things the patient can do at home.
TMD is an inflammatory disease (unless we’re talking about Trigeminal neuralgia or a tumor in the joint or soft tissue). Meaning, some parts of the jaw joint or the various musculature around the head and neck get inflamed, and then the symptoms start secondary to the inflammation. So the rationale follows that if we reduce inflammation, the symptoms should get better. And for reducing inflammation, sports medicine has taught us the “RICE” moniker: rest, ice, compression, and elevation.
- Rest
The patient should “rest” the muscles in and around their head and neck as much as possible. This means the patient should eat a soft diet, avoid repetitive jaw movements (e.g. chewing gum) and avoid clenching or grinding.
- Ice
When it comes to numbing pain, ice is the best. That’s why professional athletes often sit in ice baths. They’re not trying to prove their machismo! They’re dulling their aches and pain without taking all sorts of pain meds. An ice pack on the face where it hurts for 5 minutes at a time can be quite helpful.
- Compression
This term refers to wrapping the injured body part to keep swelling down. However, this really doesn’t apply to TMJ. You definitely don’t want to wrap your head and jaw up together as there are no benefits other than looking a bit silly.
- Elevation
The purpose of elevating or lifting the body part is to keep the weight off it. That’s why people use crutches when they injure their knees. In TMJ, we don’t really “elevate” the jaw. We want to think instead of disengaging the jaw. There’s an old saying “lips together, teeth apart.” This means that when we are not chewing food or swallowing, our bottom teeth should not be touching the upper teeth. This essentially takes the excess load off the jaw, much like the elevation of the knee in the example above.
- Pain Medications – NSAIDs
Aleve, Advil, and Motrin are some of the most common NSAIDs on the market. These drugs provide pain relief and reduce inflammation. Both are good for dealing with acute TMJ pain. However, all drugs come with a whole host of side effects and should not be taken for long periods of time.
- Stress Reduction – Massage
Some people clench or grind their teeth when they are stressed. And we don’t know why exactly. Reducing clenching and grinding is one of the key components for treating TMJ successfully. Patients should consider yoga and meditation or anything else that reduces their stress levels. Massaging the inflamed facial muscles can also be quite helpful.
- CBD’s
CBD oils and lotions may be helpful for some. There is a wide variety of products available. Please follow all state laws and regulations.
Now that we have looked at the self-care remedies, let’s take a look at what the dentist or surgeon may be able to offer you.
Non-Invasive TMJ Treatment
Non-invasive treatment is sometimes referred to as “reversible” therapy. Meaning the results of the treatment (good and bad) can be reversed by discontinuing the treatment. And further implying that the patient does not undergo any permanent irreversible changes in a short period of time. These treatments involve bite splints (for day and/or nighttime use), physical therapy, lasers, other electro-therapeutics (TENS, Ultrasound, Iontophoresis), and injectable medications (e.g. Botox, joint injections, etc.) Let’s look at each a bit further.
- TMJ Bite Splints – Night Guards
For a mouthguard or bite splint to be effective, it needs to be made with TMJ symptoms in mind. There are many types of mouthguards. Using the wrong ones can result in no change at best and worsening of the symptoms at worst. More on this later. And just because it is made by your dentist or surgeon, it doesn’t mean it’s the “right” one. Unless your dentist or surgeon understands the TMJ issues clearly and is using the appropriate splint. A daytime TMJ splint is different than one for nighttime. Some patients may need a daytime appliance only. Using a nighttime TMJ splint on these patients will not prove that useful. Same for a patient who needs a nighttime splint and is given a daytime one. Other times the patient may need both. That’s why you want a dentist that understands and has the training to treat TMJ disorders.
- Physical Therapy
Physical therapy at the right time is very helpful. Physical therapy is used primarily to regain function. For example, when a bone breaks the patient is put in a cast. Afterward, when the break has healed and the cast comes off, the patient starts physical therapy to regain the use of the limb as the muscles have not been used and have weakened. This patient will not benefit from PT when the break has just happened or is still in the healing phase. The same can be said for TMJ. Physical therapy can be used when the inflammation has been handled and the patient is trying to regain lost function.
- Lasers – Electrotherapeutic Modalities
Advances in technology over the years have allowed doctors to offer treatments that would have otherwise been unavailable. Lasers are the latest in the way of electro-therapeutics available. Regardless of the modality involved, the goals are reducing inflammation, increasing circulation, and promoting healthy cellular activities (ie. cellular regeneration).
- Botox – Joint Injections
For severe joint pain, the jaw joints can be directly injected with medication. For patients who clench uncontrollably, Botox injected into the jaw muscles is quite beneficial. And while some may consider these treatments as irreversible, they really are not. The effects of the injections wear off after a period of time and there is no permanent irreversible change to the patient after only one treatment.
Invasive – Surgical TMJ Treatment
At the other end of the spectrum from reversible therapy, we have invasive therapeutic options. These treatments can involve restorative dentistry, orthodontics, joint surgery, and facial/joint reconstruction.
- Restorative Dentistry
Sometimes a procedure commonly referred to as “bite adjustment” is performed by the dentist. This often involves grinding directly on the teeth in the patient’s mouth. Done selectively with a clear goal in mind it can be helpful. Done haphazardly with no end game in sight is hardly recommended. What is ground off cannot be put back, at least not as easily.
- Crowns, Bridges, and Full Mouth Reconstruction
An “unhealthy bite” can result in TMJ. Correcting the bite can be done by changing the shape of the teeth and how they fit together using dental crowns and bridges. When multiple crowns/bridges are used it is often referred to as a full mouth reconstruction. These procedures are not without their fair share of problems. They are highly technique sensitive and depend entirely on the experience and knowledge of the dentist performing the procedures.
- Orthodontic Treatment
This treatment is predicated on the TMJ being caused by bite issues again. Orthodontics involves the movement of the teeth through the bone. When it comes to esthetics and function, orthodontics is a great treatment choice. There are limitations as to what can be achieved by orthodontics alone. Sometimes orthodontic therapy is used along with oral surgery to improve the bite. These treatments have proven useful for some. They also come with their issues as well. When orthodontic therapy or combination therapy doesn’t resolve the original problem, there is no going back.
- TM Joint – Closed Surgery
Arthrocentesis and TMJ Arthroscopy are both examples of closed-joint surgery. In Arthrocentesis small needles are inserted into the joint space to irrigate the joint with fluids and flush out debris. In TMJ arthroscopy, a small tube is inserted into the joint. And with the use of super small surgical instruments through this tube the surgery is performed.
- Open Joint Surgery – Joint Reconstruction
These treatments are by far the most invasive. The surgery may involve removing a part of the joint, or the joint in its entirety. What is removed is often replaced with a prosthetic implant. A major problem with these procedures is the long and painful healing, coupled with unpredictable results for the patient.
TMJ Treatments to Avoid
While we cannot give medical advice, we can give you a road map you can use in getting help. The safest and most predictable approach is to start with home remedies. If that doesn’t do the job see a dentist who specializes in these disorders. Non-invasive solutions should be looked at first carefully before jumping to invasive or surgical solutions. Along with this road map, we want to provide you with some red flags to be aware of.
- Over-the-Counter, Boil-and-Bite Mouthguards
These are often available in retail sporting goods stores or online retailers. They are great for sports, but horrible for patients with TMJ. Do not use one as you are guaranteed to get worse.
- Anti-Depressants, Muscle Relaxants
These medications never solve or help with the root of the problem. They can cause serious side effects as well. Plus what they are used for is easily accomplished by using something with fewer side effects like Excedrin.
- “Fixed” Dental Appliances
Any dental treatment that involves bonding or gluing something to the teeth for treating TMJ should be avoided. These devices are often marketed to the unsuspecting dental provider as a viable treatment option for TMD. Nothing can be further from the truth. These devices often result in undesirable tooth movement and leave the patients worse off than before. Just look at the AGGA debacle.
- Occlusal Equilibration – Bite Adjustment
When you tell your dentist that you have jaw problems and such, if their first recommended treatment is to adjust your bite, you might want to consider a second opinion. Always try non-invasive treatment before doing something that cannot be undone.
- Full Mouth Reconstruction Without Splint Therapy First
Full mouth reconstruction is a complex and arduous task for the dentist, not to mention what the patient goes through. If your dental provider is talking about a mouth full of crowns without first having helped you with a bite splint, get another opinion. A full mouth reconstruction should only be considered after your initial problems are handled to your satisfaction. Again, use caution.
- Orthodontics
Orthodontic therapy is not designed to treat TMJ. The only way orthodontic treatment helps with TMJ is for a very small group of the population. For most people though, their TMJ issues are not because they have crooked teeth. Their TMJ is due to excessive clenching. Straightening the teeth won’t help with the clenching. And remember about “fixed” dental devices for treating TMJ. Braces are usually bonded onto the teeth.
- Surgical Options
Surgical options should be viewed as the last resort for treating TMJ. You should consider these only when all other options have been exhausted and you can fully accept that there may be little or no gain, or even worsening of your symptoms and developing new ones.
Conclusion
TMJ disorders are quite painful and debilitating. No doubt they have a huge impact on the patient’s quality of life.
When starting treatment, start with non-invasive therapies. Be wary of solutions that claim your TMJ can be cured by using XYZ appliance or procedure. There is no cure for TMJ. The goal is to minimize and manage the symptoms so the patient can function comfortably.
Our dentist has years of experience treating TMJ disorders successfully. Contact us if you have any questions or want to set up a consultation with the doctor.