Pain Management
It is the standard of care that in best medical or dental practice the simplest most conservative treatment should be attempted before more invasive treatment that may involve unnecessary procedures , risk, or expense to a patient especially if that treatment is irreversible.
Conservative treatment for TMD involves the following:
Reducing forces to the jaw joints
- Rest and behavioral management including home care and exercises
- Modified softer diet
- Postural reeducation to reduce jaw activity and position
- Improving sleep either with sleep hygiene instructions so that clenching and grinding can be reduced
Medications
*It is also standard of care that habit forming, or addictive medications usually can be avoided in pain management and only used for a short period of time or as a last resort
The most common and safest medications used for TMD are:
- Anti-inflammatory medications
- Muscle relaxers ( also to enable improved sleep.
Intraoral Appliances
These appliances often called bite-guards, nightguards, or splints have been used for decades to treat TMD. The appliances used for treating TMD are specifically designed to reduce harmful forces to the joints. The Orofacial Pain dentist custom designs the appliances to benefit the individual patient according to diagnosis, and to insure that the appliance will cause no harm to the mouth teeth or the bite. These appliances are meticulously adjusted, and the patient will be seen during treatment at specific intervals to keep the appliance properly adjusted.
Appliance management can be the most critical aspect of treatment. In order for the appliance to be effective, the following elements are ESSENTIAL and must be incorporated into each appliance.
- That the appliance is made from the proper material ( hard ) and fits comfortably with no excessive pressure on the teeth, no movement or looseness. The biggest reason for appliance failure is that it is uncomfortable for the patient, and they cannot wear it.
- The appliance should be full coverage and cover all the teeth and touch all the opposing teeth.
- Both upper and lower appliances work the same way. Lowers tend to be more comfortable and can be worn during. Depending on many factors the dentist will decide which is appropriate for each patient.
- The biting surface should be flat, have no indentations, provide freedom of movement, and not force the jaw into any position.
Injection therapy
The Orofacial pain dentist is trained to safely inject structures both in the mouth and outside the mouth for diagnostic and therapeutic purposes.
Injectables include dental anesthetics and steroids.
Botox
Botox is an organic muscle paralyzer from bacteria that has become popular for cosmetics, treatment of migraine headache, sweating, drooling, neuropathic pain, and involuntary muscle movement such as tics.
There is no evidence that it reduces muscle pain or joint pain in TMD, and it is the opinion of the Orofacial Pain Community that although it is generally safe it is overused, expensive and unnecessary in the treatment of TMD. It also needs to be repeated and will thin the face. It is not covered by insurance for muscle pain.
We do use it in a small number of patients to reduce the forces from clenching.
TMJ Surgery
Conservative care is successful for the vast majority of TMD patients, however for a small number ( 5% of patients with disc displacements) surgical intervention maybe helpful. There are very few Oral Surgeons who routinely perform TMJ surgery. We have access to them on our team when needed.
TMJ surgery is most commonly recommended for patients with persistent limited opening or remaining pain from arthritis . Most of the time this surgery can be performed with minimally invasive techniques ( arthroscopy) without incision over the joint.