TMD & TMJ Disorder
updated July 22nd, 2014
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TMJ is an acronym that stands for temporomandibular joint, the joint located just in front of the ear on either side of the head. The temporomandibular joints and surrounding ligaments and muscles hold the mandible, or lower jawbone, to the temporal bone of the skull. Discs between each joint cushion the bones of the joints for smooth, painless movement. The TMJs allow motions of the jaw that facilitate eating, speaking, and making facial expressions. The TMJs are two of the most used and complex joints in the body.
When the jaw joints are not properly seated, associated muscles work to hold the jaw in proper position. Over time, the muscles become fatigued and swollen, which puts stress on local nerves. This condition, known as TMJ disorder, or TMD, causes pain and discomfort across the body, including the jaw, mouth, face, ears, neck, shoulders, and back. Some people experience tingling toes and fingers, and some doctors contribute certain cases of carpel tunnel syndrome to TMJ disorder. The condition can develop when one or both of the temporomandibular joints stop functioning properly. According to research, more than 10 million Americans suffer from TMJ disorder.
Symptoms of TMJ Disorder
The symptoms associated with TMJ disorder vary and can include the following:
- Jaw joint pain: For those suffering from TMJ disorders, jaw joint pain is one of the most common complaints. Many patients notice a clicking, popping, or grinding sound when they chew or yawn and describe the pain they are experiencing as either dull and constant, or sharp and sporadic.
- Face pain
- Ear pain: Many TMD sufferers do not know that their TMJ is the source of their ear pain or ringing (tinnitus) and assume instead that it must be caused by an ear infection or another inner ear problem. Radiating pain from the affected joint, nerves, or muscles may seem like it is originating from the ears.
- Headaches: When improper articulation of the jaw joint places stress on muscles and nerves, moderate to severe headaches, including chronic migraines, may result.
- Tooth pain: TMJ is most often linked to tooth pain in patients who habitually clench or grind their teeth; this habit is known as bruxism. The extreme pressure absorbed by the teeth and jaw joints while clenching or grinding can wear down tooth enamel and cause crazing or fracturing, which leads to tooth sensitivity. Worn molars also disrupt occlusion, so upper and lower teeth no longer fit together as they should. This, in turn, creates malocclusion, which also causes bruxism. A destructive cycle begins, and without treatment, only worsens with time.
- Tingling extremities
- Neck, shoulder, and back pain
- Carpel tunnel syndrome
Causes of TMJ Disorder
There are many causes of TMJ disorder and jaw joint pain, including:
- Cartilage wear and tear: The cartilage discs that pad the TMJs become worn or displaced, allowing the bones of the joint to grind against one another.
- Dislocated TMJs: Dislocation of the joint is indicated by popping and cracking noises when the jaw is opened or closed, and may negatively affect movement of the jaw and strain the musculature of the jaw, face, and neck.
- Clenching and grinding: Bruxism is one of the most common causes of TMJ disorders. The added stress on the jaw joint can cause wear and tear of the cartilage disks, and may cause the jaw joint to become dislocated. In addition, bruxism leads to tooth wear and malocclusion, which can cause more clenching and grinding, due to overworked muscles in the jaw.
- Misaligned bite/malocclusion: If the bite of the upper and lower teeth is not aligned properly, everyday jaw motions can cause stress to muscles, tendons, and nerves surrounding the jaw joints.
- Arthritis: Arthritis can cause uncomfortable inflammation of the TMJ and may also result in swelling in the adjoining tissues, ligaments and muscles. Arthritis patients may experience difficulty opening and closing the mouth, as well as other painful TMJ symptoms.
Classifications of TMD
Because the causes and symptoms of TMJ disorder vary, the condition is typically classified into three main sub-categories:
- Myofacial pain
- Internal derangement of the joint
- Inflammatory joint disease
These classifications help doctors develop effective treatment options for sufferers of TMJ disorder, based on each patient's unique symptoms and needs. For proper diagnosis and treatment of TMJ pain, a patient may require evaluations from multiple medical specialists. In addition to general dentists, dentists trained in neuromuscular dentistry, primary care physicians, and otolaryngologists (ear, nose, and throat specialists) are typically sought for TMJ diagnosis and treatment.
Definition of TMD Treatment
Treating TMD involves first finding and correcting the cause of the dysfunction, then correcting damage caused by the condition. Treatments vary but may begin with an oral appliance, custom made to hold the jaw in proper position and stop the habit of clenching and grinding teeth. This oral splint is sometimes called a night guard or TMJ guard. In some cases, orthodontics are employed to correct malocclusion so that teeth and jaw joints can develop a comfortable resting position. Building up back teeth with dental crowns is another technique for treating TMD. Called equilibration, the use of restorations to correct malocclusion can stop bruxism and TMJ pain, in some cases. Other therapies include exercises, stress reduction, habit cessation (stop gum chewing, for instance), and in serious cases that don't respond to conservative treatment, surgery may be recommended.
The ideal candidate for TMD treatment presents at least one symptom of the disorder and is committed to maintaining an ongoing treatment regimen. Additionally, candidates may suffer mental or psychological stress stemming from their condition, which, in turn, may only exacerbate their symptoms. Finally, patients who suffer from systemic conditions related to their TMJ disorder may also benefit from treatment. These conditions include:
- Chronic fatigue syndrome
- Chronic headaches
- Irritable bowel syndrome
- Interstitial cystitis
- Sleep apnea
Although scientists are unsure of the connection between TMJ and these other disorders, patients who present with two or more conditions can significantly benefit from treatment for their jaw pain.
Non-invasive TMJ treatment has very few risks and side effects. Splint therapy, the most commonly used treatment for TMD, is highly effective. However, in rare cases, it can realign the jaw so much that it causes facial distortion. Typically, this only occurs when a patient wears his or her splint beyond the recommended treatment time of six months. Additionally, oral splints made from poor-quality material can lead to infection and soft tissue irritation.
TMJ surgery, like any surgical treatment, involves more risks than non-invasive care. However, most patients consider these low risks a small price to pay in comparison to the great physical and mental relief the treatments can provide. Nevertheless, patients with compromised immune systems, allergies, and negative reactions to anesthesia should alert their health care providers about these conditions. Armed with this knowledge, doctors and dentists can devise a treatment plan that poses as few risks as possible.
Whenever possible, doctors and dentists will use non-invasive treatments for TMD. However, patients who suffer moderate to severe jaw pain and do not respond to more conservative treatment may benefit from surgery. Additionally, patients who have a changed facial structure because of severe TMJ disorder may be good candidates for surgical care. A dentist may recommend surgery such as arthrocentesis or arthroplasty to patients in otherwise good physical health who have not responded to other forms of treatment.
The costs associated with TMJ treatment vary, depending on whether the condition is being treated non-surgically or surgically.
Fees for Non-surgical TMJ Treatment
Because the symptoms and severity of TMJ disorder varies widely for each patient, treatment is highly personalized, and there is no set cost for TMD care. Of course, non-invasive treatment typically costs less than surgery, although, again, the exact price varies depending on the extent of treatment needed. For example, patients with mild cases of TMJ can often find relief from a simple mouth guard, which may cost no more than $200. On the other hand, patients with severe TMJ could require a combination of procedures, including orthodontic care, as well as crowns, medication, and a mouth guard. Because each treatment is priced separately, the entire cost of care could reach $10,000.
Fees for Surgical TMJ Treatment
Surgery typically has a higher cost than more conservative care, although simple procedures such as minimally invasive arthrocentesis may cost as little as $300. More complex procedures like discectomies or disc replacement surgery take longer and require the expertise of a skilled oral surgeon. Therefore, these surgeries will cost more, and fees could top $50,000.
Whether patients undergo surgery or they receive more conservative care, it is important for them to remember that TMD treatment is an investment in their future. Without proper care, their pain could continue to get worse, and they could suffer from severe dental erosion, tinnitus, sleep disruption, and the inability to focus on work and daily tasks.
Before undergoing treatment for TMJ disorder, you will want to be aware of all the payment options available to you.
Many physicians and doctors work with third-party financing institutions to make treatment affordable. Ask your TMD doctor about CareCredit®, Springstone®, or Capital One Health Advantage®. In some cases, doctors also work with local banks to offer patients financing options. Most reputable physicians and dentists also accept credit cards.
Medical or dental insurance rarely cover all or part of TMD therapy. Dental insurance providers often consider TMJ treatments medical, and medical providers categorize treatment as dental. However, if your medical or dental insurance will provide partial or full coverage, ask your treatment provider whether he or she will file the insurance on your behalf. Doctors don't often file dental insurance, though dentists who treat TMD may file medical insurance.
Health Savings Accounts (HSA)
If you have an HSA through your employer, you may be eligible to use those funds to pay for TMD treatment or to cover your co-pay, if insurance will pay for part of treatment.
How to Choose a TMJ Dentist
There are two primary philosophies of care for dentists who treat TMD. Conventional treatment involves a manual manipulation of the jaw joints as part of the assessment for diagnosis. The dentist will consider your symptoms, oral structures, and x-rays when planning conventional treatment with an oral splint or equilibration. The second school of thought is neuromuscular dentistry. Trained at the Las Vegas Institute for Advanced Dental Studies (LVI), neuromuscular dentists rely on technological tools to diagnose and plan treatment for TMD.
Doctor Training: Conventional
General dentist are trained to understand how the jaw should function and how malocclusion, bruxism, and stress can contribute to TMD. All dentists are general dentists and hold either a DMD or DDS, which are equivalent diplomas. Those who want to pursue TMJ disorder diagnosis and treatment can take postgraduate coursework on the subject.
Associations and Courses: Conventional
There is no official certification when it comes to treating TMJ disorder, so choosing the right doctor or dentist can be a challenge. However, you should look for dentists or doctors who hold memberships in organizations such as:
- American Association of Dental Boards
- American Academy of Craniofacial Pain
- American Medical Association
- Federation of State Medical Boards
You can also look for a dentist or doctor who has taken specialized courses in TMJ surgery, orthopedic physical therapy, and musculoskeletal problems with a focus on the craniofacial region. Finally, you may want to select a practitioner who has published articles on TMJ or who has made significant research contributions to the field.
Doctor Training: Neuromuscular
Trained at LVI, neuromuscular dentists are taught to use technology to pinpoint a reading that conveys the exact measurement of jaw joint position. By finding the current position reading and comparing it with the patient's ideal position, the dentist knows exactly what treatment is poised to achieve.
Associations and Courses: Neuromuscular
Only dentists who have trained at the Las Vegas Institute for Advanced Dental Studies can provide neuromuscular dental treatment. There, they take classes on TMD-related topics such as:
- Scan interpretation
- Sleep disorders
Of course, in addition to their training at LVI, you should look for membership in organizations such as the American Dental Association and various state dental associations.
The Initial Consultation
Before beginning any treatment, patients will have a complete consultation. Typically, the dentist or doctor will begin by discussing a patient's symptoms, including their frequency and severity. The practitioner will then move on to joint and muscle palpitations. This will allow him or her to check for any noticeable swelling or irregularities, and at the same time, patients can alert their caregiver about any tenderness or pain to the touch. The doctor or dentist will also examine a patient's range of motion, and he or she will listen for any clicking or popping noises that might occur with jaw movement. Finally, x-rays and CT scans can reveal any joint abnormalities or tissue inflammation.
Neuromuscular TMJ Examination
One of the hallmarks of neuromuscular treatment is the complete diagnostic exam, which assesses a patient's bite alignment, posture, airways, bite pressure, and joint movement. The initial exam involves several different tests, including:
- Transelectroneural stimulation (TENS): Electrical pulses will allow a patient's jaw muscles to relax, so that the dentist can determine the natural position of the joint.
- Electromyography (EMG): This test measures the electrical activity of the facial muscles to determine whether they are overused or strained.
- Electrosonography (ESG): This computerized test records vibrations of the joint during movement, and it becomes especially valuable when combined with other tests.
- Computerized Mandibular Scanning (CMS): Using magnetic tracking and censors, this test measures the movement of the jaw in three dimensions within 1 mm of accuracy.
In addition to these highly advanced tests, a neuromuscular exam will include traditional palpitations, as well as an examination of medical and dental history.
Diagnosing TMJ Disorder
After a complete diagnosis, the doctor or dentist explains the patient's condition, using x-rays and CT scan images as a visual guide. If a patient received a neuromuscular exam, the results of these tests are presented at this time. Then the dentist or physician outlines a patient's treatment options, beginning with the simplest, most conservative care. He or she may also explain surgical procedures, which could become necessary if a patient does not respond to the initial treatment.
During the case presentation, patients should questions about their symptoms, various treatment methods, and payment. When they have a full understanding of their condition, they can choose to accept or decline the proposed treatment plan. It is important for patients to be honest with themselves and their care provider at this time.
Because there are several causes of TMJ disorder, the tests required to determine the cause and corresponding treatment cost for each patient's condition will vary. In addition, dental and medical insurance may be very particular as to what treatments they will cover, if any. Dental insurance often excludes those procedures that fall outside of the realm of general dentistry, including orthodontic procedures. Since medical insurers may regard some TMJ treatments as belonging to the realm of dentistry, however, they may exclude them from coverage.
The following is a general pricing guide:
- Mouth Guards: Mouth guards, or stabilization splints, will cost anywhere between $200 and $1,000
- Bite Therapy: If the position of a patient's jaw is determined to be the cause of his or her TMJ, a number of options can be used to establish an optimal bite. Since TMJ bite therapy may encompass a number of procedures, such as orthodontics or dental crowns, the cost will depend on the treatments involved. It could range from a few hundred dollars up to $10,000.
- Surgery: The cost of TMJ surgery varies dramatically according to the procedure and practitioner and can range anywhere from $300 for a minimally invasive procedure to $50,000 for a complex procedure.
- BOTOX® Injections: Depending on the doctor and the number of injections needed, TMJ treatment with BOTOX® injections ranges between $1,000 and $1,500 and may be recommended every three to four months.
If your insurance provider will not cover the cost of TMJ treatment, you may wish to ask your dentist about the financing options available. Many dentists offer payment plans that allow patients to break up the cost of treatment into smaller payments to be paid over a specified length of time. In addition to offering these plans, dentists are often affiliated with CareCredit®.
CareCredit® offers patients a line of credit up to $25,000 to help pay for dental treatments. Much like a credit card, CareCredit® makes it easier for you to get the treatment you need, when you need it, by offering convenient monthly payments. Visit the CareCredit® website or your dentist's office to find out how to apply.
Find a Dentist
TMJ syndrome is a complicated subject within the field of dentistry. The level of training and TMJ treatment experience among dentists varies considerably. DocShop can help you find a dentist in your area with the background necessary to offer a high level of skilled treatment for TMJ.
Non-Surgical TMJ Disorder Therapies
There are many treatments for TMJ disorder, including:
- Mouth Guards: Mouth guards are soft plastic protectors that slip over the upper and lower teeth to prevent grinding of the teeth. Guards make it more difficult to clench the jaws, an important first step in TMJ pain relief. Your dentist will take a mold of your upper and lower teeth to custom-fit your TMJ mouth guards for maximum comfort and efficiency.
- Jaw Exercises: TMJ exercises are designed to relax the jaw and eliminate clenching, and also to help in the correction of alignment problems. After careful analysis, your dentist may provide you with an appropriate series of very simple exercises to be performed in front of a mirror. The use of a mirror in TMJ exercises helps you see the misalignment that is one of the factors in TMJ syndrome. Gradually, the exercises will teach you control of the jaw muscles and eliminate clenching.
- Bite Therapy: A process known as TMJ therapy, or bite therapy, is used by dentists to help find the causes of TMJ syndrome and provide long-term pain relief. TMJ bite treatment begins with a careful, detailed analysis of your mouth and jaw to find the causes of your disorder. For some, the issue may be jaw clenching; this can usually be attributed to stress or simply a bad habit. For others, the teeth may not come together evenly, a condition known as malocclusion. This can cause uneven use of the jaw and result in muscle pain. Dentists have several tools at their disposal to measure bite pressure throughout the mouth and formulate a plan for dental work that will correct malocclusion and provide TMJ pain relief.
- BOTOX® Injections: BOTOX® injections can be used as an alternative treatment for TMJ. The injections relax the jaw muscle for up to four months.
- Surgery: When mouth guards and bite therapy cannot provide relief from the symptoms of TMJ, surgery might be a solution. Surgery options range from minimally invasive to open surgery. Arthrocentesis is a minimally invasive procedure that involves removing fluid from the temporomandibular joint. Arthroplasty encompasses all of the different types of open surgeries for TMJ, including disk repositioning, discectomy, and joint replacement.
Neuromuscular TMJ Treatment
As with conventional TMJ disorder treatment, the goal of neuromuscular dentistry is to realign the jaw and reduce inflammation in the surrounding muscles and ligaments. However, neuromuscular dentists use advanced computer imaging to provide highly personalized treatment that will more precisely realign the jaw and reduce pressure from bite imbalance. There are typically two stages of neuromuscular treatment.
During Phase I, the dentist will use TENS to relax the facial muscles and bring the jaw into proper alignment. Once this is done, he or she can provide patients with a specialized oral splint, or neuromuscular orthosis, carefully fabricated using the data gathered during the diagnostic exam. Typically, patients wear these hard plastic devices for three to nine months. Dentists will carefully monitor their patients progress to ensure that overuse of the oral splint does not cause lasting damage. During this time, dentists or doctors may recommend physical therapy or massage to relax muscles and reduce inflammation.
Once the jaw is in a new, healthier position, patients can begin Phase II. This stage can involve several different treatments, including:
- Neuromuscular orthodontics: Like traditional braces, this treatment straightens teeth and permanently realigns the bite. However, the braces will be crafted using the highly precise measurements obtained during the electromyography, electrosonography, and mandibular scanning tests.
- Semi-permanent splint: Much like the orthosis in Phase I, this splint realigns the bite and is created with neuromuscular measurements. However, patients will wear their device for nine months to two years to achieve permanent results.
- Restorative dentistry: Procedures such as crowns, bridges, and implants can restore bite alignment, and they can also improve the aesthetics and functionality of a patient's smile.
Orthodontic Treatment for TMJ
Orthodontic treatment is an extremely effective method of treating the symptoms of TMD. There are several orthodontic devices that can be used, depending on the severity of a patient's malocclusion.
- Oral splints are the most conservative and common orthodontic devices used in the treatment of TMJ disorder. There are several different types of splints. Stabilization splints, modified Hawley splints, and NTI splints (Nociceptive Trigeminal Inhibition Tension Suppression System) work much like the mouth guards mentioned above, and they are simply designed to prevent jaw clinching and teeth grinding. A repositioning splint actually realigns the jaw, moving it forward or backward. Often, these splints can have permanent results, but because they are a more aggressive form of treatment, dentists may try other devices before recommending a repositioning splint.
- Braces: Traditional braces, made of metal brackets and wires, can permanently straighten teeth and realign a patient's bite. This treatment can be very helpful in reducing jaw pressure.
- Clear braces: Clear braces, such as Invisalign® or ClearCorrectTM, have similar results to traditional braces. However, they use clear plastic aligner trays to gently straighten a patient's teeth. Although clear braces are suitable for most cases of malocclusion, patients with severe bite alignment issues may be better candidates for traditional braces.
- Retainers: Like mouth guards or splints, retainers are removable devices. Most frequently, dentists recommend patients wear them after their braces come off to help their teeth stay in their new positions.
TMJ Disorder Surgery
Dentists and doctors will always recommend non-invasive treatment before they suggest surgery. However, patients who do not respond to orthodontics, therapy, medication, and other treatment may find lasting relief after more aggressive care. Treatments differ widely, ranging from quick, minimally invasive procedures to open surgery. Options include:
- Arthrocentesis: The most conservative form of TMD surgery, patients with misplaced discs are often the best candidates for this treatment. During arthrocentesis, an oral surgeon will use two hypodermic needles to remove damaged tissue by washing the joint with a sterile saline solution. At the same time, the physician will also inject a steroid solution in the joint to reduce inflammation. The procedure is performed under local or general anesthesia, and patients typically face minimal downtime.
- Arthroscopy: A bit more involved than arthrocentesis, arthroscopy still involves minimal discomfort and a short recovery. During this treatment, the oral surgeon will use a microscopic device called an arthroscope to look inside the TMJ's, remove scar tissue, and smooth the jawbone. In some cases, an oral surgeon can even reposition the cushioning disc that has slipped out of place.
- Arthroplasty: This treatment is an open surgery performed under general anesthesia in a hospital or surgical center. Through a carefully hidden incision along the ear, a surgeon may remove bone spurs, move discs back into their proper position, correct bone fusion, or graft muscle tissue, among other functions. Depending on the extent of a particular procedure, patients may need to take several weeks off from work for recovery.
- Total Joint Replacement: Typically joint replacement is the final resort for patients with severe jaw pain or significantly reduced joint function. Patients should remember, however, that the surgery replaces the joint only, and it will not directly treat neurological or muscular pain. During this surgery, which is performed under general anesthesia, the oral and maxillofacial surgeon (OMS) will create one or two carefully concealed incisions along the hairline and, often, in the fold of the neck behind the jaw. Through these incisions, the doctor will remove the old, damaged joint and replace it with a plastic and metal implant that functions like a natural ball and socket joint. Patients should plan to take at least six weeks off of work following their jaw replacement surgery, and they will need to avoid strenuous physical activity during this time, as well.
Results of TMJ Therapy
Both conventional and neuromuscular TMJ therapy is designed to achieve several results. The most immediate goal of any treatment regimen is to reduce or eliminate symptoms. Following successful treatment, patients may enjoy a better range of motion, less discomfort, and reduced swelling. The second objective of TMJ therapy is to realign the jaw and address the underlying causes of a patient's TMJ disorder.
Benefits of TMJ Therapy
Quality of Life
Many patients do not realize how much TMD was affecting their life until they experience relief from their symptoms. Following therapy, patients can enjoy:
- Improved concentration at work or school
- A better night's sleep
- Improvement in sleep apnea and/or snoring
- A fuller range of motion in the jaw
- The ability to eat a more varied diet
- Improved capability in recognizing and coping with stress
At its core, TMJ therapy is intended to realign the jaw and restore balance to the entire maxillofacial structure. Following successful treatment, patients may experience a reduction or even complete elimination of jaw pain, headaches, shoulder pain, and neck stiffness. They may also experience a decrease in migraines and muscle spasms. Although it can take several years of dedicated effort on the part of both patient and medical professional, most TMJ patients experience enduring relief from their symptoms.
Risks of TMJ Therapy
There are very few risks involved in conservative conventional or neuromuscular treatment for TMD. As stated above, patients who receive an ill fitting or poor-quality oral splint may suffer some infection and tissue irritation, but these side effects are rare, especially when patients choose an experienced dentist or doctor.
TMJ surgery, like all surgical treatments, does carry some risks, which increase in proportion to the severity of the procedure. Risks common to all surgeries include infection, blood clots, scarring, and adverse reactions to anesthesia. Because the jaw joint is positioned so close to the facial nerves, if the nerve is damaged, patients can experience paralysis on one side of their face. They may also experience permanent numbness in one area of their face. Alternatively, if a nerve is affected, it may also cause wrinkles around the forehead and eye. Patients should rest assured, however, that these side effects are extremely rare.
Unfortunately, TMJ surgery is not always effective. In these cases, a good doctor or dentist will recommend alternative treatments and therapies that can help to control jaw pain and other symptoms, even if does not entirely cure a patient's TMD.
Reduce Risk for Failure
There are several steps that a patient can take to minimize risks and complications, especially following TMJ surgery:
- Choose a qualified doctor or dentist: TMD treatment, whether conservative or surgical, is more likely to be successful when it is performed by an experienced medical practitioner. Patients should follow the instructions above concerning the selection of a TMJ dentist.
- Be upfront about medical history: Patients should give their doctors or dentists a thorough medical history and be as detailed as possible regarding specific symptoms. It is also important to alert him or her about any allergies, as this can greatly affect the outcome of TMJ surgery.
- Follow all post-treatment instructions: Typically TMJ treatment involves a lengthy regimen, and before patients receive care, they should be committed to the ongoing process. They should continue to wear any orthodontic devices, as directed by their dentist. They may also have regular jaw exercises as well as regular visits to their care provider.
- Rest the jaw: Following TMJ surgery, most patients will be placed on a liquid diet for several weeks. However, all patients, whether they have surgery or they have more conservative care, should rest their joints to alleviate inflammation and irritation. Although they may not have to follow a strict liquid diet, eating soft foods for several weeks can help the jaw to heal. At the very least, TMD patients should avoid extremely hard or chewy foods. They should also stop chewing gum, as this is can irritate the already overused jaw muscles.
Temporary Side Effects of TMJ Treatment
Following surgery for TMD, it is normal for patients to experience some discomfort and swelling. However, patients can expect slightly different side effects and recovery time following different procedures:
- After arthrocentesis, the least invasive of the TMJ surgeries, patients may need to take 2 to 3 days off from work. Swelling and discomfort should subside within a few days, and patients will not typically have any mandatory dietary restrictions.
- After arthroscopy, patients may have a limited range of motion in their jaw for up to a month. They should begin physical therapy within a few days to prevent permanent jaw stiffness, and they will also need to follow a soft or liquid diet for several weeks.
- Because the discomfort following an arthroplasty can be more intense, many doctors recommend that patients stay in the hospital the night after their surgery. Recovery time can vary significantly with arthroplasty, depending on the exact nature of the treatment. However, patients will typically need two to six weeks for a full recovery.
- Following a full joint replacement, patients will spend three to five nights in the hospital. Side effects can include numbness, tingling, and facial paralysis, although these symptoms typically subside within several months.
After Conventional or Neuromuscular Treatment
Non-invasive treatment for TMJ has very few temporary or long-term side effects. Mouth guards, oral splints, and night guards can sometimes irritate the soft tissues and tongue, but most patients adjust to their orthodontic devices very quickly. Patients who do experience this type of discomfort should alert their dentist, who can often make adjustments to the device. Additionally, it may take patients several weeks to learn to speak clearly with their oral splints. Neuromuscular treatment also has few temporary or long-term side effects, although transcutaneous electrical nerve stimulation can sometimes cause skin irritation and muscle soreness.
Injectable treatments can have additional temporary side effects, such as:
- Discomfort at the sight of the injection
Fortunately, these side effects typically dissipate within a few days, and they pose little danger to overall health.
Orthodontic treatment has been used with great success for many years, although there are several common, though generally mild, side effects. They include:
- Tooth discomfort: Because braces and retainers straighten teeth using a gentle pressure, patients may need some time to adjust to the feeling, especially right after the dentist places or tightens their braces.
- Tissue irritation: The metal brackets and wires can sometimes chafe the soft oral tissues, particularly on the lips and inside the cheeks.
- Dental decay and discoloration: Orthodontic devices, especially non-removable braces, can trap bits of food and bacteria. It is vital that TMJ patients be extremely thorough in their dental hygiene, using antibacterial mouthwash and specially designed floss, if needed.
Conservative TMJ treatment has very few safety risks. Surgical treatments are still fairly recent developments, and research about these procedures is ongoing. Although there are some risks following surgery, initial research indicates that these procedures can have significant benefits for TMD patients:
- According to a study of 68 patients by D.W. Nitzan, arthrocentesis successfully reduced symptoms for over 94 percent of patients.
- Another study by K.L. Fridrich, J.M. Wise, and D.D. Zeitler found that arthroscopy was successful for 82 percent of patients, and arthrocentesis proved successful for 75 percent.
- A 1992 study by J.P. McCain was the largest study to date regarding the success and safety of TMJ surgery. After evaluating 4,831 joints at 12 different surgical centers, McCain and his colleagues concluded that arthroscopy was very safe. They also determined that if was highly effective in treating jaw pain and improving range of motion.
Many times, patients feel that they are alone as the struggle with their TMD. Alternatively, they may fear that treatment will prove ineffectual. A look at the statistics should prove reassuring for these individuals:
- According to the National Institute of Dental and Craniofacial Research, TMJ disorder is the leading cause of facial pain, and it affects 5 percent to 12 percent of the total US population.
- Two-thirds of patients with jaw pain will seek treatment.
- According to tmjhope.org, 95 percent of TMD patients are women.
- Women using birth control or estrogen supplements are more likely to seek treatment for TMJ.
- TMJ disorder affects young people more frequently than middle-aged or senior patients.
- According to a 1974 study published in the Journal of Oral Rehabilitation, most patients experience long-lasting relief following TMD treatment. The study found that 81 percent of patients experienced short-term improvement, and two to three years after treatment, 72 percent reported long-term improvement in their symptoms. 35 percnt of patients told the researchers that they were completely cured.
Do popping jaw joints mean that I have TMJ disorder?
Popping jaw joints are a symptom of TMD, but it can be caused by other factors, as well. In fact, many people experience intermittent clicking, which can be a sign of temporary facial tension. However, the only way to know if your jaw clicking is caused by TMJ disorder is to schedule an appointment with your dentist. It is especially important to do so if you experience related symptoms of TMD, such as headaches, jaw pain, or neck stiffness.
Will TMD treatment stop my migraines and/or ringing ears?
The trigeminal nerve runs very close to the jaw joints, and when this nerve becomes inflamed and irritated, it can lead to chronic migraines. Similarly, there is also a strong connection between TMD and tinnitus, although scientists are not sure of the exact nature of the relationship. Some speculate that inflamed jaw muscles irritate the muscles connected to the inner ear. Others theorize that TMD affects the ligaments connecting the jaw and the hearing bones inside the ear. Still others believe that nerve irritation can affect the brain's ability to distinguish sounds. Whatever the reasons, there is a clear connection between chronic headaches, tinnitus, and TMD. TMJ therapy is aimed at all the related symptoms, and while no doctor or dentist can guarantee a complete cessation of symptoms, most patients experience significant relief after treatment.
How long will I have to wear my TMD splint?
Typically, you should not wear your splint for more than six months. In fact, overuse can lead to jaw and bite disfigurement. You may wear your splint all the time, or you may only wear it at night. Your particular treatment regimen will depend on the alignment of your jaw and the severity of your symptoms.
Why do some doctors condone neuromuscular dentistry, while others don't support the philosophy?
Advocates of neuromuscular dentistry believe that TMD is primarily caused by muscle overuse and dental misalignment. By permanently realigning the jaw according to highly precise, computer-generated calculations, neuromuscular dentists feel that they can achieve more effective and long-lasting results. Opponents of this philosophy say that there is little scientific evidence to support its methods. They believe that any success neuromuscular dental methods may have achieved is too sporadic and temporary to form the basis of a widely used treatment plan.
Will insurance cover neuromuscular diagnosis of TMD?
Typically, dental insurance does not cover the cost of neuromuscular diagnosis and treatment. However, medical insurance will often cover 15 to 50 percent of your care. Ultimately, however, you will need to talk to your dentist or health care provider to discover whether you will receive any coverage.
Can TMD return, once I've completed treatment and received a good bill of health?
Unfortunately, your jaw joints are always moving and face constant stress, and it is possible that your symptoms could return. In some cases, they may even be worse than they were before. Luckily, even if your symptoms do come back, your doctor or dentist can often treat them using similar methods.
What diseases have symptoms similar to TMD?
While TMJ is often the most common reason for symptoms such as headaches, popping jaws, and tinnitus, there are other conditions that can cause these disorders. They include:
- Tension headaches
- Giant cell arteritis
- A broken jaw
- Cocaine abuse
- Meniere's disease and more
Can orthodontic patients wearing braces also wear an oral splint for TMD treatment?
Yes. Although not all orthodontists use this method, some practitioners offer a combination of braces and oral splints for faster treatment.
Can a sleep apnea splint or snore guard double as a TMD splint?
In some cases, a sleep apnea splint can help to relieve the symptoms of TMD. However, you should never attempt to treat your condition yourself, and you should always ask your doctor or dentist before using one device to treat another problem. In some cases, sleep apnea splints can actually exacerbate the symptoms of TMD.
What exercises will help relieve TMD pain?
There are many different exercises that can help to relieve your jaw pain. Your doctor, dentist, or physical therapist will recommend specific exercises based on your symptoms. Examples include:
- Place your thumb below your chin and press lightly on the chin bone. Slowly open your mouth, working against the resistance from your thumb.
- Place your tongue on the roof of your mouth and slowly open your jaw without moving your tongue.
- Push down on your bottom teeth with one hand and, at the same time, push upwards with your jaw.
- Cross your arms across your chest with one hand on each shoulder. Stretch your neck backwards and to the right. Then switch sides. This exercise helps to relieve related neck tension.
What habits contribute to TMD pain?
Many times, TMD patients suffer from chronic stress and anxiety, which can cause them to engage in a number of harmful habits. Stress may lead patients to unconsciously clinch their jaw or grind their teeth, especially at night. Other habits that could exacerbate jaw pain include frequent gum chewing, resting the chin in the hand, poor posture, yawning too wide, and chewing ice or pencils.
Can children develop TMD?
Yes. Although TMD most often affects patients in their 20's to 40's, children may suffer from the condition as well. The causes are the same for children and adults, and they may include bite misalignment, bruxism, and facial trauma.
Can denture wearers develop TMD?
Yes. In fact, ill-fitting dentures frequently cause jaw pain and TMD. When patients wear false teeth that are too loose, they unconsciously try to bring them into alignment, putting constant strain on their TMJs. Additionally, it can take longer for denture wearers to chew up their food, meaning their jaw must move more than those who have natural teeth or implants.
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