According to statistics, 75% of Americans have experienced one or more signs or symptoms of temporomandibular joint dysfunction. For treatment to be effective, the examining dentist or dental specialist will investigate and attempt to determine whether the symptoms are associated with muscles and ligaments, the joint structure itself, or mechanical (how the structures and ligaments all work together).
The vast majority of TMD situations are treatable with non-invasive and non-surgical alternatives. Only about 5% of cases ever require any major direct surgery involving the jaw joints.
This is one aspect of dentistry where most dental practitioners prefer a non-invasive approach. For some patients, finding the right or effective treatment for their condition may be a matter of just trial and error. Finding the exact cause of the symptoms, though, may involve a time-consuming process.
Diagnostic Tools used for TMD
Many dentists and dental specialists have certain diagnostic methods they use all the time. The list below is of those diagnostic methods that are potentially available to dental practitioners for the diagnosing of TMD, though not every dentist will use them, and other dentists may be able to make a diagnosis without using every single method.
1) X-rays of the skull (cephalometric) and dental structures (panoramic)
2) MRI
3) Electromyography (to study muscle function)
4) Motion performance studies to determine how the joints, ligaments and teeth function together and may potentially be contributing to the condition
5) Joint vibration analysis (a form of ultrasound)
6) Study casts of upper and lower jaw to study occlusal function (how the teeth of the upper and lower jaw fit together and work together – or not – when chewing or at rest)
Conditions that Affect TMJ Health and Function
The health and function of the TMJ can be affected by many conditions and will determine which treatment can be used and, indeed, if treatment is at all possible or beneficial. Such conditions include:
1) rheumatoid and osteoarthritis
2) inflammation of the joint
3) inflammation of the synovium (the thin tissue layer surrounding joints and tendons)
4) internal displacement of the condylar heads (a double-layered sleeve of fibrous tissue that surrounds the joint)
5) perforation or tears of the articular disks
6) torn ligaments
7) missing teeth
8) uneven chewing surfaces of the teeth
9) bruxism (clenching/grinding)
10) malocclusion (where teeth in the upper and lower jaw do not fit together well during function or sit in a position at rest that stresses the tendons, ligaments and joints)
11) presence of wisdom teeth
12) trauma
Medications used to treat TMD
Since the causal factors of TMD vary, so do the medications that can be tried to alleviate the symptoms. As with any medication, effectiveness varies from patient to patient. While one treatment may work well for many, it may not work for everyone.
Glucosamine sulphate – Usually used in conjunction with MSM (methylsulfonylmethane – a natural source of sulphur which is believed to have anti-inflammatory properties and to prevent and treat osteoarthritis) and chondroitin sulphate (an important structural component of cartilage), glucosamine has proven effective in alleviating many symptoms where the issue was actually a deterioration of the structural integrity of the cartilage. These are available in supplements and can be taken separately and independently of one another or used as an anti-arthritis power pack.
Non-steroidal anti-inflammatories (NSAIDS) – Aspirin, Ibuprofen, Naproxen (tendons, ligaments and muscle inflammation)
Muscle relaxants – Valium (diazepam) will address muscle issues, but often make the user drowsy
Cortizone injections – Some patients have found relief using this method
Non-surgical Treatments for TMD
The vast majority of patients will see some improvement in their symptoms with these methods and will be able to manage their symptoms comfortably with these treatments. Some of these methods you can do on your own (whether they’re effective or not depends on the reason for the discomfort), others will need to be carried out with the supervision of a dentist or dental specialist.
- resting the muscles and joints by eating soft foods, which may be recommended especially if there has been recent trauma
- refrain from chewing gum
- avoid clenching and bruxism with either stress management (bio-feedback) or a bite splint
- relax muscles with moist heat
- restore missing or eroded bite surfaces with crowns, or with dentures
- regulate the height of tooth surfaces through grinding so the teeth fit together
- orthodontics (possibly in conjunction with orthognathic – major jaw – surgery)
On this last point, orthodontics may be indicated where the poor alignment of the teeth and their subsequent functioning could be contributing factors to the onset of the TMJ symptoms.
It should be noted that once there is damage to the TMJ structures there is no way to rebuild them or for the structures to heal once the causal factors have been addressed. The hope is that in addition to providing better chewing efficiency and function, any further damage will be reduced or prevented.
Surgical Treatment Options for TMD
Like the non-surgical treatments and the medication options, the treatment chosen will be determined by the nature of the symptoms and condition, and the extent of the damage to the joints. Surgical treatments include:
- Extraction of wisdom teeth – for many teenage and adult patients, who didn’t have their wisdom teeth removed, this solves the problem where the wisdom teeth crowd the other teeth and put pressure on the nerves, tendons and muscles.
- Orthognathic surgery – a procedure designed to physically set the jaws into a better position so that chewing function is more even and the biting forces are more regulated through the jaw bone (usually in conjunction with orthodontics)
- Implant placement – The implants would be used to restore a person’s bite where there are missing teeth. Dental implants, which are successful in 95-98% of cases, provide better stability for restorations than conventional bridges. Some patients may also require bone grafting to provide a stable foundation for the new restoration.
- Arthrocentesis – The dentist or dental specialist will inject saline and a steroid into the joint to reduce inflammation. This is a blind procedure, though, because the dentist cannot see precisely where the needle is going and has to rely on his skill and the information provided in dental X-rays. The dentist will not be able to re-place the cartilage but will only be able to reduce the inflammation causing the pain.
- TMJ microsurgery (arthroscopic centesis) – a small incision is made in front of the ear and the surgeon will insert a needle with a camera that will help him/her see what needs to be done, then he or she will be able to place the displaced cartilage where it belongs
- Open surgery – This may be required for the dental specialist to shorten stretched ligaments, repair torn ligaments, and/or pull the displaced cartilage into position. The surgeon can repair, remove or replace the cartilage. Sometimes the cartilage is removed without replacing, but there are both natural and synthetic cartilage replacement options.
- Joint replacement – This done in only very extreme cases.
As with everything, discuss your symptoms and any other health conditions and habits with your dentist or dental specialist to help him/her determine the cause of your symptoms and develop an effective treatment plan. Not every treatment plan or medication will work for everyone. There is always a chance that the treatment will not work in your particular case, and there is always risk where surgical intervention is undertaken. Be an informed patient!
Sources: www.tmjtreatment.org; www.wellsphere.com; www.tmjoint.com; www.answers.com; www.tmjtherapy.com