How To Treat TMJ Disorder

TMJ, which is the temporomandibular joint, can sometimes become painful and inflamed. This is known as a TMJ disorder and can be treated in a variety of ways, depending on the severity of the symptoms and cause. When suffering from TMJ disorder, symptoms might be as mild as the occasional clicking jaw, or as severe as migraines, neck pain and tinnitus. Pain and inflammation in the jaw joint can be debilitating so it is essential to find a treatment plan so the disorder doesn’t impact your everyday life. We explain every treatment option for TMJ, whether your symptoms are mild or severe.

What is a TMJ Disorder?

TMJ disorder is a general term that is used for the dysfunction of the temporomandibular joint, known as the TMJ. TMJ are the two joints at the front of the ear where the jaw hinges. They connect your lower jaw to your skull, and consist of the mandible (lower jaw) and the temporal bone (the side and base of the skull). The complex motions of these joints allow us to speak, eat, and make facial expressions. When the TMJ is misaligned or injured due to overuse or trauma, it causes pain, unusual sounds, headaches, stiffness or even ear aches.

Diagnosis of TMJ Disorder

Healthcare professionals like your dentist will be able to diagnose a TMJ disorder. If you are experiencing pain in the jaw or limited movement, it is recommended to make an appointment with the dentist. Your dentist will look for the cause of the disorder and then decide on the right treatment. During the consultation, your dentist will:

• Medical history: Ask you about your dental and medical history, and how long you have been experiencing the symptoms for.
• Physical examination: Do a physical examination including listening to the jaw as you open and close your mouth, pressing on areas of the jaw to identify pain spots, and watching how the jaw moves. Normally the jaw functions quietly without pain, so any indication of discomfort or clicking sounds could indicate a disorder.
• X-rays: The dentist may then take x-rays to examine the teeth and jaw.
• CT Scan: The dentist may also do a CT scan to examine the bones involved in the joint.
• MRI: The dentist may also do an MRI to examine the surrounding tissue or problems with the joints and disk.
• Arthroscopy: Occasionally, the dentist will recommend an arthroscopy to diagnose a potential disorder. An arthroscopy must be performed by an Oral and Maxillofacial Surgeon. This procedure allows the dentist and surgeon to see inside the TMJ by using a camera inserted through a small cut in the skin.
• Recommend treatment: After the consultation, and with any imaging results, the dentist will have an understanding of the cause of your TMJ disorder and recommend the best treatment option.

How to Treat TMJ

If the pain from TMJ does not go away by itself, there are a wide variety of TMJ disorder treatments. Sometimes simple home remedies like applying heat or ice packs can help alleviate the symptoms. Chronic cases may require medical intervention from pain relief to joint surgery. The following list is a guide of treatments available for TMJ issues.

Home treatments

Minor cases of TMJ disorder can be treated successfully at home with some simple practices. Try the following to see if they help alleviate symptoms.

• Apply heat or ice: Application of a heat or ice pack can help relieve the pain of TMJ disorder. Ice will help reduce the pain and swelling, and heat will increase the blood flow and relax the jaw muscles. First apply the ice pack for 15 minutes and then apply a warm cloth or heat pack. Gently open and close the mouth while applying each pack. Try this method a few times a day.
• Try a soft diet: Eating a soft diet causes the jaw to work less and put not as much strain on the TMJ. Hard foods like apples or steak force you to open your mouth to bite them and require repetitive movement. A soft food diet like eggs, dairy, fish or smoothies will give your jaw the chance to rest and heal while still supplying sufficient nutrients.
• Avoid caffeine: As caffeine is a stimulant, it may cause muscle tension in the body, including the jaw muscles and contribute towards clenching. This muscle tension exacerbates the pain of TMJ. Try to avoid or cut back on food or beverages with caffeine in them to help relax the muscles and ease TMJ pain.
• Sleep on your back: The best position for people suffering with TMJ disorder is to sleep on the back and use pillows to support your neck. When you sleep in this position, there is no pressure on the jaw which makes you less likely to grind your teeth, one of the symptoms of a TMJ disorder. Try to avoid sleeping on your stomach or side and, if you do, make sure your hand is not under your jaw as this adds to extra pressure on the jaw muscles.
• Stop biting nails: The unnatural movement of nail biting can aggravate the TMJ as it forces the jaw to work in a way that is not intended. Nail biting feeds tension into the key muscles which are involved in the intricate mechanisms of the jaw joint. To stop nail biting, try taking care of your nails, regular manicures, or applying polish that is designed to deter nail biting.
• Stop using your teeth to open things: In a similar way to nail biting, using your teeth to open things puts unnecessary pressure on the TMJ and surrounding muscles. Always take time to find the proper tool to open something.
• Stop chewing gum: When suffering from TMJ disorder, the worst thing to do is overuse the jaw joint. Chewing gum requires a continuous movement of the jaw and can result in muscle tension which makes the symptoms worse. Stop chewing gum to give the TMJ a chance to rest and heal.
• Correct your posture: Poor posture plays a significant role in the alignment of the jaw. When the body isn’t aligned it puts excess pressure on the bones and joints. Bad posture habits like rounded shoulders, anterior pelvic tilt, or a forward neck could be aggravating a TMJ disorder. When standing make sure your body weight is evenly distributed. When sitting, sit up straight and try to align the ears, shoulders and hips. When sitting at work or for prolonged periods, take a break every hour and walk around. If you work at a desk, consider a standing desk you can adjust as needed.

Medical

If TMJ pain persists, it may be time to try some pain medications. The best start is over-the-counter medications and anti-inflammatories. However, there are a list of options you can try to help treat a TMJ flare up. These include:

• Pain relievers: Pain relief medications fall under the category of over-the-counter or prescription. First try over-the-counter drugs to alleviate the pain. These include non-steroidal tablets like ibuprofen, aspirin or paracetamol. If over-the-counter medication does not work, the dentist may suggest stronger pain medications like prescription strength ibuprofen.
• Antidepressants: For chronic TMJ pain, antidepressants are sometimes prescribed in low doses than used to treat depression. Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), are often the most effective as they influence how your body interprets pain.
• Muscle relaxants: Sometimes muscle relaxants can help ease chronic TMJ pain. This is because the pain TMJ sufferers experience is usually caused by tense, overactive jaw and face muscles. When taking muscle relaxants, the body experiences a sedative effect which prevents the nerves from sending signals of pain to the brain.

Therapy

There are other options for treating TMJ disorder that do not involve medications. These are therapies that the dentist will be able to suggest or perform to help ease and hopefully stop jaw pain.

• Oral splints: Also known as a mouthguard, an oral splint is a removable dental appliance that covers some or all of the upper and lower teeth. By using a splint, the muscles and ligaments in the mouth can relax. This may relieve some of the tension in the jaw and prevent teeth grinding.
• Physical therapy exercises: The dentist may recommend some physical therapy which can be done at home or via a professional physical therapist, depending on the acuteness of the pain. The physical therapist will teach you exercises to correct jaw misalignment. Exercises may include controlled opening rotation, jaw opening with resistance, and tongue on a hard plate. The goal is to restore normal and pain free movement of the jaw.
• Counselling: Sometimes anxiety and stress can trigger teeth grinding and jaw clenching which can lead to TMJ disorder. If you feel that a psychological issue might be the root cause, then seeking out counselling is beneficial. Trained psychologists and counsellors can teach you relaxation techniques, help reduce stress and anxiety.

Alternative Medicine

Conventional treatments like medications and therapy can help alleviate TMJ. However some people seek out more alternative, naturopathic treatments. Here are some popular alternative techniques.

• Acupuncture: This traditional Chinese medical technique involves using thin needles placed in specific parts of the body. These needles stimulate the central nervous system and release chemicals into the body which promote natural healing. With TMJ, acupuncture treatment locally reduces inflammation and tension in the jaw and surrounding tissues.
• Biofeedback: Biofeedback can be helpful to treat TMJ disorder as it uses equipment that monitors muscle tension and skin temperature on the jaw muscles. If you clench your teeth or have poor posture, the machine will produce a signal. When you relax the signal stops. This method is useful for training you to recognise when it’s happening and consciously relax.
• Buccal massage: A buccal massage can relieve TMJ disorder symptoms by reaching deep layers of the facial muscles and releasing tension. Buccal massage can also improve the alignment of the jaw. It is called buccal massage as it is a facial massage that concentrates on the buccinator muscle which is one of the main cheek muscles. During a buccal massage, the therapist will use gentle pressure, stretch and kneading of the facial muscles to release tension.
• Transcutaneous Electrical Nerve Stimulation: This therapy known as TENS therapy employs a low voltage electrical current to reduce pain. The electric signals intercept and disrupt the pain signals to the brain. During a TENS treatment, electrodes are strategically placed on the jaw joint and surrounding painful areas. As the muscles relax and the pain disappears, the body releases endorphins which further reduce pain and create a sense of overall well being.
• Herbal remedies: Ginger, turmeric and chamomile are herbs that have anti-inflammatory properties and can be used to help reduce TMJ pain. They can be taken as a tea, supplement or used as an essential oil.
• Botox: One of the best non-surgical treatments for TMJ discomfort is using an injectable like Botox. As a natural muscle relaxant, botulinum toxin can ease muscle tension for several months at a time.

Surgical and other treatments

Should conservative medications or natural remedies fail to fix a TMJ disorder, surgery may become a necessary option. Most TMJ issues can be resolved without resorting to surgery. However about 5% of sufferers will need one of these surgical procedures.

• Arthrocentesis: This procedure works by injecting fluid into the joint. This washes out any of the inflammation and chemical byproducts that create pressure on the jaw. The procedure is usually carried out under a general anaesthetic in a day procedure and it is minimally invasive. After an arthrocentesis, the jaw is usually a lot more mobile.
• Arthroscopy: Arthroscopy is also considered minor surgery and you should be home within the day. With this procedure, carried out under general anaesthetic, the surgeon inserts a narrow cannula into the joint with a small camera to see the joint clearly. During an arthroscopy, the surgeon can remove scar tissue, reshape the joint, inject medication, and relieve pain or swelling.
• Open joint surgery: For severe TMJ disorder, a surgeon may decide to do open joint surgery. This requires a longer incision so that the surgeon can access the jaw joint directly. Open joint surgery is usually performed with TMJ disorders where bone growth has stopped the joint from moving, there is tissue fusion, or it is unable to be reached with an arthroscopy. This surgery is done under general anaesthetic, requires a short hospital stay, and 2 to 6 week recovery period.

With the right treatment, TMJ disorder is controllable and in some cases, will go away. If you are suffering from any TMJ disorder symptoms that do not dissipate it is important to visit your dentist. A proper assessment will be the first step in finding the right treatment for your TMJ disorder. The friendly team at Hawthorn road family dental are experts in diagnosing and treating TMJ.