The
key words to keep in mind about TMD treatment are
"conservative" and "reversible." Conservative treatments
are as simple as possible and are used most often
because most patients do not have severe, degenerative
TMD. Conservative treatments do not invade the tissues
of the face, jaw or joint. Reversible treatments do
not cause permanent, or irreversible, changes in the
structure or position of the jaw or teeth.
Because
most TMD problems are temporary and do not get worse,
simple treatment is all that is usually needed to
relieve discomfort. Self-care practices, for example,
eating soft foods, applying heat or ice packs, and
avoiding extreme jaw movements (such as wide yawning,
loud singing and gum chewing) are useful in easing
TMD symptoms. Learning special techniques for relaxing
and reducing stress may also help patients deal with
pain that often comes with TMD problems.
Other
conservative, reversible treatments include physical
therapy you can do at home, which focuses on gentle
muscle stretching and relaxing exercises, and short-term
use of muscle-relaxing and anti-inflammatory drugs.
The
health care provider may recommend an oral appliance,
also called a splint or bite plate, which is a plastic
guard that fits over the upper or lower teeth. The
splint can help reduce clenching or grinding, which
eases muscle tension. An oral splint should be used
only for a short time and should not cause permanent
changes in the bite. If a splint causes or increases
pain, stop using it and see your practitioner.
The
conservative, reversible treatments described are
useful for temporary relief of pain and muscle spasm
-- they are not "cures" for TMD. If symptoms continue
over time or come back often, check with your doctor.
There
are other types of TMD treatment, such as surgery
or injections, that invade the tissues. Some involve
injecting pain relieving medications into painful
muscle sites, often called "trigger points." Researchers
are studying this type of treatment to see if these
injections are helpful over time.
Surgical
treatments are often irreversible and should be avoided
where possible. When such treatment is necessary,
be sure to have the doctor explain to you, in words
you can understand, the reason for the treatment,
the risks involved, and other types of treatment that
may be available.
Scientists
have learned that certain irreversible treatments,
such as surgical replacement of jaw joints with artificial
implants, may cause severe pain and permanent jaw
damage. Some of these devices may fail to function
properly or may break apart in the jaw over time.
Before undergoing any surgery on the jaw joint,
it is very important to get other independent opinions.
The
Food and Drug Administration has recalled artificial
jaw joint implants made by Vitek, Inc., which may
break down and damage surrounding bone. If you have
these implants, see your oral surgeon or dentist.
If there are problems with your implants, the devices
may need to be removed.
Other
irreversible treatments that are of little value --
and may make the problem worse -- include orthodontics
to change the bite; restorative dentistry, which uses
crown and bridge work to balance the bite; and occlusal
adjustment, grinding down teeth to bring the bite
into balance.
Although
more studies are needed on the safety and effectiveness
of most TMD treatments, scientists strongly recommend
using the most conservative, reversible treatments
possible before considering invasive treatments. Even
when the TMD problem has become chronic, most patients
still do not need aggressive types of treatment.
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