Happy, Happy New Year and may all your resolutions come true!  Last week I discussed several “at home” and over the counter treatments for temporomandibular disorders (TMD).  This week we will look into more advanced treatments when home care doesn’t give the results you need.  Depending on the diagnosis, people with TMD will receive specific types of professional therapy.  The treatment you receive will depend on the cause and how much discomfort you are having.

If your dentist doesn’t provide the following treatments he/she may refer you to another healthcare provider.

• He/she may refer you for massage therapy and ultrasound treatment if the primary cause of your discomfort is muscle related.
• Cold spray and stretching can also be utilized to relax the musculature.
• Exercises and physical therapy to strengthen the muscles of the TMJ may be offered as adjunctive treatment as well.

The majority of the time treatment can be provided in the dental office.  Let’s talk about how the whole oral complex works.  The TMJ is part of a system that includes the teeth.  Because the joints and teeth work together, a problem with your teeth or bite can be linked to TMD.  If you clench/grind your teeth or have a bad bite your dentist can often help.  Some of the treatments include:

• Bite splint therapy – A splint is an appliance that fits in the mouth.  It may also be called an orthotic, night guard or occlusal appliance.  There are different kinds of splints for different kinds of needs.  When adjusted properly, a bite splint will reduce pressure on the joints and align them in their most stable position.  This not only creates an environment for the joints to heal, but also protects the surfaces of your teeth from the stress of clenching or grinding.  They are typically worn at night when you sleep, but in some instances they are worn all day for short periods of time to allow the joints to heal.  Precise adjustment of the bite splint is critical.  Studies have shown the teeth can feel a discrepancy in the bite as small as 9 microns (that is really small!).  A precise adjustment is necessary for proper healing to occur.

• Equilibration (bite adjustment) – malocclusion (bad bite) means the teeth don’t fit together properly.  A “bad bite” can result in pain and problems with jaw function.  An equilibration equalizes the forces on your teeth to minimize the ravages of grinding.  The teeth are adjusted and reshaped to fit together in positions where the forces are equally dispersed.  A good analogy is to think of it like your car.  If you don’t have the wheels properly aligned, the car will still run but the tires will wear or “blow out” a lot sooner than they should.  Your teeth are the same way.  If they aren’t “aligned” and adjusted to have the proper forces placed on them when your joints are in their most stable position they will still function, but will crack, wear, fracture, loosen and become sensitive long before their time.  Whenever there is excessive force on the system from clenching and/or grinding something will eventually fail.  If the teeth aren’t affected then it will typically be the TMJ or supporting bone and gums that give way.

• Restorative treatment – If your bad bite is caused by missing or damaged teeth, your dentist may restore the teeth to proper function with crowns, bridges or dental implants.  Missing teeth often cause the remaining teeth to tip and shift.  This in turn requires the teeth to take more of a load than they were designed to withstand.  Losing a single tooth can cause huge problems over time, so carefully consider your alternatives if you ever think you want to have a tooth removed.

• Orthodontic therapy – Sometimes the upper and lower jaws are out of alignment or the teeth are too far out of line, turned, crowded or spaced to allow equilibration as treatment.  Your orthodontist can align your teeth with braces or other orthodontic devices that will provide a more comfortable bite and joints. 

• Joint Surgery - Surgery is very rarely needed in the treatment of TMD.  However, if other treatments haven’t worked, you may be referred to an oral and maxillofacial surgeon for evaluation.  Less than 1% of the patients with TMD will need this intervention.

I hope the last few weeks have helped your understanding of the temporomandibular joints and their disorders.  I also hope and pray that God will rain His richest blessings down on each of you during the new year.