If Self Care for TMJ Disorder Fails
by Stacy Stone
If self care techniques for TMJ Disorder do not relieve your pain, your physician might recommend moving forward with treatment more involved than self care.
This can include:
Imaging: MRI, CT, X-Rays (Panorex, Tomogram, etc.) and other imaging techniques can be used to determine the state of the joints and surrounding tissues as well as determine what treatment may be the most appropriate. MRI's are primarily used for visualizing soft tissue such as discs and muscles, while CT scans show bone in great detail. X-Rays give a basic look at the joints and their relationship with your occlusion (the way your teeth fit together).
Splint Therapy: Splints, nightguards, biteplates and NTI's (all words for similar devices) are the most common treatment for jaw related pain and muscle disorders.
Injections: Trigger point injections are injections to address knots in muscles that cause pain. They can be done with anesthetic only, that is, without epinephrine or anti-inflammatory. After having these injections, your physician will direct you to use some sort of coolant such as spray and stretch or ice and to do stretching exercises to avoid discomfort. Some physicians may choose to do a type of injection called "dry needling" which involves no anesthetic or steroids. Anti-inflammatory injections are given with anesthetic followed by either a steroid or serapin, which is a type of anti-inflammatory derived from a natural plant source. The amount of steroid injections are limited because the structure of muscles can be compromised if given too much.
Physical Therapy: Some doctors will send you to physical therapy, others will perform it in their offices, and others will have you do it at home. The most common modalities performed in physical therapy are TENS, ultrasound, infared, iontophoresis, stretching exercises, hot and cold packs, massage, and evaluation of posture, ergonomics, and sleeping positions.
Alternative Therapy: Some doctors will refer you to chiropractors, massage therapists, acupuncturists, biofeedback therapists or nutritionists. An osteopath - a doctor who has different medical training than an MD - is trained to perform all of these functions. As with any medical procedure, one must do their homework and be comfortable both with the modality and the practitioner for it to be successful.
Medications: There are many medicines used to treat TMJ disorder depending upon your symptoms. These include muscle relaxants to relax muscles around the joint, pain medications to help with daily function, anti-depressants such as SSRI's and tri-cyclics for pain and depression, non-steroidal anti-inflammatory drugs (NSAIDs) to assist with pain relief and inflammation, sleeping medication to assist with sleep disruption that often accompanies pain, anti-seizure medication used for nerve pain and sometimes headaches, headache abortives as many TMJ patients respond positively to Migraine or headache medicines for head pain. Sometimes medication management gets complicated and patients are referred to pain clinics or specialists such as neurologists. These physicians will take care to ensure that there are no interactions between medications, and that the medication and its side effects are not exacerbating symptoms.
Referral to Specialists: Many of the symptoms of TMJ disorder can be complicated and require referral to specialists. These specialists will work with your general physician or dentist to form a team. This can include:
- neurologists for migraines, headaches, and nerve pain
- pain specialists for pain management, medication management, and neck and back pain,
- rheumatologist for arthritis, fibromyalgia or other related diseases and disorders
- ear nose and throat doctor for ear and hearing related symptoms. Depending on who is originally treating you, you might be referred to a "TMJ specialist" or oral surgeon.
More Advanced Treatment: If conservative treatments fail after a period of time, then more invasive treatments may be considered depending on your particular situation. Any invasive treatments should only be considered after exhausting extensive conservative, non-invasive therapies and receiving multiple opinions from independent physicians.
Please keep in mind that there are no board certifications, no standards of care, and very little conclusive research on TMJ disorder and its treatment. Dentists, surgeons, and medical doctors do not agree on a treatment protocol that is effective for the majority of patients. Therefore, it is a good idea, as with any medical treatment, that you proceed carefully and do extensive research.
Last Updated: 7/20/07