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Treatment

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.