How Can I Deal With My TMD?

shutterstock_247249192In our last blog we talked about what Temporomandibular Disorder (TMD) is and how you could identify it. Now you know what it is, but what do you do about it?

Diagnosis is an important step before you begin any treatment. There are many other dental conditions that can cause some of the same symptoms as TMD. Please always consult with your dentist before you begin any treatment.

Home Remedies

There are things that you can at home to relieve your pain. But, we still recommend that you go to see your dentist as soon as you suspect you might have TMD.

  • Avoid extreme jaw movements – keep yawning to a minimum and avoid yelling, singing, and anything else that requires your mouth to open wide.
  • Keep your chin up – Don’t rest your phone between your shoulder and your ear, don’t rest your chin on your hand, and make sure that you’re practicing good posture. Proper posture reduces tension on your neck and will help relieve the pain.
  • Don’t grind your teeth – keep your teeth slightly apart as often as possible. Constant clenching and grinding causes a lot of damaging pressure. Put your tongue between your teeth to help control the habit.
  • Eat soft foods – yogurt, mashed potatoes, soup, scrambled eggs, fish, cooked veggies, beans, and cottage cheese are all healthy and soft foods. Crunchy foods like pretzels and raw carrots or chewy foods like caramels and taffy will dramatically increase the strain in an already sensitive area.
  • Avoid excess chewing – don’t chew gum, avoid chewy candies, don’t munch on ice, and stop chewing on pencils/straws/pens. Overly repetitive motions will aggravate the situation.
  • Use cold packs and moist heat – Apply an ice back to the side of your face and temple for about ten minutes, stretch your jaw, and then hold a warm wash cloth to your face for about five minutes.
  • Take over-the-counter medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen will reduce the swelling and reduce muscle pain.
  • Learn to relax – your tension will be held in your jaw as well as through the rest of your body. Physical therapy, massage, and biofeedback are all options for stress reduction. Yoga is a fantastic way to stretch and focus on yourself. Meditating is also an excellent way to reduce your tension levels. Ask your doctor to show you some simple stretches or massage techniques to stretch, strengthen, and relieve your muscles.

Traditional Treatments

At your next appointment, these are some options to discuss with your dentist. They’re all tried-and-true ways to relieve your discomfort.

  • Dental work – crowns, bridges, implants, or braces are all ways to rebalance your bite surface or correct a bite problem that might have caused your TMD.
  • Bite Guardsplastic mouthpieces that are molded to fit over your teeth are actually quite comfortable. The guards will keep your teeth apart and prevent grinding or clenching. These can also correct your bite, if necessary, by pulling your teeth into the proper position. Night guards are worn while you sleep and splints are worn all the time.
  • Medications
    • Pain Relievers – if over-the-counter remedies aren’t enough, your dentist can prescribe higher dose NSAIDS.
    • Tricyclic Anti-depressants – traditionally used for depression, medications such as amitriptyline can be used for pain relief as well.
    • Muscle relaxers – if you grind or clench your teeth these can be used for a short amount of time to help stop the habit.
    • Anti-anxiety sedatives – reducing anxiety can sometimes reduce the stress that causes the grinding, clenching, and tensing of your facial muscles that contribute to TMD. Taken at night they’ll work while you sleep.

Other Treatments

These are less traditional remedies but have proven to be effective for many people.

  • Physical therapy – heat/cold treatments, stretches, and exercises will stretch and strengthen the affected area.
  • Counseling – can help you to understand the factors and behaviors that aggravate your pain.
  • Trigger point injections – pain medication and anesthesia can be injected directly in the tender muscles, or trigger points, to give more immediate relief. Corticosteroids and Botox are also occasionally used.
  • Ultrasound – deep heat applied to the joint will help to improve mobility.
  • Radio wave therapy – stimulate the joint and increases blood flow to reduce pain.
  • Transcutaneous electrical nerve stimulation (TENS) uses low-level electrical currents to relax your jaw joint and facial muscles.
  • Low level laser therapy – lowers inflammation to help you move your neck easier and open your jaw wider.

Surgical Options

If all of the other options have been exhausted and you still haven’t found relief you can discuss surgery with your dentist. Once surgery is done though, it can’t be undone so make sure that you’ve explored all of your other options and even get a second opinion. The National Institute of Dental and Craniofacial Research recommends that surgery be avoided whenever possible.

  • Arthrocentesis – if you haven’t had a history of TMD but your jaw is locked, this is the procedure most likely to be used. It can be performed in office with only general anesthesia. A needle is then inserted into the joint to wash it out. If there’s damaged tissue, a dislodged disk stuck in the joint, or just to unstick the joint, a special tool will be used.
  • Arthoscopy – is performed with an arthroscope; a tool with a lens and a light on it that allows your doctor to see your joint. Hooked up to a video screen, the tool is inserted through a small hole in front of your ear. With the aid of the lens the doctor can see any damage, remove inflamed tissue, or realign the disc. This is minimally invasive, leaves a tiny scar, and has a short recovery time.
  • Open-joint surgery – is the most extreme option. If your joints are wearing down, there are tumors in or around the joint, your joint is scarred, or your joint is filled with bone chips this procedure might be necessary. There is a longer recovery time, a larger scar, and greater chance for complications.