By Ellen Klein
Every day, about 10 million Americans suffer from pain in their jaws; pain that can be accompanied by tightness, clicking, headaches, earaches and difficulty chewing. Temporomandibular disorders (TMD) may not be life-threatening, but anyone who suffers from them knows they are no laughing matter. That TMD can be treated successfully through non-invasive means comes as good news to many patients.
The temporomandibular joint (TMJ) connects the lower and upper jaws, and the various structures that comprise it help to facilitate chewing. The TMJ includes muscles, tendons, and joints, and the pain associated with TMD originates from within them.
Habitually clenching the jaw and grinding the teeth, changes in hormone levels, and stress and anxiety are some causes of TMD, so it’s important when treating the symptoms non-invasively to also address the possible cause, or causes. If patients don’t make lifestyle or other changes to support the process, they may be faced with the prospect of treating TMJ-pain and other symptoms indefinitely.
While some causes or symptoms of TMD may require surgery, most cases can be treated by non-invasive means. According to the U.S. National Institutes of Health (NIH), those means can include self-care practices, pain medication, and stabilizing splints.
Various self-care techniques have proven effective in the treatment of mild to moderate TMD symptoms. Improving posture and avoiding jaw movements that place the joints under stress, such as chewing gum or yawning widely, are two such techniques. As stress and anxiety can ultimately cause TMJ-pain, it’s important to practice relaxation techniques and find other ways to manage stress. Applying moist heat or ice packs to the affected area can help relieve the pain that patients feel in the various structures that comprise the joint.
Clenching the jaw and grinding the teeth are common causes of TMD. Using a mouth guard is one of the non-invasive ways of treating these causes. A mouth guard that’s been custom made will fit comfortably over the patient’s teeth, and it can limit or prevent them from clenching their jaws and grinding their teeth. The nature of a patient’s symptoms will determine whether their dentist recommends a regular mouth guard, or one that’s been designed specifically for TMD.
When recommending non-invasive treatments, dentists may analyze the patient’s jaw movements and recommend simple exercises to be performed daily in front of a mirror. The exercises can help patients to develop better control of their jaw muscles, and in doing so, stop them clenching their jaw.
If a patient’s TMJ-pain and other symptoms persist, their dentist may recommend that they visit a physical therapist who may combine several treatments that can alleviate them. Treatments commonly used by physical therapists in the treatment of TMD include exercises and stretches, ice, moist heat, and ultrasound.
There are two approaches to using medication to treat TMD symptoms.
The first is to use over-the-counter painkillers such as aspirin or paracetamol. The second is to use stronger prescription drugs such as higher doses of NSAID pain relievers, and muscle relaxers such as ibuprofen, and diclofenac. Some symptoms may require a dentist or doctor to use trigger-point injections, which involve injecting pain medication into various facial muscles. Depending on the cause of the patient’s TMD, a doctor may also prescribe an antidepressant or anti-anxiety medication.
If simpler self-care practices make little difference to the pain a patient experiences, their dentist may recommend neuromuscular TMJ treatment. In this case, computer imaging systems are used to draw up a two-stage treatment plan. These plans usually include multiple treatments that aim to reduce muscle inflammation and to realign the patient’s jaw.
TMD can be caused by the incorrect positioning of a patient’s jaw, which places stress on the TMJ. In this case, their dentist may treat TMD non-invasively by reshaping some of their teeth, or by fitting crowns that will help adjust their jaw position. In many cases, TMD symptoms have been eliminated by restoring the patient’s bite alignment.
Orthodontics such as retainers, splints, and technologies such as JawTrac can be effective in treating TMD. They work by realigning the patient’s jaw and their smile, which results in a more comfortable bite. This places less stress on the TMJ, which can alleviate TMD symptoms.
Some patients have found that their TMD symptoms were treated effectively with the use of radio wave therapy. This non-invasive treatment uses radio waves to increase blood flow to the TMJ and surrounding area, which can relieve pain. Therapeutic low-level laser therapy can help to restore motion range in the patient’s jaw joints and neck. Transcutaneous electrical nerve stimulation can offer relief from the pain associated with TMD by relaxing the TMJ and facial muscles through the application of low-level electrical currents.
Botox, which is used normally to reduce wrinkles and lines on the face, may provide temporary relief from the pain caused by TMD. However, it’s important to note that although Botox has been given FDA approval for migraine treatments, it's not yet approved for TMD. Providers usually inject Botox into the masseter muscles, which are part of the TMJ. The muscles play an important role in chewing, and when injected with the correct dosage, they are relaxed enough to stop the patient from grinding their teeth. Relaxing the masseter muscles also helps to reduce TMJ pain.
Patients should be made aware that the use of Botox in treating TMD is not without potential complications. According to Dr. Nancy Samolitis of Los Angeles’ Facile Dermatology and Boutique, the relaxation of the masseter and other jaw muscles can lead to a loss of facial volume and jaw definition. Furthermore, if their Botox provider is inexperienced or ignorant of facial anatomy, they could inject the wrong muscles, or the toxin could spread to the wrong muscles, which could cause a crooked smile or the loss of the ability to smile, which can last for several months.
TMD can be treated, and it’s important not to focus on just alleviating the symptoms, but on the cause too. For treatment to be effective, dentists and patients must address the factors that led to the issue in the first place.
Ellen Klein is an Editor at Choice Mutual, where she covers topics such as financial management and risk management. She’s a realist and believes that planning for life’s unknowns is best. When she’s not busy with volunteer social work, she can be found scribbling away at her keyboard.