TMJ/TMD and Bruxism
Bruxism and TMD (tempromandibular disorder) are most commonly treated with an orthopedic bite splint as shown in the two photographs. The purpose is to allow complete freedom of movement of the lower jaw and eliminate "tooth contacts" that restrict jaw movements and cause muscle spasm and/or tempromandibular joint disorders. This is termed a permissive appliance since it permits the jaw to seek its most natural anatomical position. This helps relieve inflammation, swelling and pain. Variations occur in the type of appliances, but each one must be carefully adjusted to the occlusion or bite of each individual patient.
TMJ refers to the tempromandibular joint or the hinge axis joint of the jaw. It allows us to open and close or move our lower jaw from position to position when talking, eating and swallowing. Each end of the jaw has a "ball shape" end on it called a condyle. This condyle fits into a concave area on our skull called a fossa. A flexible disk rests between the condyle and fossa to act as a cushion. Muscles open, close and move the jaw around.
Whenever the joint, the disc or the muscles get out of a normal position, a condition called TMD occurs. This stands for tempromandibular disorder. This condition sometimes corrects itself if it is due to a temporary musle spasm. Rest, moist heat packs, and limited opening of your mouth usually leads to an improvement. In more severe cases an "orthopedic bite appliance" is useful in taking pressure off the joints to facilitate healing. However, this must be carefully balanced to the patients occlusion (bite) so that the tempromandibular joints are properly positioned and the muscles are in a resting position.
Bruxism, which means clenching and/or grinding of the teeth, is very common in TMD patients. A "bite appliance" is extremely important in helping to prevent damage to the teeth and irreversible damage to the TMJ. It is the treatment of choice in most cases for bruxism and many TMJ cases.
As with any joint in the body, permanent and irreversible damage may occur to the condyle, fossa or disk, due to arthritic changes or trauma. If this occurs, treatment by an Oral/Maxillofacial Surgeon is usually necessary. If you go to Links on this website, more information is available regarding surgical management of this condition.
If you think you have TMJ/TMD:
1. Limit opening your mouth and avoid chewing hard or chewy foods. (Eat soft, easy to chew food for several days.)
2. Alternate cold (ice) packs and hot packs (don't burn yourself) every 20 minutes to help disrupt a pain cycle.
3. At the onset take either: Advil (3 tablets of 200mg ibuprophen) or Aleve (2 tablets of 220mg naproxen), as long as you are not allergic* and do not have an ulcer or a stomach condition. (*Ask your doctor before taking any mediction when you are unsure) You may repeat this dose every 8-12 hours for 3 to 5 days. (Tylenol offers some pain relief, but does not reduce swelling like Advil or Aleve.)
4. If you don't experience significant improvement, please call our office as soon as possible for an appointment.
Examination
1. A TMJ history and examination of: ability to open and move side to side; joint and/or muscle tenderness; and abnormal joint sounds such as popping or crepitus.
2. Digital Panorex to screen for bone and/or joint changes.
Treatment Recommendations (May include)
1. Palliative treatment (heat, cold, medictions, etc.) and monitor improvement
2. "Splint Therapy" to reduce bruxism and/or take pressure off the joint (similar to a knee brace that allows natural improvement and healing)
3. Referral to a surgical specialist for MRI examination and possible surgical treatment
Splint Therapy (Dr. Stanley's Office)
1. Accurate, detailed models of the upper and lower teeth are made.
2. A "bite registration" that properly positions the upper and lower jaw is secured.
3. A maxillary (upper) "bite splint" is fabricated by a dental laboratory.
4. The splint is delivered and adjusted for patient comfort and "proper jaw positioning".
5. Recall appointments and adjustments are made as needed.
