Temporomandibular Joint Disorder (cont.)
How are patients evaluated and diagnosed when TMJ problems are suspected?
A complete dental and medical evaluation is often necessary and recommended to evaluate patients with suspected TMJ disorders. One or more of the following diagnostic clues or procedures may be used to establish the diagnosis. Damaged jaw joints are suspected when there are popping, clicking, and grating sounds associated with movement of the jaw. Chewing may become painful, and the jaw may lock or not open widely. The teeth may be worn smooth, as well as show a loss of the normal bumps and ridges on the tooth surface. Ear symptoms are very common. Infection of the ear, sinuses, and teeth can be discovered by medical and dental examination. Dental
X-rays and computerized tomography (CT) scanning help to define the bony detail of the joint, while magnetic resonance imaging (MRI) is used to analyze soft tissues.
How can TMJ disorders be treated?
The mainstay of treatment for acute TMJ pain is heat and ice, soft
diet, and
antiinflammatory medications.
1. Jaw rest: It can be beneficial to keep the teeth apart as much as possible. It is also important to recognize when tooth
grinding is occurring and devise methods to cease this activity.
Patients are advised to avoid chewing gum or eating hard, chewy, or
crunchy foods such as raw vegetables, candy, or nuts. Foods that
require opening the mouth widely, such as a big hamburger, are also not
recommended.
2. Heat and ice therapy: These assist in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold applications is best. Cold packs can be helpful for relieving pain.
3. Medications: Antiinflammatory medications such as aspirin,
ibuprofen (Advil and others), naproxen (Aleve and others), or steroids can help control
inflammation. Muscle relaxants, such as diazepam (Valium), aid in
decreasing muscle spasms. In certain situations, local injection of cortisone preparations (methylprednisolone [Depo-Medrol], triamcinolone [Kenalog], Celestone) into the TMJ may be helpful.
4. Physical therapy: Passively opening and closing the jaw, massage, and electrical stimulation help to decrease pain and
increase the range of motion and strength of the joint.
5. Stress management: Stress support groups, psychological
counseling, and medications can also assist in reducing muscle
tension. Biofeedback helps people recognize times of increased
muscle activity and spasm and provides methods to help control them.
6. Occlusal therapy: A custom-made acrylic appliance which
fits over the teeth is commonly prescribed for night but may be
required throughout the day. It acts to balance the bite and reduce
or eliminate teeth grinding or clenching (bruxism).
7. Correction of bite abnormalities: Corrective dental
therapy, such as orthodontics, may be required to correct an abnormal
bite. Dental restorations assist in creating a more stable bite.
Adjustments of bridges or crowns act to ensure proper alignment of
the teeth.
8. Surgery: Surgery is indicated in those situations in which
medical therapy has failed. It is done as a last resort. TMJ
arthroscopy, ligament tightening, joint restructuring, and joint
replacement are considered in the most severe cases of joint damage
or deterioration.
- The temporomandibular joint (TMJ) is the site where
the upper jaw (maxilla) and lower jaw (mandible) meet.
- TMJ disorders are a group of complex problems with
many possible causes.
- Symptoms of TMJ disorders include headache, ear pain,
dizziness, and fullness or ringing in the ear.
- There are many treatment options for TMJ disorders.
Last Editorial Review: 9/26/2008
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