You can get relief for hard-to-treat TMD

Some dentists are quick to recommend surgery for people who suffer from the often painful conditions known as temporomandibular disorders (TMD).

But that’s a mistake. Surgery should be the last resort for the vast majority of patients who suffer from these disorders, which affect the jaw joint and/or facial muscles that allow us to chew, speak and swallow.

Good news: Roughly 95% of the 10 million Americans who have TMD can get relief without surgery — if they use the right treatments. What you need to know…

RED FLAGS TO WATCH FOR

Contrary to popular belief, people with TMD do not always suffer jaw pain. In fact, these disorders often go undiagnosed because they can cause symptoms in other areas of the body, including in the neck, head, face or ears.

When jaw pain does occur, it’s usually related to the temporomandibular joint (TMJ) — there’s one on each side of the head, and it acts as a hinge connecting the lower jaw to the skull. These joints are almost constantly in motion — when we chew, yawn, speak or tighten or relax our facial muscles.

This constant movement means that even slight misalignments of the jaw (the bite) or other problems can produce painful inflammation that can persist for years or even indefinitely without treatment.

Many TMD patients — with or without jaw pain — first complain to their doctors about headaches, earaches or sinus pain. About 75% of my TMD patients also have neck pain. Most people with TMD eventually experience pain in the jaw. Common TMD symptoms…

  • Headaches, particularly tensionlike pain on the sides or the back of the head. Headaches in the morning indicate that the TMD might be related to bruxism, nighttime tooth-grinding, gnashing or clenching. Headaches during or after meals indicate a problem with bite alignment.
  • Aching facial pain or face fatigue, especially after meals. This can be due to an uneven bite or teeth making premature contact, which stresses the jaw and causes fatigue.
  • Ear pain and stuffiness (meaning the ears feel clogged) are common symptoms because the same nerves that carry signals to the chewing muscles also connect to muscles in the middle ear. People who clench their teeth often report ear discomfort as well as jaw pain.
  • Clicking or popping sound in the jaw, with or without pain. Clicking means that something within the joint is binding (so that the cartilage is slipping back and forth).

    • DIAGNOSIS AND TREATMENT

    Most cases of TMD can be diagnosed by a dentist who takes the patient’s medical history, followed by a hands-on evaluation of the movement of the joints and/or jaw muscles, listening for clicking, popping or grating, looking for limited jaw motion and examining the bite. Main causes…

  • Disk displacement. Each temporomandibular joint has a ball-and-socket that is held together with a shock-absorbing disk. When this disk slips out of place, the cushioning between the joints is gone, causing clicking.

    • Two possible treatments…

    Disk manipulation. During this in-office procedure, the dentist will inject a local anesthetic, then manipulate the jaw to push the disk back into the normal position. This can eliminate pain and/or unlock the jaw, but it’s a temporary solution because the disk will still have a tendency to move out of position.

    Bite plate appliances, such as bite guards or mouth guards, are usually custom-made for each patient and fit over the teeth and keep the jaw stable. This prevents the disk from slipping. Most patients will need to wear the plate continuously for the first few days. This allows inflammation and muscle tightness to subside. After that, they need to wear the guard only while sleeping to prevent tooth grinding, a common cause of displacement.

    Important: A custom-made dental guard from your dentist, which typically costs $250 to $1,000, is more durable than an over-the-counter mouth guard.

  • Bruxism is a common cause of TMD because the jaw is in continuous — and forceful — motion when a person grinds his/her teeth during sleep. Most patients with this condition have only minor, occasional pain, but it can cause long-term damage to the teeth and, secondarily, the gums unless it’s treated.

    • Stress management is critical because stress can exacerbate the grinding or trigger it. Relaxation techniques such as massage therapy and biofeedback can be helpful. These patients should also wear a dental guard at night.

  • Teeth alignment. Patients with missing teeth, or changes in how the upper and lower teeth come together, will often experience neck pain and other symptoms of TMD.

    • Self-test: When you bring your teeth together, the bite should close without any shifting of the jaw. If your lower teeth slide against the upper teeth to achieve a “normal” bite, there’s a misalignment that may be causing excessive pressure.

    A dentist can evaluate your bite height and tooth positions and make the necessary adjustments — by removing tooth material in some places, for example, or by adding height with a crown.

    Self-Care for TMD

    Most people with TMD can significantly reduce their discomfort and avoid the need for medical procedures with self-care. Helpful…

  • Apply ice (wrapped in a washcloth) to the painful area for a few minutes at a time two to three times throughout the day.
  • Eat soft food during painful episodes. Avoid any food that requires opening the mouth wide (such as a whole apple).
  • Gently exercise the jaw with up-and-down and side-to-side movements even when it’s tender. Movement will help prevent subsequent stiffness in the joint.
  • Don’t chew gum and/or ice. Limit excessive stretching of the jaw — with big yawns, for example — during painful episodes.
  • Take over-the-counter anti-inflammatory medications, such as ibuprofen (Advil), as needed, following the directions on the label.