Temporomandibular Joint Disorders (TMD)

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Many other conditions cause similar symptoms -- like tooth decay, Ear ache, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the Oral and Maxillofacial Surgeon will ask about your health history and conduct a physical exam.

They’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. They’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus they’ll test your bite and check for problems with your facial muscles.

In addition, radiographs (X-rays) may be taken to view the jaw joints and determine the extent of damage. These may include:

• Panoramic X-rays. This type of dental X-ray shows a broad overview of your teeth, jawbone and TMJs.
• CBCT scans. Cone beam computed tomography (CBCT) scans capture thousands of images of your teeth, jaws, facial bones and sinuses. These pictures are then stitched together for a detailed 3-D image. Dental CT scans give your healthcare provider a more detailed view of your facial anatomy.
• MRI scans. In some cases, magnetic resonance imaging (MRI) may be used to view soft tissues in and around the jaw joints. These images show the position of the disk, inflammation and possible jaw locking. This can tell your healthcare provider if the TMJ disc is functioning properly and in good condition.
• TMJ arthroscopy is sometimes used in the diagnosis of a TMJ disorder. During TMJ arthroscopy, your doctor inserts a small thin tube (cannula) into the joint space, and a small camera (arthroscope) is then inserted to view the area and to help determine a diagnosis.

You'll probably first talk about your TMJ symptoms with your family doctor or dentist. If suggested treatments don't provide enough relief, you may be referred to a doctor who specializes in TMJ disorders.

What you can do?

You may want to prepare a list that answers the following questions:

· When did your symptoms begin?

· Have you ever had this occur in the past?

· Has your level of stress increased recently?

· Do you have frequent headaches, neck aches or toothaches?

· What medications and supplements do you take regularly?

· What to expect from your TMJ Specialist

Your doctor may ask some of the following questions:

· Is your pain constant or do your symptoms come and go?

· Does any activity seem to trigger the pain?

· Does your jaw click or pop when you move it? Is that clicking painful?

· Is it difficult to open your mouth normally?

Your Surgeon will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time.

Primary goals in treatment of TMD are to alleviate pain and to improve mandibular biomechanical function. The importance of initial conservative approaches in the management of TMD cannot be overstated for reasons that are not yet fully understood. These treatment modalities, when adhered to for two to three months (either alone or in combination), often provide the majority of patients with relief and/or resolution of signs and symptoms. 

Contemporary conservative TMD management may include any or all of the following:

There are things you can do on your own to help relieve TMD symptoms. Your doctor may suggest you try some of these remedies together.

• Take over-the-counter medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs), to relieve muscle pain and swelling.
• Use moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple jaw stretches (if your dentist or physical therapist OKs them). When you’re done, hold a warm towel or washcloth to the side of your face for about 5 minutes. Perform this routine a few times each day.
• Eat soft foods. Add yogurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans, and grains to your menu. Cut foods into small pieces so you chew less. Skip hard, crunchy foods, chewy foods, and thick or large bites that require you to open wide.
• Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and don’t yell, sing, or do anything that forces you to open wide.
• Don't rest your chin on your hand. Don’t hold the phone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
• Keep your teeth slightly apart as often as you can. This will relieve pressure on your jaw. Put your tongue between your teeth to control clenching or grinding during the day.
• Learn relaxation techniques to help loosen up your jaw. Ask your TMJ Specialist if you need physical therapy or massage. Consider stress reduction therapy as well as biofeedback.

Talk to your TMJ Specialist about these tried-and-true treatments for TMD:

Medications

• Pain relievers and anti-inflammatories. If over-the-counter pain medications aren't enough to relieve TMJ pain, your TMJ Specialist may prescribe stronger pain relievers for a limited time.
• Antidepressants. These medications are used mostly for depression, but in low doses, they're sometimes used for pain relief, bruxism control and sleeplessness.
• Muscle relaxants. These types of drugs are sometimes used for a few days or weeks to help relieve pain caused by TMJ disorders created by muscle spasms.

A splint or night guard 

• These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. 
• What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your Oral and Maxillofacial Surgeon will tell you which type you need.

Dental work

• Undergo corrective dental treatments. These treatments include replacing missing teeth or using crowns, bridges or braces to bring your bite into proper balance and alignment.

Counselling

• Education and counselling can help you understand the factors and behaviours that may aggravate your pain, so you can avoid them. Becoming more aware of tension-related habits — clenching your jaw, grinding your teeth, leaning on your chin, biting fingernails or chewing pencils — will help you reduce their frequency.

If conservative treatments are unsuccessful, your healthcare provider may suggest one or more of the following:

• Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist's office or at home.
• Ultrasound. Deep heat applied to the joint can relieve soreness or improve mobility.
• Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called "trigger points" to give relief.
• Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.
• Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.
• Botulinum Toxin (Botox®). These injections help reduce muscle mass and inflammation.

Recovery from a TMJ surgery depends on the person and the type of surgery performed.

• Most TMJ surgeries are outpatient procedures, so you can usually go home the same day. You’ll be monitored in the recovery room to make sure that your vitals are stable before your medical team allows you to leave.
• If you had general anesthesia, you’ll wake up in the recovery room. You’ll likely feel some pain in the jaw. Let your nurse know if you’re experiencing discomfort so they can give you pain medicine and help you feel comfortable.3
• If you’re staying in the hospital overnight, you’ll be taken to your hospital room. For a total joint replacement, you may be at the hospital for three to five days before you’re able to go home. Hospitals and surgery centers may differ on their discharge policies.

Your surgeon can give you information about when you can expect to go back to work after your procedure. For minor procedures, this might be the next day. Open-joint procedures, on the other hand, may require several weeks off, depending on your job and the type of surgery.

Depending on the procedure you had, you may have bandages to wear for several days afterward. Your stitches may dissolve on their own or they may need to be removed at a follow-up appointment. Your surgeon will let you know when you can remove the bandage and when you can clean the area with soap and water.

With most TMJ surgeries, you’ll experience swelling, bruising, jaw pain, and tenderness. Apply ice packs to the face for no more than 20 minutes at a time for the first day after surgery. Keep your head elevated using two or three pillows when resting to help with swelling. After 48 hours, you can apply warm heat from a heating pad or a microwaved wet washcloth to help with any discomfort. Your jaw will probably be swollen for a week or more after surgery.

For discomfort, your healthcare provider may prescribe pain medication or suggest taking over-the-counter medicines. They may prescribe muscle relaxants if you’re experiencing any spasms.

You may notice a change in your bite or clicking in your jaw. Let your healthcare provider know if this doesn’t resolve on its own as your joint heals over the days and weeks after your procedure.

Physical therapy or jaw exercises can help to restore your jaw’s function and range of motion. Your surgeon may suggest that you see a physical therapist to start jaw exercises in the first week after your surgery.

Wear a splint or other device on your jaw at all times until your doctor tells you it’s OK to remove it.

With all TMJ surgeries, you’ll need to eat a soft diet during the healing process. This may start with liquid-based foods, like smoothies and soups. After several days, you may be able to add soft foods like yogurt, applesauce, oatmeal, soup, mashed potatoes, and eggs. Avoid hard, chewy, and crunchy food.

Your healthcare provider will let you know when you can start adding other foods to your diet. For total joint replacement surgery, this process may take up to eight weeks.

It may be easier to eat small amounts every few hours rather than large amounts at mealtimes.

Your healthcare provider will probably suggest you schedule a follow-up appointment about two to three weeks after surgery to make sure everything’s healing correctly and discuss how you’re feeling.

Your recovery will depend on the procedure that you had done.

TMJ Surgery                                                              Anticipated Recovery Time

Arthrocentesis, arthroscopy                                        A few days to a week

Arthrotomy, arthroplasty                                             Two weeks

Joint replacement                                                       Three to eight weeks