Question

TMD/TMJ pain

I have a tempero-mandibular joint (TMJ) problem with pain in the jaw. I have talked to my dentist about this and he usually gets out the drill and works on my "bite". I feel something more is wrong, as I don't grade my teeth or anything like that. What type of dentist or doctor should I go to?

Answer

Treatment for Temporo-Mandibular Disorder (TMD) is of two types, reversible and irreversible. The very fact that there are so many different approaches shows the difficulty in finding an effective treatment. Before treatment of any kind, the physician should palpate the shoulders, head, neck, muscles of mastication and the TMJ to eliminate any obviously treatable disease.

Reversible treatments options are:

1. Medication

A. Anti-Inflammatory medications (e.g. acetaminophen, NSAIDs)

B. Muscle relaxants

2. Behavior modification

3. Physical therapy

A. Moist heat/cold

B. Transcutaneous electro-neural stimulation (TENS)

C. Microcurrent electro-neural stimulation (MENS)

D. Ultrasound

E. Vapo-coolant spray and stretch

F. Accupressure or acupuncture

G. Injection of 2% lidocaine into trigger points

H. Proprioceptive awareness training

I. Exercise therapy

4. Muscle relaxation appliances

Of all the above treatments, the most important is behavior modification!

Irreversible treatment options:

1. Bite (occlusion) adjustments

2. Crown and partial dentures that alter the bite

3. Orthodontics (braces)

4. TMJ surgery (arthroscopy or open joint surgery)

In general, irreversible treatments #1, 2, and 3, which permanently alter the occlusion (bite) relationships of the teeth are to be avoided. Surgery should only be considered for a small percentage of patients who exhibit persistent significant pain and dysfunction, and only after more conservative treatments have failed.

As you can see, the treatment of TMD is not very simple. The professional to see is a dentist who is qualified in disorders of the temporo-mandibular joint. There are many dentists who have studied this particular specialty, and are listed in your phone book. Most DDS dentists or dentists that specialize in dental surgery are familiar with the above procedures and will advertise that they treat TMJ disorders.

Links

• TMJ Dysfunction