a guide to tmd treatment from melbourne tmj solutions the ...€¦ · pain medications over the...

Melbourne TMJ Solutions

A guide to TMD treatment from Melbourne TMJ Solutions

To get the most out of your consult with a specialised TMD practitioner, it is important to educate yourself

to be able to ask questions and make knowledgeable decisions. We have compiled this document to help

you better understand the complex nature of TMD and associated symptoms.

The Basics of the Jaw Joint

What is the Temporomandibular Joint?

The Temporomandibular Joint (TMJ) is the jaw joint, one in front of each ear. They work as a pair to

connect the lower jaw bone (the mandible) to the temporal bones on each side of the head. The muscles

controlling the joints are attached to the mandible and allow the jaw to move in three directions: up and

down, side to side, and forward and back.

When you open your mouth, the rounded upper ends

of the mandible on each side of the jaw (the condyles)

glide along the joint socket at the base of the skull.

They slide back when you close your mouth. To keep

this motion smooth and to absorb shock, a soft tissue

disc lies between the condyle and the socket. The

combination of synchronized as well as three-

dimensional movements of the paired joints

distinguishes them as the most complicated joints in

the body.


What are Temporomandibular Joint Disorders (TMD)?

Temporomandibular Disorders (TMD) are a complex set of conditions characterized by pain or restriction

in one or both jaw joints and surrounding tissues. Injuries and conditions that routinely affect other joints

in the body, such as arthritis, also affect the Temporomandibular Joint. TMD can affect a person’s ability to

speak, chew, swallow, make facial expressions, and even breathe.

Who is affected?

Approximately 12% of the population, mainly women of child-bearing years, are affected by TMD. The

ratio of about nine women for every one man increases with the severity of symptoms, major limitations

in jaw movements and chronic, unrelenting pain. Scientists have found that most patients with TMD,

mainly women, also experience disorders like chronic fatigue syndrome, chronic headache, endometriosis,

fibromyalgia, interstitial cystitis, irritable bowel syndrome, low back pain, sleep disorders, and vulvodynia.

What Causes TMD?

Environmental factors like gum chewing or sustained positions, such as resting a phone on your shoulder,

may contribute to TMD. Singers and musicians, like violinists or flautists, may also be susceptible to TMD

due to jaw stretching for mouthing or positioning the head, neck and arm to play the instrument.

Adding to TMD complexity is that there can be no known obvious cause or multiple causes such as:

Autoimmune diseases (in which the body's immune cells attack healthy tissue

Infections

Injuries to the jaw area including trauma (direct and repetitive strain)

Prolonged mouth opening (for dental procedures or breathing tube insertion for surgery)

Various forms of arthritis

Genetic, hormonal, environmental and lifestyle factors

Symptoms of TMJ Disorders

TMD pain is often described as an intermittent dull, ache in the jaw joint and nearby areas. However, some

people report no pain but have poor jaw motion. Symptoms may include the following:

Pain and tightness in the muscles of the jaw, neck or shoulders

Chronic headaches

Ear pain, pressure, fullness, ringing in the ears (tinnitus)

Clicking, popping, clunking or grating in the jaw joint when opening or closing the mouth

A bite that feels "off"

Dizziness

Visual problems


Whom Should You See?

The TMJ is a complex area, which needs the specialist knowledge of a practitioner who has proven

knowledge in TMD. At Melbourne TMJ solutions, we specialize in treating TMJ related disorders.

Liaising with your health team, which may include doctors, dentist, psychologist, we can confirm diagnosis

and the care plan and rule out some of the conditions that may mimic TMD. For example, facial pain can

be a symptom of many conditions, such as sinus or ear infections, decayed or abscessed teeth, various

types of headache, facial neuralgia (nerve-related facial pain), and even tumors. Certain other diseases

such as Ehlers-Danlos syndrome, dystonia, Lyme disease, and scleroderma may also affect TMJ function.

Diagnosis

Research recommends that a diagnosis of TMD or orofacial pain conditions be based primarily on the

patient’s history and a clinical examination of the head and neck. Discuss concerns with your care provider

to help rule out other conditions which can cause symptoms and to manage pain and dysfunction.

Treatments

Most people with TMD have mild or periodic symptoms which may improve within weeks or months with

self-care like eating soft foods, applying ice or moist heat, and avoiding extreme jaw movements (wide

yawning, loud singing and gum chewing). Experts recommend using the most conservative, reversible,

non-invasive treatments, which do not permanently change the structure or position of the jaw or teeth.

Pain Medications

Over the counter pain and anti-inflammatory medications have been found helpful but it is best to consult

your doctor for a wider range of individualised options and to monitor effects.

Splints

Dentists may recommend an oral splint made of hard acrylic resin and fits over the upper or lower teeth.

However, studies of their effectiveness in providing pain relief have been inconclusive.

Nutritional Health

TMD pain and restriction can cause poor nutrition. Medications can lead to dry mouth, which increases the

risk of dental cavities, yeast infections, and broken teeth, which add to chewing and swallowing difficulty.

The mouth can become more sensitive to pain and temperature and taste may be affected. Consult your

doctor, dental specialist or dietician to address this.


Research for Solutions

There is a growing consensus of health professionals who consider TMD a complex family of conditions, so

the person with TMD should not be seen as someone with an isolated dental or jaw condition but rather

viewed as a whole individual subject to genetic, hormonal, environmental and behavioral factors that may

contribute not only to jaw pain and dysfunction, but to other conditions.

Management of Jaw Sprain in Temporomandibular Disorder-TMD

Maintain upright, relaxed neck, back and shoulder posture; don’t protrude chin (e.g. applying

lipstick, at computer or talking) or slump; think tall, especially at work, on phone, exercising.

Ensure good work set-up with computer screen directly ahead, eyes at mid-screen, sit back in a

supportive chair; avoid prolonged postures and move regularly from sit to stand, walk. Minimise

prolonged, tilted and slumped posture when texting or gaming, take regular standing breaks.

Be mindful of jaw tension (avoid clenching, grinding) especially when concentrating, trying hard,

when frustrated or stressed. Remember to have a few millimetre gap between the teeth at rest.

Avoid hard (whole apples, carrots, nuts, pens, fingernails) chewy (lollies, gum, tough meat) or wide

(crusty breads, hamburgers, rolls, corn cob) foods, which overwork the sprained jaw with hard or

prolonged chewing

Cut or grate foods into bite-sized pieces to chew with the back teeth, juice raw fruit and vegies

Avoid wide mouth opening as in yawning. Yawn smaller and support the lower jaw in a yawn.

Advise dentist or anaesthetist (prior to any procedure) of TMD to reduce jaw sprain with

prolonged mouth open

Open the jaw in an even hinge or arc motion; practise in front of a mirror to correct asymmetries

Try to sleep on your back with a supportive pillow. If you do sleep on your side have good pillow

support of the neck and do not sleep on your jaw. Good sleep is essential for well-being and lack of

it contributes to chronic pain; discuss sleep deprivation management with your doctor

Minimise or manage stress with relaxation and daily exercise (e.g. 40 mins of rapid walking daily).

Counselling can give strategies to enhance well-being, as the mind and body work together

Discuss with your dental clinician appliances to rest the sprained jaw and protect teeth

Apply moist moderate warmth to the facial and temporal muscles (ensure it does not burn)

Follow a program of massage and exercises to loosen and strengthen the jaw as directed by your

physiotherapist. This aims to improve function with reduced pain and restriction

Myo-Fascial Trigger Points

Head and neck muscles play a significant part in TMD, so accurate diagnosis of affected muscles in each

case is essential. The diagrams below show particular muscles can cause distant pain and dysfunction.

Being able to identify and treat these muscles is essential to your recover from TMJ. Sometimes a single

treatment for the correct muscle can provide dramatic relief even to those long standing conditions.


Trigger points are tight muscle bands, which restrict blood supply and send erratic nerve signals that

contribute to pain. Treating trigger points is essential in resolving your TMD. Our therapists are trained to

accurately locate and treat precise head and neck trigger points that may contribute to TMD. See below:

Sternocleidomastoid Trigger Point Diagram

Lateral Pterygoid Trigger Point Diagram


Trapezius Trigger Points Temporalis Trigger Points

Masseter Trigger Points Medial Pterygoid Trigger Points


Levator Scapulae Pts Buccinator Trigger Points

Semispinalis Capitis & Multifidi Infraspinatus Trigger Points


Frequently Asked Questions

We recommend you read through the following list of FAQ’s and also consider the following.

1. What is the purpose of the proposed treatment, and will it help my symptoms?

2. Is the treatment reversible, or irreversible?

3. What side effects or complications may I experience, and what should be done about them?

4. What are the proven advantages of proposed treatments rather than other forms of therapy?

5. How many follow-up treatments will be necessary?

6. How much will the proposed treatment cost and will health insurance contribute to costs?

7. Is there a payment contract I must sign? (If so, ask to take the form home to review.)

8. Is there a consent form I must sign for treatment? (If so, ask to take the form home to review.)

Why is the jaw so much harder to treat than any other joint in the body?

The temporomandibular joint is one of the most complex joints in the body. Despite the tremendous

patient population and the significant dysfunction related to a plethora of TMJ disorders, the TMJ has been

poorly studied in comparison to joints of interest to the orthopaedic community.

I recently was referred to bioesthetic dentist for my TMJ problem. What is bioesthetic dentistry and will

this help me?

In bioesthetic dentistry ( another name for bite modification) diverse signs and symptoms like worn or

cracked teeth, gum recession, a history of multiple root canal treatments, headache, TMJ problems,

ringing in the ears, equilibrium problems, fibromyalgia, etc. are all related to a disharmony between the

way teeth meet and the correct position of the temporomandibular joint. The bioesthetic dentist has

patients wear a bite appliance called a MAGO (Maxillary Anterior Guided Orthotic) for six to twelve weeks,

which is supposed to get the bite to match the correct jaw position. This position is then maintained by

tooth grinding, bonding, crowns or braces. No scientific evidence supports claims made by the bioesthetic

dentists, so patients should be wary of having such irreversible changes made to their teeth and bite.

I recently had my tonsils and adenoids removed and a little over a month later I started experiencing jaw

pain. I have since been diagnosed with TMJ and was wondering if the surgery could possibly cause TMJ?

Intubation during surgical procedures has been known to cause jaw joint disorders. The patient's mouth

must be opened quickly, and very widely, to insert the respiration tube, and the jaw may remain fixed in

place for a prolonged period of time.


I recently had a crown put on my left molar. A week later, I woke up one morning and could not close my

left jaw. Is it normal to wake up and have a TMJ problem so suddenly or does it usually creep up on you?

A number of complications can occur in preparing and placing a crown; sensitivity of the tooth, aches and

pain are the most common. Some patients report onset of a TMJ condition after dental work.

Manipulation of the jaw, including overt trauma is to be expected to cause pain and dysfunction.

I’ve been noticing popping or clicking in my jaws recently. My dentist suggested having my wisdom teeth

removed. Will this help?

Wisdom teeth do not cause TMJ problems. These teeth only need to be removed when local events justify

their extraction. This includes inflammation of the gums around the wisdom teeth, or their negative

impact on the neighboring teeth.

Every time I open my mouth to yawn or to eat a sandwich, my right jaw makes a popping sound. My

dentist says that since I don't have pain there's really nothing I can do for it. Is this still considered TMJ?

Jaw noises unaccompanied by pain or decreased mobility typically mean you do not have a problem. If

there is pain and altered movement / function of the jaw, we recommend getting it assessed. It is

important to get several independent opinions before agreeing to irreversible treatment designed to

eliminate a click or noise in the joints. Repositioning splint therapy is unproven, irreversible and expensive.

A click without other symptoms is usually nothing to worry about. If jaw opening is difficult, try to

consume food like purees, soups and smoothies which can be taken without over-stretching the jaw.

I recently had my wisdom teeth removed, could this be the cause of my TMJ pain?

Certain dental procedures appear to cause TMJ symptoms in some people. To avoid causing or worsening

an existing problem, minimise application of too much pressure or backward push of the jaw or building

caps too thick or fillings too high. Lengthy dental work requiring prolonged, wide mouth opening can cause

or aggravate a TMJ problem. We frequently hear from patients who experienced their first symptoms after

wisdom teeth extraction. Although many doctors remove wisdom teeth in adolescents to prevent future

problems, according to a prior study, most wisdom teeth do not cause trouble. Some patients suffer jaw

spasms and other surgical complications, after extraction of their third molars.

I need dental care but I'm unable to have the work done because of my TMJ problem. What can I do?

TMJ patients frequently have difficulty receiving general dental care and hygiene. We suggest that you ask

several dentists about their care of orally compromised patients. Some accommodate patient difficulty in

breathing and swallowing when reclined by doing the work in a more upright position. To prevent spinal

pain, pillows are placed at the neck and back. Dental work is carried out with minimal mouth opening and

a dentist, sensitive to a TMJ patient's jaw tiring, will ask the patient for a sign when needing to close the

mouth. Frequent rest periods are also recommended.


What are the expected costs for different types of treatment?

Costs vary according to the procedure. For Orthodontic work, braces on the teeth to realign the jaw can

cost approximately $5000. A mouth guard worn at night can cost up to $3000. Costs at Melbourne TMJ

Solutions depend on the practitioner seen and length of consultation. Please call the clinic to discuss

costs. The initial consultation fee ranges from $92 to $185; follow up appointments are $82 to $120

(correct at time of editing, subject to change).

I was diagnosed with internal derangement of disc. What does this mean?

An internal derangement refers to a displacement of the temporomandibular joint disc. If the displaced

disc returns to its normal position when the mouth is opened, it is accompanied by a clicking and/or

popping sound, and is called an anterior disc displacement with reduction. If the disc is so displaced that it

does not return to the normal position during attempted mouth opening, there is locking and the patient

generally cannot open more than 20-25 mm, this is an anterior disc displacement without reduction. Both

conditions are usually accompanied by TMJ pain. Disc displacement can be effectively treated by reducing

muscle spasm in the trigger point areas in this guide. Many of these muscles are deep and cannot be

accessed without knowledge of their location; precise treatments are available to release the muscles.

I was diagnosed with a dislocated TMJ disc, but have no pain. Should I proceed with treatment to

reposition my disc?

Many people suffer from a dislocated disc and don't even realize it. You're fortunate that you have no

pain. Pain is only one factor to decide if you need treatment. If your jaw does not function properly to

allow you to open it fully, this a problem that can be remedied quite quickly and prevent further

complications. We have clients who have misaligned jaws for 10+ years and the jaw improves from the

first treatment. Commonly we hear “if I knew how simple this was to fix I would have done it years ago”.

I have had an earache and am hard of hearing since my TMJ problem began. Is this problem reversible?

Earache and perceived hearing loss are symptoms we hear frequently from TMJ patients. It's possible that

the TMJ ear-related pain is caused by inflammatory processes in the back of your mouth or the tissues

close to your middle ear. We suggest seeing an ear, nose and throat specialist to rule out any problem

treated by them. Most earaches are effectively treated by relatively simple means and should be excluded

prior to any TMJ treatment. Many TMJ patients report pain in and around the ear which is the result of

referral of deep pain and not of a problem with the ear itself. Should the earache and hearing loss be

related to your TMJ disorder, effective treatment to the TMJ is beneficial in resolving any ear issues.

What is the relationship between TMJ problems and migraine headaches?

Headaches may be linked with TMJ and masticatory muscle problems as a referred pain interpreted as a

headache, or as a true muscle contraction (tension) headache in a muscle of mastication like Temporalis.


Is it possible to experience TMJ symptoms after a bad car accident?

Yes high velocity impact can cause injury to deep tissue. Soft tissue injuries can remain undetected in an

E.D. visit because immediate acute care focuses on medical, superficial tissues and bone status.

I was told I should have a TMJ splint made. Are there different types of splints and how will a splint help

me?

We caution patients to be careful of any TMJ treatment that is irreversible, or can produce irreversible

changes, and non-conservative such as crowns, braces, surgery and repositioning splints. Ask the intent of

the splint (flat plane or repositioning), what happens if it doesn't improve or worsens your condition, what

further treatment will be needed if any, what kind of splint, how long is it worn, and how much will it cost.

Splints are the most universal type of treatment for TMJ and many types of splints are in use. The one that

is considered to be the most benign is called a flat plane or stabilization splint, which is intended to allow

your muscles to relax and help reduce clenching and grinding. It should not cause any change in your bite.

Another type of splint is a repositioning splint, intended to put your jaw into a position other than where it

is, therefore, causing permanent changes in the bite as well as repositioning muscles and ligaments.

My nightguard helped relieve my pain in the beginning, but why has the pain returned?

Though the flat plane splint is intended to reduce clenching and grinding, in some patients, it actually

increases them. It may be explained by the brain telling the teeth to go where they used to be. This is

called proprioception. In other words, the teeth are trying to get to where they feel they should go but the

splint is in the way; therefore, you are clenching harder in order to get the teeth to that position. Recent

studies have shown that sham splints (placebo) evoked a similar response as the therapeutic ones. Other

patients mention that the splint helps to reduce pain for a while, but then problems may arise, such as the

development of an "open bite" (meaning when the mouth is closed, there is a gap between the upper and

lower front teeth). Your custom made splint depends on the expertise of your dentist.

Can wisdom teeth removal exacerbate TMJ?

Masseter muscle pain is not unusual following the removal of lower impacted third molars. It is also

possible when a patient has pre-existing TMJ problems that there can be some stretching of the joint when

lower third molars are moved under sedation or general anesthesia. Both of these conditions are generally

temporary. Symptoms may subside with a soft diet, moist head, a mild pain medication and limited jaw

function for 1-2 weeks.


TMJ Disorder Self-test

If you answer yes to any of the following questions you may have TMJ disorder or similar condition.

Jaw pain YES/NO

Jaw clicking YES/NO

Neck and/or upper shoulder muscle pain YES/NO

Dizziness YES/NO

Ringing in the ear YES/NO

Face pain, headache, migraine YES/NO

Limited movement of the jaw YES/NO

Altered jaw movements YES/NO

Jaw locking or stiffness YES/NO

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We trust that you have found this information informative and will help you to make an informed choice

about how to resolve your TMJ disorder. At Melbourne TMJ Solutions we pride ourselves on being able

to help even the most difficult cases of TMJ. Our team is led my Ms. Meg McNena who has dedicated

over 25 years to researching and treating TMJ disorders. Our primary goal is to get people better as

quickly as possible and ensure that the problems does not return. We are confident that Melbourne

TMJ solutions has the experience and knowledge to help you that we offer a satisfaction guarantee -

100% satisfaction or your money back and your next session free.

To make an appointment, please call 9486 – 7543.

The information contained in this article is of a general nature only and should not be taken as advice. It has not taken into account

your personal situation or needs. You should seek professional advice before taking any action in regard to the general comments

in this article.

a guide to tmd treatment from melbourne tmj solutions the ...€¦ · pain medications over the...

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