Temporomandibular Joint Disease (TMJ)
& Myofascial Pain Syndrome Although the exact nature of temporomandibular
joint disease and myofascial pain syndrome are different, the causes and
treatment can be similar. There are a number of basic things that all patients
can do to minimize their pain and disability and to facilitate their treatment.
Your symptoms are similar to those of any other orthopedic injury, in which
there is injury to the joint itself or the related ligaments, tendons and
other soft tissues. Treatment is directed toward allowing the body to repair
the injury by its own natural healing process. Surgery is always the last
resort and is avoided whenever possible. Remember, like all other injuries,
it will take time for your symptoms to improve and to evaluate your response
to treatment. This is especially true if your pain and limitation has existed
for some time. Do not expect to get better overnight.
The most basic treatment is resting the jaw joint and muscles.
This is done by avoiding crunchy (e.g.: carrots, pretzels) and chewy (e.g.:
bagels, steaks, chewing gum) foods, which put a lot of stress on the joint
and require the muscles to exert considerable force. You should cut your
food into smaller pieces or put it into a blender in order to minimize
the work of eating.
Try to relax your jaw and keep your teeth apart when not eating.
This will take the stress off the joint and soft tissues. Try to become
aware of when you clench or grind your teeth, such as when you are under
stress, and try to break yourself of the habit.
Good back, neck and head posture help maintain good jaw posture. Try
to hold your head up straight and avoid leaning on your hand when reading
or watching television. You may use a lumbar support for your lower back.
Moist heat over the affected muscles and ligaments helps to relax
them. This can be done up to 3 or 4 times per day for 20 minutes. If there
is acute inflammation, alternating with ice directly over the painful
area for 20-30 minutes may give relief. This can also be done 3 or 4 times
Relaxation techniques, such as deep breathing, yoga, relaxation
tapes, biofeedback, etc. may be useful in reducing stress. Some patients
may also benefit from professional counseling to help deal with life or
job stress, which is contributing to the TMJ problem.
Anti-inflammatory medications are frequently prescribed (e.g.:
Ibuprofen 800 mg three times per day). They are most effective when taken
on a regular schedule, rather than just as needed. You should take the
medication every day, whether you need it or not during the initial treatment
period. After the pain and symptoms have resolved, you will be taken off
the medication. You may also be prescribed a muscle relaxant, if it appears
that it will be helpful for your situation. All muscle relaxants may cause
drowsiness or difficulty concentrating. Some must be taken for a few days
before the effect is noticed.
If you have any problems or questions about your medications, please
call our office. If you have limited mobility of your jaw, you may practice
jaw-opening exercises in front of the mirror. Try to open and close
your mouth straight up and down. This will help loosen ligaments and strengthen
muscles. You can do this in the morning and evening, only when pain is
not flaring up.
An occlusal orthotic (night guard or splint) is an important
part of therapy in many patients. This allows the jaw and muscles to find
the most relaxed position, to allow the joint to rest. It also helps to
stop you from clenching and grinding your teeth unconsciously when awake
and asleep. You may need to wear it 24 hours per day, or just at night,
depending on your particular case. Your general dentist or orthodontist
can fabricate these appliances if they are needed to treat your condition.
Physical therapy may be indicated in your treatment. Some techniques
can be performed in the office as part of your regular follow-up visit,
but it may be necessary to have a physical therapist involved in your
care for specialized treatments.
Dietary supplements, such as chondroitin and glucosamine have
been recently shown to be important in joint function. Taken in therapeutic
doses, they may help reduce joint pain and inflammation. Recommended doses
are Chondroitin sulfate 600 mg twice per day, and Glucosamine sulfate
750 mg twice per day. These supplements can be purchased at most pharmacy
and health food stores.
Other treatments, such as orthodontics, restorative dentistry or surgery
may be indicated in your case, and will be discussed with you when appropriate.
A very small percentage of TMJ patients will benefit from surgical procedures
relative to the temporo-mandibular joint. Surgery is considered when there
is loss of joint function to the point of daily incapacity and when less
invasive treatment options have been exhausted.