Treatment
The key words to keep in mind about TMD treatment are "conservative"
and "reversible. " Conservative treatments are as simple as possible
and are used most often because most patients do not have severe, degenerative
TMD. Conservative treatments do not invade the tissues of the face, jaw
or joint. Reversible treatments do not cause permanent, or irreversible,
changes in the structure or position of the jaw or teeth.
Because most TMD problems are temporary and do not get worse, simple
treatment is all that is usually needed to relieve discomfort. Self-care
practices, for example, eating soft foods, applying heat or ice packs,
and avoiding extreme jaw movements (such as wide yawning, loud singing
and gum chewing) are useful in easing TMD symptoms. Learning special techniques
for relaxing and reducing stress may also help patients deal with pain
that often comes with TMD problems.
Other conservative, reversible treatments include physical therapy you
can do at home, which focuses on gentle muscle stretching and relaxing
exercises, and short-term use of muscle-relaxing and anti-inflammatory
drugs.
The health care provider may recommend an oral appliance, also called
a splint or bite plate, which is a plastic guard that fits over the upper
or lower teeth. The splint can help reduce clenching or grinding, which
eases muscle tension. An oral splint should be used only for a short time
and should not cause permanent changes in the bite. If a splint causes
or increases pain, stop using it and see your practitioner.
The conservative, reversible treatments described are useful for temporary
relief of pain and muscle spasm -- they are not "cures" for
TMD. If symptoms continue over time or come back often, check with your
doctor.
There are other types of TMD treatment, such as surgery or injections,
that invade the tissues. Some involve injecting pain relieving medications
into painful muscle sites, often called "trigger points. " Researchers
are studying this type of treatment to see if these injections are helpful
over time.
Surgical treatments are often irreversible and should be avoided where
possible. When such treatment is necessary, be sure to have the doctor
explain to you, in words you can understand, the reason for the treatment,
the risks involved, and other types of treatment that may be available.
Scientists have learned that certain irreversible treatments, such as
surgical replacement of jaw joints with artificial implants, may cause
severe pain and permanent jaw damage. Some of these devices may fail to
function properly or may break apart in the jaw over time. Before undergoing
any surgery on the jaw joint, it is very important to get other independent
opinions.
The Food and Drug Administration has recalled artificial jaw joint implants
made by Vitek, Inc. , which may break down and damage surrounding bone. If you have these implants, see your oral surgeon or dentist. If there
are problems with your implants, the devices may need to be removed.
Other irreversible treatments that are of little value -- and may make
the problem worse -- include orthodontics to change the bite; restorative
dentistry, which uses crown and bridge work to balance the bite; and occlusal
adjustment, grinding down teeth to bring the bite into balance.
Although more studies are needed on the safety and effectiveness of most
TMD treatments, scientists strongly recommend using the most conservative,
reversible treatments possible before considering invasive treatments. Even when the TMD problem has become chronic, most patients still do not
need aggressive types of treatment.
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