TMD Treatment: From Basic Care to Advanced Therapies

It is a very  difficult and confusing task to accurately diagnose and treat TMD. This is because a patient is usually suffering from more than one symptom that are generally not similar in two patients. Therefore, you should consult your physician or dental surgeon for proper medications and treatment.

Treatment methods that are used for TMD can be categorized into two types

1. Definitive treatment- Methods that help in controlling or eliminating  the causative factors of the disorder.
2. Supportive therapy– Methods that only help to control the symptoms of TMD.

Now, we will discuss the definitive therapy treatments and supportive therapy according to the causative factor. To know the cause of TMD, it is very important that you consult an experienced and knowledgeable doctor.

DEFINITIVE TREATMENT

Occlusal factors(upper and lower teeth contacts)

It involves changing the position of your mandible or upper and lower teeth contact alteration according to the situation.

1. Reversible occlusal therapy– This therapy will change the occlusal condition only temporarily by applying an occlusal appliance all over the teeth of either upper or lower arch. This will change the occlusal contact pattern and your TMJ gets relaxed.
2. Irreversible occlusal therapy– It will permanently change the mandibular position or occlusal condition. E.g. of treatment are- braces, surgical procedures, grinding of teeth or any restorative procedure so that your TMJ gets in harmony with your teeth.

Emotional stress

Increased levels of stress can affect the patient’s muscle activity by performing muscle activity even during rest or by developing bruxism. Patients should try to become aware of any time contact with teeth other than chewing, swallowing and speaking. Diet should be altered by taking a soft diet and smaller bites. Patient shpould restrict the jaw movement within painless limit. Stress reduction therapy should be initiated. 

Trauma: it can be of two types

1. Microtrauma- when trauma is because of a small amount of forces over a long period of time like bruxism or clenching. Main therapy in this case is to reduce these types of activities by using occlusal appliances.
2. Macrotrauma- it is because of some sudden injury like accidents or sports injury. Only preventive measures can be taken in such cases like soft occlusal appliances or mouth guards.

SUPPORTIVE THERAPY

Medications

Medications along with proper physical therapy and definitive treatment offer the proper treatment approach of TMD.

Common medications that are given in TMD are

1. Analgesics– Acetaminophen, Aspirin, Opioid narcotics(moderate to severe acute pain and for shorter duration)
2. NSAIDs– Ibuprofen 
3. Antiinflammatory drugs– Aspirin, Ibuprofen, Ketoprofen
4. Corticosteroids– Hydrocortisone injection in joint, sodium hyaluronate(intracapsular injection)
5. Anxiolytic agents– Diazepam, Clonazepam, Alprazolam
6. Muscle relaxants– Mephenesin, Carisoprodol, Methocarbamol, Flexeril
7. Antidepressants– Amitryptyline
8. Local Anesthetics– 2% Lidocaine, 3% Mepivacaine, 0.5% Bupivacaine

Physical therapy

These are the physical treatments that are applied to the patient. Some of theses therapies are-

Thermotherapy

A hot amd moist is applied over the affected area. A hot water bottle applied ovet the towel. This is a method of providing surface heat and applied for round 10- 15 minutes. An electrical heating pad can also be used but care should be taken not to leave it unattended.

Coolant therapy

It relaxes the muscles that are in spasm. Ice should be applied directly over the symptomatic area and moved in circular motion. When you feel numbness stop icing. Ice should not be placed for more than 5- 7 minutes. When you again feel warm, second round of icing should start.

Ultrasound therapy

It increases the temperature of the interface of tissues which is deeper than the surface heat.

Phonophoresis

In this method a medication is applied over the affected area and ultrasound transducer is applied directly. This method helps in introducing medication along with heat therapy directly through the skin.

TENS(Transcutaneous Electrical Nerve Stimulation)

This therapy stimulates the cutaneous nerve fibres at subpainful level. When a TENS unit is applied over the affected part, electrical activity decreases the pain perception.

Acupuncture

When certain points of acupuncture are stimulated, it releases the endorphins and help in reducing the pain sensations.

Manual techniques

• Hands on therapies are given by physical therapists for reduction of pain

• Gentle and deep massage over the painful area can help in reducing the sensation of pain

• Gentle distraction of the joint can help in breaking adhesions and can help in the patient’s joint mobilization.

• Some jaw muscle exercises can help in restoring the normal jaw functioning.

CONCLUSION

This post briefly describes all the treatment options for TMJ dysfunction/ TMD. As described in another post, TMD is a combination of disorders of the jaw and muscles. So, each and every patient can have different signs and symptoms. It is very important to properly diagnose the cause of this disease as it helps in deciding the treatment options. 

REFERENCES

1. Okeson JP. General considerations in the management of Temporomandibular disorders. 7th edition. St.Louis:Mosby;2013.
2. Veeraiyan DN. Temporomandibular Disorders. 2nd edition. JP;2017.