Conventional Medical Treatment

There are a wide variety of medical treatments employed by physicians, physical therapists, and other health care professionals to treat people with TMJ disorders. Many of them are also employed by dentists.  Sometimes it seems like the treatment a patient receives depends on where the elevator stops in the medical-dental building.

The MOST COMMON way to treat TMJ disorders is to “manage” the occasional bouts of severe symptoms by means of short term and supportive therapies, ranging from medication to meditation. Some management techniques, such as nutritional counseling and stress relief, work by enhancing the body’s natural adaptive capacity. Other management techniques such as massage, spray and stretch, trigger point injections, and sedative drugs, work by loosening tight jaw muscles.  Even closed surgeries such as arthroscopy and arthrocentesis are sometimes used as management tools.  

REDUCING TMJ INFLAMMATION can be accomplished with anti-inflammatory medications, much like those used for reducing inflammation in other injured joints.  The medications can be taken in pill form, injected into the TMJs, or applied topically on the skin over the TMJs and electronically drawn into the skin using iontophoresis.  However, reducing inflammation without addressing its cause usually just provides short term relief.

REST of the affected part is the standard medical model for acute injuries, therefore many dentists and doctors advise patients with TMJ disorders to avoid chewing gum or tough foods; however most TMJ disorders are chronic conditions rather than acute injuries, and they need rehabilitation rather than rest.  Rest can provide some relief during a severe bout of TMJ disorder symptoms, but even acutely inflamed TMJs usually benefit more from mechanical distraction combined with passive movement than from lack of use.  For example, it usually feels better to rest your jaw on food or even a piece of chewing gum on the side of the inflamed TMJ than to not bite at all.

JAW MUSCLE TREATMENT can improve resting jaw muscle circulation and thereby provide some quick relief for muscular symptoms when the TMJs are not inflamed.  Even though muscles rarely initiate problems, jaw muscle tightness and contracture frequently become integral parts of the symptom generating pathway.  Consequently, treating the jaw muscles with any of a wide variety of therapies used for tight muscles in other parts of the body can provide quick temporary relief.  These therapies include stretching the muscles to restore normal resting lengths, injecting or forcefully compressing (mashing) trigger points or knots located within tight bands in the muscles, icing muscles while stretching them (spray and stretch), deep heat (ultrasound or laser), applying medication on the overlying skin and driving it in with iontophoresis, transcutaneous electrical nerve stimulation (TENS) which temporarily enhances local circulation, and high voltage electrogalvanic stimulation (EGS) which treats trigger points.  In some patients, the jaw muscles may be strengthened by exercises.  In other patients the forces applied by the jaw muscles during nocturnal bruxism are diminished by a front flat plate appliance, deep relaxation, or drugs.  

BOTOX injection reduces jaw muscle forces by temporarily weakening them.   It has been shown to have some pain relieving properties in experimental injuries to rats, and in humans it can provide a few months of relief for some cases of chronic migraine and unusual neuropathic pain conditions involving muscle spasm, such as oromandibular dystonia or cervical torticollis; but it has not proved effective in treating most TMJ disorders, because so few TMJ disorders are caused by excessive jaw muscle strength.  Weakening the jaw muscles diminishes the forces they can apply to the TMJS during nocturnal bruxism, but those forces are rarely the ultimate cause of the TMJ problem.  In fact, TMJ disorder patients tend to have weaker than normal jaw muscles.  In addition, weakening the jaw closing muscles reduces their ability to regulate subsequent facial growth, which is at the root cause of most TMJ disorders.  
 
RESTORING SYMMETRICAL MOVEMENT PATTERNS is a frequent focus of some exercises prescribed to provide relief. However there is no evidence that it is helpful.  The right and left TMJs are often very different in form in healthy people, and their differences alter the opening and closing pathways of the jawbone. 
 
JOINT INJECTIONS in the TMJs work like they do in other joints.  Anesthetic injections are useful diagnostically.  Steroid injections can provide quick relief of inflammation.  Hyalouronic acid has been injected into joints for decades and sometimes works for reasons we don't understand.  Prolotherapy injects a chemical irritant into ligament attachments in order to try and stimulate fibrosis.  Some studies have found it effective, but others have not.  In TMJ disorders, it is injected into the retrodiskal area where reactive fibrosis of the tissues could assist with pseudodisk formation.  
 
SUPPORTING GENERAL ADAPTIVE CAPACITY
Because most TMJ conditions are ultimately caused by an adult facial growth pattern that continually applies stresses to the jaw system, the presence of symptoms is determined largely by the ability to adapt to those stresses.  As a result, anything that impairs the body's overall adaptive capacity (such as stress, poor nutrition, or an unrelated disease or injury) can trigger or exacerbate symptoms, and anything that enhances the body's overall adaptive capacity (such as improved nutrition, meditation, exercise, or social support) can relieve symptoms.  A wide variety of health care practitioners can relieve symptoms by enhancing general adaptive capacity.
 
OPEN SURGERY of the TMJ is risky, because failures can be disasterous due to a build-up of scar tissue can prevent natural adaptation. Further surgeries are necessary to clean out the scar tissue, but the chance of eliminating the pain decreases with each successive surgery. For that reason, according to insurance company statistics, the primary indication for TMJ surgery is previous surgery, and even the oral surgery journals warn that open TMJ surgery should be considered a last resort. With so many different treatments available, having failed one type of non-surgical treatment is still not an indication for open surgery.  Unfortunately, there are still oral surgeons who only provide a simple nightguard before concluding that conservative treatment is ineffective and surgery is necessary.
 
CLOSED SURGERY
Arthroscopy and arthrocentesis are closed surgeries that don’t involve the same risk of failure as open surgery.  Instead of cutting the joint open, the surgeon inserts two little tubes which are used to irrigate the TMJ. Arthrocentesis employs tubes that are just large enough to flush out the waste products and inflammatory mediators.  Arthroscopy employs slightly larger tubes that can incorporate a fiberoptic cable for visualization and small instruments such as miniature cutters to remove scar tissue.  These closed surgeries can provide quick temporary relief of symptoms by flushing out the joint, however they do not create structural changes in the jaw system. If they are not combined with some orthopedic or behavioral changes that address the cause of the problem, the symptoms are likely to recur.