TMJ Solutions

 

Introduction

Our goal in treating TMJ disorders is to provide relief of pain and restoration of function in the least invasive way possible.  The key to providing the correct treatment modality is making the correct diagnosis.  This is why we feel strongly about performing a comprehensive and multi-discipline initial evaluation for each patient. Determining the correct diagnosis in TMJ treatment is not always straightforward and requires an experienced team.  Once a diagnosis is made, treatment will follow the Amato Center treatment algorithms and protocols.

There are six main categories of TMJ solutions:

  • Conservative treatment

  • Injections

  • Minimally Invasive

  • TMJ Surgery

  • Corrective Jaw Surgery

  • TMJ Reconstruction

 

Conservative Treatment

Modification of Daily Activities

Most of the time, regardless of the diagnosis, the initial treatment begins with  conservative therapy to relieve muscle spasm and joint pain. Intial treatment typically begins with ibuprofen,  ice and heat to the affected areas, and modifications in daily activities to rest the TMJ including:

  • Resting your jaw

  • Keeping your teeth apart when you are not swallowing or eating

  • Eating soft foods

  • Exercising your jaw

  • Practicing good posture

Splint Therapy

If conservative therapy fails to achieve relief, there are various additional conservative therapies which can be attempted including the fabrication of splints. A splint is a clear plastic appliance which fits over your top or bottom teeth and helps re-position the teeth and jaws, thereby relaxing the muscles and reducing pain. There are different types of splints used for different purposes. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw and aids in disk re-positioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day or just at night to move your jaw into proper position. A flat plane splint eliminates any interferences in the bite which might be positioning the lower jaw into an uncomfortable position.

Similarly, nightguards are used to unload the pressure of nightime clenching and grinding, protecting the cartilage and joint surfaces,

Various medications including anti-inflammatories, muscle relaxants, and psychotropic agents may prove beneficial in certain cirumstances.  

 
Behavior Modification

Lastly,  a very effective aspect of conservative treatment is behavior modification. The key to behavior modification is prescribing the correct therapy and having experienced therapists perform the treatment. Behavior management strategies include:

 

  • Stress Management techniques

  • Yoga/meditation

  • Physical Therapy

  • Biofeedback

  • Accupuncture


Injections

There are four main categories of injection solutions:

  • Trigger point injections 

  • Intra-articular injections

  • Botox

  • Nerve blocks

 

Trigger Point Injections

Trigger point injection therapy has been used successfully to treat muscle pain in the back, neck and jaw for over 50 years. The injections are used to mechanically break up trigger points commonly referred to as “knots”.  The trigger points  form as a result of muscle fatigue, strain, injury and overuse typically caused by grinding and clenching. Once formed, trigger points are capable of producing intense muscle pain.

Because trigger points form at predictable locations, injections can be used to mechanically stimulate the affected muscle, “breaking up” the knots in the muscle. Local anesthetic is used making the process comfortable.

A series of trigger point injections are typically necessary to obtain optimal benefits. Sessions can be spaced weekly and delivered three to four times.

 

Intra-Articular Injections

Sometimes, if all attempts at conservative therapy have failed, local anesthesia and/or steroids may be injected directly into the joint to help alleviate pain and reduce inflammation.  These injections should always be part of a comprehensive long term treatment plan.

 

Botox® Injections

Although most people think of  Botox® as an anti-aging medicine, it was originally used to treat muscle imbalances of the eyes and neck. In fact it was first approved in 1989 by the FDA for use in the treatment of eye muscle spasms and in 2000 for the treatment of neck muscle spasms.  It wasn't until 2002, 13 years after the initial FDA approval, that Botox® was approved to treat wrinkles.  Given this history, it is not surprising that Botox® is now being used to treat spasms of the muscles associated with the TMJ.  

 

Nerve Blocks

Sometimes, in order to differentiate between the different sources of head and neck pain,  it’s necessary to perform nerve blocks. Nerve blocks numb specific nerves in the head and neck, helping to assess whether the pain is caused by the TMJ or x® is properly utilized it will reduce the ability of the extremely strong chewing muscles so that they are not able to clench or grind as hard and have less ability to spasm.  This is similar to its use in the muscles in the forehead to reduce tension headaches and the initiation of migraines.

 

Minimally Invasive Treatments

Only when all conservative treatments have failed, are minimally invasive procedures performed.  There are many minimally invasive procedures available.  Our team believes that the most simple and least invasive approach which produces the desired results is always the best.  We believe that simply irrigating the joint with sterile saline provides as good results as any of the other more complicated procedures.  This opinion has been well documented and supported in the TMJ literature.  In a simple procedure, sterile saline is used to flush out all of the toxins and inflammatory mediators which are producing the pain and swelling.  Many times this procedure is enough to provide significant relief and return of function. If this does not provide a solution than more advanced procedures such as arthroscopy and disk repositioning surgery can be considered.

 

TMJ Surgery

When there are disorders inside of the joint which cannot be fixed, surgery to adjust the anatomy within the joint may be indicated (see Internal Derangement).  As we have stated many times our team believes that the most simple and least invasive approach which produces the desired results is always the best. It is our opinion that surgery which will restructure the anatomy joint without opening the joint space is preferable.  Our extensive experience in jaw reconstruction, allows us to utilize less complex and less invasive techniques to restructure the TMJ allowing for the passive repositioning of its components to their most comfortable positions without violating the joint itself. These procedures are referred to as condylotomies rather than open joint surgery. The literature supports the use of these procedures and reports their increased success rates over other procedures.

Corrective Jaw Surgery

Many times TMJ pain and dysfunction is related to an abnormal positioning of the jaws related to growth issues, developmental disorders, or trauma.  In these situations the teeth and the bite become misaligned leading to an imbalance in the entire dental-jaw complex.  As a result, abnormal chewing and jaw positioning habits develop. These TMJ becomes affected by these abnormalities and “wear and tear” leads to TMJ pain and dysfunction.  When jaw abnormalities are present with TMJ dysfunction, repositioning the jaws into a more normal position is typically the first step in achieving TMJ relief.  Our team of surgeons are the regional experts in corrective jaw surgery.

 

TMJ Reconstruction

TMJ reconstruction may be required in four different scenarios:

 

  • The TMJ has degenerated from constant trauma of an incorrect bite or habit

  • Arthritis

  • Resorption (Juvenile Rheumatoid Arthritis, Idiopathic condylar resorption, etc.)

  • Developmental deformity or absence of parts of the TMJ.  

 

Typically when there is less than 50% of a functioning joint present for any reason, a total joint replacement may be recommended. Total joint replacements may be custom designed and fabricated out of titanium for a tailored fit or may be reconstructed from a rib.  Total joint replacement is reserved as a last resort for patients who have failed all other attempts at relief.  

 

 
 
 
 
 
 

Dr. Amato is the founder of:

SMILING FACES FOUNDATION

© 2016 All Rights Reserved.  The Amato Centers For Facial Surgery are divisions of the Metropolitan Craniofacial Center

 

CONTACT

office: 973-736-1714

fax: 973-325-3487

email: info@theamatocenter.com

 

LOCATIONS

West Orange, NJ
101 Old Short Hills Road, Penthouse 2
West Orange, NJ 07052

 

HOURS OF OPERATION

Monday - Friday 9:00 am - 5:00 pm

Saturday & Sunday - CLosed

 

 

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