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| Q |
What causes TMD? |
| A |
Severe injury to the jaw or temporomandibular
joint such as a heavy blow, or a whiplash-type accident (because
of the close relationship of the cervical muscles to the base
of the jaw) is an obvious cause; however, other than these misfortunes,
experts have no specific answers as to why TMD develops. Researchers
will agree that there may be many contributing factors: Clenching
or grinding the teeth, some suggest stress (an aggravation),
congenital factors, or arthritis. The exact causes are really
not clear; however, there is no disagreement that TMD is real
and deserving of medical attention.
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| Q |
How do I know if I have TMD? |
| A |
Contact a dentist or doctor with expertise in the field of orofacial pain if you have complaints of:
- Pain in your jaw joint region with or without clicking or popping.
- Limited movement or jaw locking.
- Painful clicking, popping, or grating sounds in your jaw joint when opening or closing your mouth.
- A change in the way you feel your upper and lower teeth fit together.
- Frequent headaches, earaches (after ear infection has been ruled out).
Simple clicking without pain is quite common and generally not a cause for concern.
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| Q |
How is TMD treated? |
| A |
If a diet and usage of non steroidal anti-inflammatories are not helpful,
an oral appliance is usually recommended. Oral appliances (oral
orthotic or splint) are conservative, reversible, and considered the
"standard of care" before any irreversible or invasive treatment is
recommended. A splint functions to reduce the loading forces to the
tempomandibular joint allowing them to heal. A splint also has been
shown to relax the jaw musculature as well as protect the tooth
surfaces from grinding. Surgery is an invasive procedure and considered
only after all conservative efforts have been exhausted.
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| Q |
What does the oral appliance/splint look like and how does it fit? |
| A |
The TMD appliance
is fabricated of a clear acrylic and secures to the teeth with
4 metal ball clasps. An upper or lower appliance may be worn,
usually not both. The splint/appliance is removable by the patient.
It looks somewhat like an athletic mouth guard or orthodontic
retainer but only covers the chewing edges of the teeth; consequently,
it will not look like you are wearing a mouth guard. With a
little practice, you will learn to speak normally with the splint
in your mouth.
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| Q |
Do I eat with my splint? |
| A |
Not generally. The
splint may be removed while eating and inserted when you have
finished your meal.
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| Q |
I wear dentures; can I still wear an appliance/splint? |
| A |
Yes. With little
exception, a splint can be made to fit over your upper or lower
denture. An impression is made of your denture, and the splint
is fabricated just the same as if the impression was made of
your natural teeth.
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| Q |
How long will I have to wear my appliance? |
| A |
Although the length
of treatment depends on each individual patient’s progress,
you can anticipate wearing your splint full time for approximately
2 to 4 months. After full time use, and depending on your individual
problem, you may be instructed to reduce wearing your splint
to sleeping hours only.
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| Q |
Will my insurance cover my appliance and follow-up visits? |
| A |
Increasingly, insurance
companies now recognize TMD as a legitimate medical problem,
and consequently have made provisions for coverage. Some insurance
companies have set maximum amounts for the coverage of TMD,
some allowances higher than others, and some have no limits
at all.
Even HMOs are involved (you may need a referral from your primary
care physician.) Coverage for TMD is usually by your
medical carrier. If for example you have Cigna, PacifiCare,
Blue Cross of AZ, Humana, and even Medicare (do not rule out
any others), you may very well have benefits for a TMD splint.
The best way to find out is to call your carrier.
Always try your medical insurance first, and then your dental.
TMD is usually considered a medical rather than a dental problem,
because treatment is directed to the temporomandibular joint
rather than to the teeth.
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| Q |
Will I need to see any other health providers while I am wearing my splint? |
| A |
Possibly, and depending
on your progress. Any referrals will be determined on an individual
basis. Two common treatment modalities used concurrently with
splint therapy are Biofeedback and Physical Therapy.
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| Q |
What is BIOFEEDBACK and how can it help with my TMD? |
| A |
If you are having
difficulty managing stress and your ability to relax, biofeedback
(behavior modification) may be helpful. It is often used concurrently
with splint therapy. Clenching and grinding can be an acquired
behavioral habit that could be stress related or secondary to
sleep disorders or medications. Certified biofeedback practitioners
show you how to listen to signals from your own body that indicate
your level of stress or relaxation. External sensors placed
on your body measure specific stress responses (such as perspiration
and muscle tension), and translate these responses into signals
you can see or hear such as lights, or audible tones. Your challenge
is to change these physical responses through relaxation, which
then alters the signal. Biofeedback can help you monitor the
progress you are making in helping your body to relax. The average
person is seen anywhere between 5 and 10 times. The number of
sessions is based on individual needs and treatment goals. Each
session is approximately 50 minutes long.
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| Q |
When is physical therapy indicated and how does it help? |
| A |
Selected patients
may be referred to a physical therapist for treatment to reduce
musculoskeletal pain particularly when symptoms involve the
cervical and shoulder region. Often, if the neck and shoulders
remain symptomatic, they may refer pain to the TMJ area and
its associated structures. Physical therapy may be quite effective
for TMD patients when used concurrently with splint therapy.
Treatment modalities may include ultrasound to stimulate the
circulatory system and decrease inflammation, hot or cold packs,
electrical muscle stimulation, massage, and exercise (in the
office as well as a home program.)
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| Q |
If I want or need to have orthodontic treatment, what do I do first, the orthodontic treatment, or the TMD treatment? |
| A |
Treatment for TMD
will most generally always come before proceeding with orthodontic
treatment. Your orthodontist will want to make sure your temporomandibular
joints are stable before permanently moving your teeth.
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| Q |
What can I expect at my initial examination and how long should I allow? |
| A |
As a rule, plan on
being in the office for approximately 1½ hours. Your paperwork
may be sent to you before your visit to save time. The paperwork
will have a series of questions to help the doctor in his assessment.
(your symptoms, medications, medical history, prior treatment,
etc.) A major part of your examination will involve measuring
your jaw range of motion, palpating the muscles of your facial
and cervical region for pain or tenderness, assessing your occlusion
and the soft tissues of your mouth, reviewing radiographs taken
in or out of the office, and checking for TMJ noises such as
popping, clicking, or grating. If splint therapy is recommended,
impressions will be made of your teeth. These impressions will
be sent to the laboratory for fabrication of your appliance.
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| Q |
If I decide to proceed with TMJ treatment with an oral appliance, what is the success rate? |
| A |
Studies have shown
a variety of results. Generally, 80% of the patients treated
conservatively obtain an 80% or greater improvement.
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| Q |
I think I have TMD. What can I do until I can get in to see the doctor? |
| A |
Chewing may be painful.
Limit your chewing to soft foods. Do not try to stretch your
mouth open to take large bites (such as biting into an apple.)
Apply ice and or heat to the joint. Ice helps reduce swelling
and heat helps the muscles to relax. Apply ice (a bag of frozen
corn or peas wrapped in a towel is good, or a gel pack) for
10 to 20 minutes at a time for pain. Use moist heat (a hot towel)
for muscle pain every 10 to 20 minutes at a time. Use the over-the-counter
pain medications you are accustomed to. Ibuprofen, for example,
helps to reduce inflammation and pain. Note: Check with your
medical doctor if you have any questions on what you should
or should not take to reduce your pain. And, basically avoid
any activity that hurts
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| Q |
Will my problem get worse if I do not have treatment? |
| A |
The answer to this
question is it could. The ultimate goal is to avoid a more debilitating
osteoarthritic condition which causes permanent damage to the
joint. For example, while simple popping or clicking usually
does not warrant treatment, if the popping or clicking is accompanied
by pain and decreased mobility, it may be risky to avoid treatment.
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