What are your recommended treatments for TMJ?
I’ve already discussed Temporomandibular Joint pain, or TMJ, in another article. This, then is a follow-up based on a question posed by a reader. I’ve broken it down into four approaches for treating TMJ.
- Orthotic Appliance
As I have said before, the majority of the pain patients I’ve seen lately have symptoms directly related to the pandemic. The place I’m always going to start is with an orthotic appliance, because I want to change the interface between their upper and lower teeth to control how the teeth touch. When your teeth come together, the nerves in the ligaments that hold your teeth in your jaw send messages to your brain about what they’re touching. The brain then sends messages to your muscles about how to react.
I want to be in charge of those muscles because 99.9 percent of the time, TMJ problems are muscle problems. If I can change how the teeth touch, I can help turn off the muscles, which will reduce the pain. Virtually every patient I treat starts with an appliance, and they are better after two or three months of adjustments, with added lifestyle changes or physical therapy.
- Occlusal Equilibration
TMJ pain also occurs when teeth don’t fit together – what I call malocclusion. When this happens, the messages being sent to the brain from the teeth cause the muscles to contract inappropriately, resulting in muscle pain. In these cases, I start with an appliance, as I don’t want to do anything that’s irreversible if I can avoid it. If that doesn’t solve the problem, I do an occlusal equilibration, which is adjusting the tops of the teeth by shaving off little bits of enamel to make the teeth fit together better. Many times, I’ll combine that with cosmetic contouring in the same process, working on both the front as well as the back teeth, because teeth that function well tend to look nice, as form follows function.
- Physical Therapy
Typically, bruxism (the grinding of teeth) and TMJ problems don’t happen in a vacuum. People with these conditions tend to have other head and neck issues, particularly if they work from home, as working at home generally means terrible ergonomics. They sit on their couches with their laptop, curled up with their heads tilted forward, which results in neck, shoulder and back issues. Those are things I can’t control, but patients can be treated with physical therapy or chiropractic care in addition to occlusal treatment.
In fact, physical therapists send me patients because they can’t do the work they need to do when a patient is bruxing, resulting in tight muscles that aren’t ready to respond to physical therapy. So, I make the patient an appliance to get their jaw muscles to calm down enough for the therapy to be more effective. It’s a two-way street: you’ve got to get the whole system working together.
- Lifestyle Changes
Speaking of systems, there are things we put into our own systems that can affect our muscles. Think caffeine, which is a muscle stimulant. For people who are clenching, grinding and having muscle contraction issues, the last thing they need is a muscle stimulant, which means that intake of coffee, soda, and energy drinks should be limited.
In addition to limiting caffeine, limiting foods that cause inflammation can also help with overall joint health. Ditch the burgers, fries and sugary soda for whole, plant-based foods with healthy fats, fish rich in omega-3 fatty acids, beans that are rich in fiber, nuts, olive oil, and whole grains Getting people to change their habits is hard, but, as they say—everything in moderation.
