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Where we do
“one size fits one” dentistry

Where we do
“one size fits one” dentistry

Can TMJ be treated without surgery?

TMJ Pain treatment

Can TMJ be treated without surgery?

Put simply, the answer is yes. I’ve been treating TMJ disorders for 20 years at Point Loma Comprehensive Dental, right here in San Diego. I’ve seen thousands of patients in that time, and I have referred only one for surgery. Before we get too far into the treatments, let’s briefly discuss what TMJ disorder is.

The temporomandibular joints consist of the bones, ligaments and muscles on each side of your jaw that make it possible for you to open and close your mouth. The most complex joints in your body, they act like sliding hinges, connecting your jawbone to your skull and allowing you to chew, speak or swallow. When you experience pain in your jaw joint—basically any problem that prevents this complex system of muscles, ligaments and bones from working properly—you are suffering from a temporomandibular joint, or TMJ, disorder.

There are many causes of TMJ disorder, but it has really exploded during the Covid-19 pandemic. People are stressed out and they’re taking it out on their muscles. About 99 percent of the time, the key problem is what we call “bruxism,” or the clenching and grinding of the teeth. The other causes tend to be some sort of systemic disease or acute trauma, such as a car accident, or a fall. Those causes are rare. The great majority of what I see at Point Loma Comprehensive Dental are people who clench and grind their teeth.

When a patient comes to see me, much of the diagnosis is done through conversation. When I sit down and talk with a pain patient, nine times out of 10, I have a diagnosis by the end of the visit. If the patient is in acute pain, we’ll start them with medications—typically anti-inflammatories or muscle relaxants—and a temporary appliance that helps to calm down their muscles and keep their teeth apart.

After the initial visit, my first priority is getting teeth off teeth with an orthotic appliance. To get the patient out of the pain cycle, I have to be in charge of how their teeth touch initially. This kind of treatment requires multiple visits. Once the muscles begin to relax, the bite will change slightly. We bring patients back in routinely—sometimes weekly, sometimes bi-weekly—to evaluate symptoms and adjust the appliance accordingly, until we get them pain free, or as pain free as possible.

Once they’re out of the pain cycle, I look at how their teeth touch and make recommendations to change that. Sometimes, that’s just a matter of going in and very mildly adjusting the tops of the teeth so they fit together harmoniously. Other times, we have to utilize an orthodontist to move the teeth into a position where they are more functional. And at other times, we do a combination of adjusting the tops of the teeth and restoring some teeth to make them fit together better.

I often tell people that I’m a continuing education junkie. I’ve been a general dentist at Point Loma Comprehensive Dental since 1991, but 25 years ago, I saw people in pain and resolved to find ways to treat it. So, I began taking continuing education courses, which gave me the guidance to better understand bite mechanics. I continued down that learning path and found I like treating TMJ disorders. Most of my colleagues don’t, which is why today, at Point Loma Comprehensive Dental, I have a constant stream of pain patients. I’m also actively seeking referrals from other dentists, surgeons, chiropractors and physical therapists to treat TMJ pain and help my patients live a more balanced life.

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