Treating Temporomandibular Disorder

When treating TMD, it’s important to be conservative. That means starting with lifestyle changes that give your jaw a rest and, if needed, adding over-the-counter painkillers to reduce pain and inflammation.  These guidelines will walk you through some treatment options.

If your TMD symptoms persist, prescription painkillers or muscle relaxants, or a mouth guard that keeps you from grinding your teeth, can be useful. Only in severe cases should surgery be considered. Drugs certainly don't cure TMD, but they can sometimes help relieve its symptoms.

• If you're in pain, try over-the-counter medications such as acetaminophen, or better yet, NSAIDs (nonsteroidal anti-inflammatory drugs), which reduce pain and inflammation.
• If these aren't enough, ask your doctor about prescription NSAIDs.
• Sometimes a mild prescription muscle relaxant such as diazepam can help.
• If your pain persists for more than six months, your doctor may prescribe a tricyclic antidepressant, such as amitriptyline, which in very small doses can be effective.
• Occasionally, a cor­tico­steroid can help, but these drugs should be used only if your TMD is related to rheumatoid arthritis.
• A Canadian study also showed that seven of 10 patients who used glucosamine sulfate (500 mg twice a day) had about a 40 percent reduction in pain; the results were slightly better than the control group, which used ibuprofen instead.

Researchers are also looking into the efficacy of injecting anesthetics into painful areas.

1. If you grind or clench your teeth as you sleep, you may get relief with a mouth guard, a plastic oral appliance, also called a splint or bite plate, which fits over either the upper or lower teeth to keep you from grinding.
2. Another new appliance, called an NTI Tension Suppression System, is for the two front teeth only; it’s much less cumbersome than the old splint.
3. Unless you need to set a broken jawbone, remove diseased tissue or correct a dislocation in the joint, you should avoid surgery. Artificial jaw joint implants have proven especially dangerous, and some have even been recalled because they break down and damage surrounding bone.
4. Chiropractic may be helpful if back problems are contributing to your TMD. Be careful about any manipulation of the neck.
5. Acu­punc­ture shows promise also, and biofeedback — educating your muscles to relax with the help of a machine that tells you if you're unconsciously clenching — is now a standard therapy. Studies show that up to 70 percent of patients who are trained in biofeedback as part of their therapy will get rid of their TMD for good.

The first and best approach for easing the discomfort of TMD is to make simple changes in your day-to-day life. You may be surprised at how quickly your jaw responds. Here are a few things to try.

• Eat soft foods until the pain goes away.
• Apply heat or cold. Both are equally helpful for reducing TMD pain and can be used interchangeably.
• Try not to yawn or chew gum.
• Reduce stress. Practice yoga, meditate or see a therapist.
• Align your spine. Although your jaw joint may hurt, your problem may start in your shoulders or neck.
• Exercise your jaw gently, if recommended by a doctor.