It is essential that the selection of treatment for TMJ begins with a careful examination of both the joints and the occlusion. Consultation with a dental professional highly experienced in TMJ is necessary when determining treatment for TMJ. Ideally, your dentist would have expertise in identifying any problems in the relationship between the jaw and the bite, as well as in procedures such as occlusal equilibration.
Dentists use a variety of treatment modalities which may be divided into Phase I andPhase II Therapy. The purpose of Phase I Therapy is to eliminate muscle spasms, TMJ swelling and dislocation (if possible), and generally reduce any type of pain. This treatment usually includes the use of splints, exercises, medication, nutrition therapy, physical therapy, and chiropractic treatment. The purpose of Phase II Therapy is to definitively correct any discrepancies, if necessary, between the upper and lower jaws. Phase II Therapy may include adjustment of the dental occlusion, orthodontics, reconstruction of the teeth, or a combination of some of the above treatments. It is important to note that Phase II Therapy should not be attempted without successful Phase I Therapy results.
Phase I Treatment
Phase I treatment for TMJ is conservative treatment, producing no irreversible changes. Generally, the use of an intraoral splint, medications, chiropractic or physical therapy, and life-style changes are very effective in treating most truly TMJ problems. Other disorders which mimic TMJ (for example, temporal tendinitis, Ernest syndrome) are often treated with Phase I therapy with medications and soft tissue treatment.
Phase II Treatment
Phase II treatment is, by definition of the American Dental Association, non-reversible, invasive therapy. Adjustment of the occlusion (adjusting the “bite”), orthodontic treatment, the placement of crowns, and surgery of all types most certainly produce changes which can’t be reversed. Therefore, it is most important that no one undergoes Phase II Treatment until a correct diagnosis is established and proven as the cause of the symptoms.
Phase I (Healing Phase):
- Stabilize the TMJ
- Establish posterior vertical
- Establish mandibular position
- Level the maxilla- temporarily
Phase II (Orthopedic Phase):
- Develop arch position
- Develop arch form
- Balance structure
Phase III (Orthodontic Phase):
- Develop tooth position
- Develop tooth form
- Establish final occlusion
Phase III can be achieve by orthodontic treatment or full mouth reconstruction.
For TMJ caused by uneven teeth surfaces that affect the bite and result in improper jaw closure, treatment may involve occlusal equilibration or the use of an appliance to correct the bite. Occlusal equilibration entails reshaping the biting surfaces of the teeth, and is used for many TMJ cases.
It is usually the case that pain is relieved immediately following the lower jaw’s renewed ability to close properly into position within the temporomandibular socket. If pain is not relieved, then the use of an occlusal appliance may be needed to adjust the bite and allow for the lower jaw to close properly.
Treatment for a Structural Disorder
If pain is still not relieved and a structural disorder of the joint is suspected, your dentist may have a panoramic X-ray ordered for your temporomandibular joint. Other imaging technology that may be used include an MRI (magnetic resonance imaging) to evaluate soft tissue and a CT scan to assess the bone of the jaw and joint. Your dentist will review these images and determine the best treatment that may involve an intra-oral appliance, orthodontia, or maxillofacial surgery. Your dentist may refer you to an oral surgeon or oral and maxillofacial surgeon who will provide further professional evaluation and treatment.
Few cases of TMJ require surgical intervention. Surgery is often the last option after all others have been tried. Your oral surgeon will administer a general anesthesia before performing any TMJ-related surgery.
Arthrocentesis is a minor surgical procedure that cleanses the joint by inserting a needle into the joint to dispense sterile fluid and reduce inflammation. In some instances, a scalpel-like instrument is inserted in the joint to remove any unnecessary tissue and reposition the disc in the joint hinge.
Another type of surgery is arthroscopy. During this procedure, your surgeon inserts an endoscope to provide a visual guide of the inside of the joint. This enables the surgeon to treat inflammation, remove any tissue adhesions, or change the position of the disc.
Alternatively, open-joint surgery affords access to damaged bone structures, chipped bone areas, tumors, or severe scarring. According to the type of problem, your surgeon may remove or re-shape the affected area using a scalpel.
Alternative Medical Treatment for TMJ
Alternative medical treatment for TMJ is believed to be less conservative and not required if initial diagnosis and treatment is properly carried out. Alternative treatments include ultrasound, transcutaneous electrical nerve stimulation (TENS), radio wave therapy, and trigger -point injections. TENS and radio wave therapy stimulate blood flow to the joint and surrounding area by sending low levels of electrical or radio waves of energy to these areas. It is important to note that these options may offer only limited and temporary relief from symptoms.
TMJ Treatment Costs
TMJ treatment costs depend on a number of considerations, including the expertise of the dentist, the location of the dentist, the facility fees for procedures, and type of insurance you have.