Temporo-Mandibular Joint Dysfunction (TMD)

TMD is a very common occurrence, particularly in young female patients (16- 35 years), and can be managed but not predictably cured. So clearly one should not embark on orthodontic treatment if curing your joint symptoms is your only motivation.

Most TMD patients have have a bruxing habit, which involves grinding or clenching the teeth, usually at night. This puts pressure on the TMJ and the lubricating fluid in the joint is forced out creating a dry joint, so the joint cartilage often clicks and sometimes locks.

The best way to manage TMD is to reduce the frequency and intensity of the bruxing / clenching by wearing a retainer or bite plate intermittently.

Anything foreign in your mouth will break the bruxing habit, until that foreign thing becomes familiar, then you simply establish a new habit and grind on it.

The best results in managing bruxing and TMD in our practice, have been by making comfortable thin plastic covers for the upper & lower teeth, which are worn intermittently, so that one doesn’t simply establish a new habit of grinding on the retainer.

For example the retainers are worn as follows; The 1st night the lower is worn, the next night the upper, then the next night neither then the following night, both are worn. This interferes with the sensory feedback that the bruxing habit feeds on and reduces the frequency and intensity of the habit.

Orthodontics can contribute to obtaining what is called incisor guidance and canine lift, which are necessary for ideal function and may help the TMD.

We can also check whether you have occlusal interferences, called non-working interferences, which can usually be corrected with orthodontic treatment or in some cases can even be simply eliminated with a dental burr.

In our experience there is no treatment modality which gives a better outcome in the long term than an untreated sample, which is why TMD is viewed as a problem that can usually be managed and not predictably cured. The only cases, which in our experience tend to be worse long term, are the ones that undergo joint surgery or intra-joint cortizone injections, so we generally don’t recommend those treatment approaches.


How to reduce TMD pain

  1. Alternative Hot and cold
    Some relief can be achieved by stimulating the blood flow to the muscles in spasm. Using hot (not boiling) water, warm up two facecloths and hold them against your cheeks and temples for one minute. Then repeat using ice-cold facecloths wrapped around ice or freezer blocks. The alternating hot and cold improves the blood flow and has a physiotherapeutic effect on the painful muscles and joints. 

  2. Opening against resistance
    Sucking your lips together separate your teeth – repeat this 10 times morning and evening. Alternatively, hold your chin up with your fingers to provide resistance and open your mouth – repeat 10 times morning and evening. This opening against resistance is a bit like stretching the muscles when you have a cramp. 
     
  3. Indirect downward pressure on the TM joint
    Place a small rubbery cylinder (which we will provide) across the lower molars as far back as possible and exert an upward pressure on your chin with the palm of your hand. The lower jaw pivots around the cylinder and reduces the pressure in the joint.
     
  4. Tongue exercise
    Press the tip of the tongue firmly on the palate behind the upper central incisors, then slide the tip of the tongue backwards down the middle of the palate while opening the mouth wide. Repeat 10 times morning and evening.
     
  5. Posture exercise
    Standing up straight clasp your fingers together behind your head. With your elbows up stretch your neck by exerting upwards pressure with your arms. This helps to align your spine and relieves tension.

Other treatments:

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