How do we treat TMJD and headaches?

Our primary focus is on the diagnosis. The old Chinese proverb, "When you understand the questions, the answers reveal themselves," applies here.

If you have TMJD or temporomandibular joint disorder, rather than MPDS or myofacial pain dysfunction syndrome, the focus is on the joint itself. If it is determined that you have MPDS with the pain from the muscles and fascia and not from the joint, then the focus is on reducing the muscle spasms and inflammation. In many cases both problems exist; the problem in the TMJ leads to a MPDS complication. Often the treatments tend to overlap with features of both within the individual case solution.

If you have TMJD:

In these cases we work to relieve the stress on the joint itself, and allow the joint to heal resulting in a reduction of the effects of the joint derangement. The optimal goal is to move the disc non-surgically back to the proper place, realign the jaw, and then stabilize the joint. A variety of therapeutic techniques are applied.  The reduction of pain is an outcome of proper diagnosis and therapy focusing on the orthopedic problems. Depending on the case some possibilities are listed below:

  1. An intra-oral orthopedic device is used to decompress the temporomandibular join to allow healing of the peri joint tissues.
  2. In many cases this invisible device usually worn on the lower part of the mouth will recapture a displaced disc and realign the disc over the joint condyle. It is not, in my experience, predictable to recapture the disc. I do not believe than an upper dental device is as effective as a treatment tool for TMJD.
  3. Pharmacological support to primarily reduce inflammation and secondarily reduce pain, at least in the initial phase, is a useful adjunct in most cases. Sometimes muscle relaxants are helpful to increase joint mobility.
  4. Physical therapies
  5. Stress management
  6. Postural management
  7. Occupational therapeutic intervention
  8. Psychological referral

In most if not all cases, after treatment of the problem is completed, a stabilization of the joint must be commenced. Depending on the patient, this could be orthodontic, orthopedic, or restorative in nature. I believe that to realign the mandible (jaw) and attain pain-free motion in the corrected position, and then to allow the jaw to return to its pre-treatment painful position is not the proper end result. TMJD even in the best of circumstances can and will recur. It is essential to give the body the opportunity to maintain itself naturally.

If you have MPDS:

With a diagnosis of MPDS, many of the symptoms are similar as with TMJD, but the goal is to reduce the pain by relaxing the spastic musculature, and associated tissues and structures. In many cases of MPDS, I find that certain types of dental appliances similar to those used for TMJDS can be successful, but in these cases we do not want to usually change the positions of the jaws orthopedically. Some possibilities for treatment of MPDS:

  1. Night appliances to control night stress (bruxism)
  2. Pharmacological support to reduce pain and inflammation
  3. Stress management
  4. Physical therapies
  5. Occupational therapeutic intervention (especially useful for MPDS)
  6. Psychological referral

URL: http://www.tmjheadache.com
E-mail: drg@tmjheadache.com