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Orthotic Appliances and Adjunctive Treatments for TMD/TMJ

Problems with your jaw joint and the muscles in your head, face, and neck that can affect it are known as Temporomandibular Joint Disorders (TMD). It is often referred to as TMJ, which is actually the jaw joint itself, or the “hinge” that connects your lower jaw to the temporal bone of your skull and is located directly in front of each ear.

In severe cases, the TMJ can actually become "locked up" in an open or closed position where the person is unable to move their jaw until the joint is realigned.  It's possible that home remedies such as ice packs to the joint, over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs), special exercises or gentle stretches of the jaw and neck, massages, and stress reduction can resolve the issue. 

Chronic TMJ dislocation may eventually cause the tendons, muscles, cartilage, and the articular eminence to become damaged, leading to nerve damage and potential permanent dislocation.  When this occurs, the only solution is to seek medical treatment from a temporomandibular joint (TMJ) specialist who can prescribe dental appliances, physical therapy, prescription medications, and alternative treatments such as injections, jaw manipulation, laser application, or other therapies. 

What Are Orthotic Appliances?

Dental appliances, commonly referred to as splints or mouthguards, are recommended and specifically designed to treat different disorders related to the jaw (TMJ) and/or facial muscles

When an orthotic appliance is the treatment of choice, it’s important for the dentist to determine why it is being used, when the patient should wear it, what is to be accomplished while using it, and how should it be designed.  They can be prescribed for wear during nighttime, daytime, some combination of both, or 24/7 depending on the diagnosis.

Orthotic Appliances are removable devices that are usually made of a durable acrylic material and fit over the (biting) occlusal surfaces of either the maxillary (upper) or mandibular (lower) teeth. The goal is to create a precise bite relationship with the opposing teeth to treat a specific TMD condition which may include:

Treating TMD Symptoms with Orthotic Appliances

Orthotic appliances are most often considered when the jaw joint makes a clicking sound when there is difficulty and limitation in opening or closing the jaw, usually due to a “dislocation” of the disc or when muscles in the head or face are tight and sore.  Often, there may be discomfort while talking, chewing, or opening wide.

Common symptoms of Temporomandibular Joint Disorder include:

Treating TMD - Alternatives to Surgery

Before considering any surgery on the jaw joint, it’s important to fully understand the risks.  There are many alternative options available that can alleviate your pain while avoiding surgery.

Dental Orthotic appliances may be used stand-alone to treat a TMJ disorder or in conjunction with other needed modalities to achieve the most therapeutic effect.

At Pittsburgh Dental Sleep Medicine, adjunctive treatments may include:

When there is a postural concern contributing to the patient’s symptoms, collaborative care working with physical or chiropractic therapy can also be helpful. 

What is Bruxism?

In people who exhibit a great amount of stress or anxiety, there may be an increased incidence of bruxism.  Bruxism is a condition in which you grind, gnash or clench your teeth which can lead to enamel wear, fractured teeth, tooth mobility, gum recession, flattening of the chewing surfaces, and can also cause TMJ dysfunction. 

Nighttime bruxism can be quite destructive because most people are unaware of the habit until it is too late and TMD signs and symptoms have already developed. An orthotic appliance can protect teeth against the destructive forces of nocturnal bruxism and act as a diagnostic treatment tool in the management of temporomandibular joint dysfunction. Early intervention can prevent many of the severe problems associated with bruxism and TMJ dysfunction.

TMD in Combination with a Sleep Disorder

A sleep-related breathing disorder can be the cause of teeth clenching as the body’s reflex to help keep the jaw forward for better breathing. The sleep breathing disorder must be confirmed or ruled out in the evaluation of a TMJ disorder.

If a sleep-breathing problem is confirmed it can be managed at the same time as the TMJ disorder so that it does not impede the progress of that treatment or cause recurrence of symptoms. Research shows that the source of 60% of TMJ (jaw) problems is an underlying breathing problem during sleep. If this concern is not suspected or ruled out by diagnostic testing, then the appropriate dental orthotic appliance is selected that can help reduce the intensity of the clenching habit and relax the related jaw and neck muscles that are often sore on awakening.

At Pittsburgh Dental Sleep Medicine, Michael F. Hnat, DMD, Craniofacial Pain and TMJ Specialist has extensive education in providing treatment for TMJ disorders. 

If you ready to treat your TMJ Pain, call Pittsburgh Dental Sleep Medicine today for a new patient appointment or more information.

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