Dealing with temporomandibular disorders requires a steady or gradual approach. Aggressive treatment with surgery for example may be unnecessary. Nonetheless, TMJ or jaw pathology can be difficult to diagnose and resolve. A broad range of symptoms are associated with jaw TMJ disorders. Finding the specific or concise treatment protocol can be challenging and reminds us that orofacial pain diagnoses and muscle/join disorders are difficult to treat. A tiered approach based on severity can be used. Although there are no exact universal guidelines available.
The first tier or simple approach begins with a soft diet. Physiotherapy, NSAIDS such as ibuprofen and sometimes going as far as physical therapy and mental health therapies can teach you relaxation techniques.
Higher tier of treatment in the second level include simple treatments for conditions such as bruxism, clenching, as well as simple headaches from the dental pathologies listed before. We can combine NSAIDS with local anesthetics as well as muscle relaxants. Furthermore the introduction such as anxiolytics and antidepressants in limited amounts may bring positive results. Starting jaw-stabilizing orthoses can be prescribed as we want to prevent dental wear and tear. Simple monoplane device and aiming for centric relation is suggested. full coverage of the device is advised and we do not want any restrictions in the horizontal excursive movement. Keep in mind the thickness of the device we aim for within the boundaries of natural rest position of the jaw as the maximum VDO. Third tier encompass more serious pain or unhealthy TMJ sensations. The basic treatment mentioned before with the additional protocol of disocclusion with target of CRO. Reprogramming devices which restrict range of opening may be used. More commonly repositioning the jaw more anterior helps open the airway for patients. Such devices require careful monitoring as the jaw/muscle movements may change and lead to change of occlusion or irreversible changes in dentition alignment. Final tier involves surgical intervention that may vary in procedure. Such is last resort and may not guarantee 100% resolution. Osteoarthritis or arthorsis at a severe degree may require need for arthroplasty to as far as TMJ replacement. Careful thought and a consultation with an oral surgeon is a must.
Brian Y. Kuo DDS FAGD
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