Diagnosis

History taking involves a detailed pain history as well as questions about functional limitations, joint noises, and parafunction. Jaw noises alone are not an indication for treatment unless associated with pain or dysfunction. It is useful to ask questions about headaches, earaches, and neck aches. Your oral health practitioner may look into your bite, tooth wear and movement but taking models. Range of motion should be pain-free, and is measured from the central incisal edges:

Normal opening = 40-50 mm (about 2 fingers)

Your oral health practitioner may suggest using imaging systems to assess your TMJ, this may involve an OPG (for screening gross degenerative traumatic or dysplastic changes), MRI (to assess the disc morphology), CT (to assess the condyle or bony changes), or a Tomograms (assessing open and closed positions). Your Oral Health Practitioner may even involve an Oral Medicine or Oral Surgeon specialist to assist with diagnosis and treatment.

Management

The goals of treatment for TMD are to decrease or manage pain (rather than curing due to the multi facet nature of TMD), decrease adverse loading, restore function and resumption of normal daily activities. The first part of treatment is identifying the contributing factors, this includes identifying habits, harmful activities, and psychosocial contributions. A management plan is constructed which involves approaches determined by these factors and the patient’s symptoms. A key component of the treatment plan is implementing reviews of the patient to identify if management is progressing as expected and adjusting treatment approaches accordingly. Your oral health practitioner may involve other health professionals if required. It is commonly recognised that initial management should be conservative and reversible as majority patients will respond to simpler treatments. Patients should understand that relief from symptoms takes time especially if the TMJ disorder has developed over a long period of time.

Education

Uncertainty about your condition may impact your quality of life. The starting point for management usually involves educating about your diagnosis and anticipated treatment as well as reassurance of its largely benign course. Which is what your doing here, so well done doing the first stage.

Self-care program

TMD has a fluctuating nature and there are simple techniques that can help manage exacerbations. Simple advice about aggravating factors and suggestions of relaxation techniques are of benefit to some patients:

Allow free space between your teeth throughout the day and rest your tongue on the floor of the mouth. - Exercises, massage, gentle movement and muscle stretching can be effective in reducing pain and stiffness.

Avoid opening your mouth wide: push your tongue against the roof of your mouth when you are about to yawn to prevent excessive mouth opening; cut your food into small portions, place them in your mouth and chew on your back teeth.

Avoid hard food, crunchy food, and foods that require prolonged chewing including chewing gum.

Try to maintain an upright and relaxed body posture. Drop your shoulders back and straighten your neck and back.

Apply heat packs on your cheeks at least twice a day for 10 minutes each to help relax your muscles.

Avoid caffeine as this is a stimulant and likely to increase stress and cause muscle tension.

TMD may be worsened by stress, anxiety, and depression. These tend to increase tooth clenching and/or grinding while awake and when sleeping. Learning techniques for relaxing may be of benefit. Individuals should also be counselled on patient-specific factors, for example: Parafunctional oral habits such as clenching, nail biting, or pen chewing should be avoided.

Occlusal Appliance Therapy (Occlusal Splint)

Occlusal splints (Are like custom made mouthguards) if you’re unsure if you grind or not especially at night when your jaw is meant to be resting. You could check with your partner or get a boil and bite mouthguard from the chemist if you notice relief or grinding marks on the surface of the boil and bite mouthguard then you may benefit from the investment of an occlusal splint. Why an occlusal splint over a boil and bite mouthguard? the mouthguards tend to be bulky as they are not custom made. As a result, patients tend not to wear them as much as occlusal splints. Your jaw is meant to rest at night-time. As a result, if you’re clenching for long periods at night-time then you are putting tension of the jaw joint, which is like rolling your ankle and then going for marathon runs never letting it rest. The occlusal splint works by creating space between your teeth and allowing you jaw joint to rest. Occlusal splints are custom made by your oral health practitioner and are usually worn at night-time. They should be monitored regularly as they may require adjustments some months later to help relieve pain.

Behaviour modification therapy:

Individual or group counselling, or support sessions, can be effective in identifying sources of stress and learning how to modify behaviour.

Specialist Management:

If pain and dysfunction are severe and chronic and initially conservative treatment has not been effective in relieving symptoms and restoring jaw function, the oral health practitioner may refer the patient to a specialist in temporomandibular disorders.

Medication:

In some cases, your oral health practitioner may recommend short term medication to help relieve symptoms and assist other methods. The oral health practitioner may prescribe a painkiller, anti-inflammatory, anti-anxiety agent, sedative, or muscles relaxant.

Surgery:

In some rare cases, surgery may be required. Your dentist will refer you to an oral and maxillofacial surgeon if surgery may be needed.