CONTINUED FROM LAST WEEK’S BLOG:
TREATMENT OF TMD BY
SEVERITY
MILD TMD
Diet and Exercise:
Eat a healthy, balanced diet. Strongly reduce or stop the use of caffeine,
tobacco, and chewing gum. Don’t open the mouth widely, especially during
flare-ups. Cut food into small bites and chew them well. Eat slowly. During
flare-ups do not eat tough, chewy foods, like heavy meats or vegetables. Get
regular exercise and stretching, especially neck and back muscles. After the
flair-up, three times daily do the face and jaw exercises we will show you. Get
30 minutes or more of fast walking four or more times per week.
Heat, Anti-Stress Treatment, and Medications: During
flair-ups, use hot, moist heat to the sore muscles of the head, neck, or face.
Use ice cubes on trigger spots in these muscles. Use Ibuprofen 400mg, or other
anti-inflammatory-pain pills that you can take, 2 or 3 times per day, not to
exceed two weeks at a time. Use medications to relax the muscles, if prescribed
by Dr. Bridger. Reduce stress through physical therapy, chiropractic treatment,
and/or psychological, stress, or biofeedback counseling. Try to not clench the
teeth or press the tongue against the teeth. For those over twenty-one years
old and who partake of alcohol, one alcoholic drink in the evening during
flare-ups is recommended.
Night Guard: A night
guard will usually be made by Dr. Bridger to be worn during the hours of sleep
and while exercising. It is a usually upper hard plastic appliance with a flat
biting surface that protects the teeth from clenching and braces the teeth that
are loose from clenching. The surface of the appliance is softer than tooth
enamel and absorbs the pressure of clenching and grinding, thereby helping the
muscles to relax and the jaw joints to be repositioned into proper alignment
with the skeleton and the bite, thereby usually reducing jaw pain. After
placing the appliance, one free adjustment within the next two months is
included.
Occlusal
Equilibration (Bite adjustment) (Limited is one adjustment at a time, Complete
is three or four adjustments): This procedure of slightly smoothing and
reshaping of the teeth so that they fit together and function properly in
harmony with the jaw joints is often prescribed by Dr. Bridger. The teeth are
shaped so that when the mouth is closed and the jaw joints are seated in the
middle of the sockets, most of the back teeth touch at the same time, and the
front teeth almost touch. They are also shaped so that when one talks or chews,
the front teeth touch or slide against each other, separating the back
teeth. The teeth may also be shaped to
make them more even and of more similar shape and length, and to smooth the
edges.
Additional Treatment:
If after the above TMD treatments, the patient is not mostly comfortable most
of the time, they may elect to go to the moderate TMD treatment below.
MODERATE TMD
All of the above
treatments for mild TMD above, except, often no equilibration is done until
later when the jaws have realigned, and appliance therapy is substituted for a
night guard.
Appliance Therapy:
Similar to a night guard with a bumpier bite surface, but for more longer
standing TMD with more pain and other symptoms, the usually upper appliance is
worn from 3-6 months 24 hours per day and night, except to eat, to help the
muscles to relax and the jaw joints to be repositioned into proper alignment
with the skeleton and the bite, thereby acquiring Orthopedic Stabilization and
usually a reduction in jaw pain. The appliance is adjusted at first weekly,
then less often, as the bite and jaws adjust themselves to a more comfortable
position. After six months, there will be additional fees for adjustments.
Usually CT jaw joint X-rays are taken before and after appliance therapy to
verify the jaw joints positions.
Possible Need Of Further Treatment: After Active Appliance
Therapy has ended and Orthopedic Stabilization and a reduction in jaw pain has
been experienced, if when the jaw joints are in their new comfortable position,
there is no solid centric bite position of the teeth, Orthographic Surgery to
reposition the segments of the teeth, Orthodontics (braces), Crowns, and/or
Equilibration (re-shaping of the bite of the teeth) may be needed to make the
upper and lower teeth fit together when the jaw joints are in their
comfortable, healthy positions, each at additional fees.
SEVERE TMD
If after treatment of Moderate TMD above without enough
success or if in addition to Structural-Functional Problems, there are Behavior
Disturbances (like sleep, family, social, psychological, and/or job problems)
or Impaired General Health (like Fibromyalgia, Chronic Fatigue Syndrome,
Chronic Bowel Syndrome, CT Disorder, Multi-Chemical Syndrome, Restless Leg
Syndrome, and others), the patient may be referred to a TMD Specialist and/or
to an MD with special training in Impaired General Health.