TMJ is the initialism for temporomandibular joint, which connects your lower jaw (the mandible) to your skull at the temporal bone. This joint controls many jaw functions, like chewing. If the chewing muscles or the joint itself are causing you pain you may have temporamandibular disorder, or TMD. TMD can be caused by stress, continual clenching of the jaw muscles, or teeth grinding.
Some of the symptoms of TMD are:
- Pain when opening or closing mouth
- Trouble chewing
- Jaw becoming stuck open or shut
- Headaches or ear pain
- Painful joint noises such as clicking, popping, or grating
- Neck pain
At Pasadena Orofacial Pain Associates, Dr. Cebula provides the care of a board-certified orofacial pain specialist with two years of post-doctoral training at UCLA. As a patient in our practice, you will receive the highest quality non-surgical management of your TMJ Disorder delivered in as conservative manner as possible. Using the biopsychosocial method of pain management, Dr. Cebula will use both pharmocological and non-pharmocological modalites including behavior modification and physical therapy to provide the most effective care. This often means that TMJ surgery will not be necessary to manage your TMD.
The conservative management of TMD is supported by the American Association for Dental Research (AADR) as well as the National Institute of Dental and Craniofacial Research, a division of the National Institute of Health (NIH). You can read more about this by clicking the following links:
- TMD IS A BIOPSYCHOSOCIAL PROBLEM, NOT JUST A BITE PROBLEM
- EVIDENCE-BASED MEDICINE SUPPORTS THE CONSERVATIVE MANAGEMENT OF TMD
Once a diagnosis of TMD has been made, Dr. Cebula will customize a personalized treatment plan to meet your needs. This most often will include self-directed physical therapy in combination with NSAID medications as well as instructions to promote healing of your jaw and avoidance of future injury. In cases where muscular pain is more severe and there is a limitation of mouth opening, a skeletal muscle relaxer may be prescribed to improve your pain and range of motion.
Occlusal appliances, also known as splints, can be useful treatment for patients suffering from TMD pain, limited mouth opening, or dislocation of the TMJ. A stabilization splint which covers all of the teeth in the upper or lower arch can be a very effective means of protecting your teeth and TMJ from clenching and grinding activity while sleeping. Daytime splint wear is almost never necessary, as most patients can be taught to relax the jaw naturally during the daytime hours. Jaw relaxation and keeping teeth apart during the day is the most effective and simple means of preventing excessive trauma to the teeth and TMJ and helping with pain relief.
Splint therapy may be ineffective for patients with undiagnosed sleep apnea and could potentially make the condition worse. Proper screening and referral to a sleep disorders specialist when appropriate, can help determine if a mandibular advancement device is a better alternative to splint therapy. Splint therapy can be effective for patients with sleep apnea when positive airway pressure such as CPAP or BiPAP are being used together with a splint.
Through careful examination, Dr. Cebula will determine if splint therapy is appropriate to help with your symptoms of TMD in combination with other treatment modalities.
Trigger Point Injection Therapy
Trigger point injection therapy involves insertion of a needle into painful muscular ‘knots’ called taut bands. This is performed by the dry needling technique using a needle only, or the wet needling technique with an anesthetic such as lidocaine or an acetylcholine-blocker such as BOTOX. Trigger point injection therapy is indicated for painful trigger points that are unresponsive to anti-inflammatory medication and physical medicine modalities such as stretching, aerobic exercise, deep breathing, and use of moist heat and ice. They are also useful as a diagnostic aid for musculoskeletal pain.
BOTOX for TMJ Disorder
When conservative therapy (such as physical therapy or NSAID medications) is unsuccessful in treating TMD, Botulinum Toxin A (BOTOX) can be an effective means of managing more advanced cases of TMD where masticatory muscles are overactive or muscular pain is severe. BOTOX is a natural protein that is produced by the bacteria Clostridium botulinum which is commercially purified and administered by injection. Injection of BOTOX into the muscles responsible for clenching and bruxing will cause relaxation of the muscles and reduction of pain. Like most medications, the effects of BOTOX eventually wear off and may need to be repeated every 10-12 weeks if symptoms persist.
If you have been unsuccessfully treated for TMD in the past, or conservative management has not produced adequate results, BOTOX is a safe and reliable option to consider. Contact Dr. Cebula to schedule an appointment to find out if BOTOX could help you.