TMJ / TMD Treatment

What is TMJ?

It is the joint that connects the jaw to the skull. The Temporomandibular Joint (TMJ) is highly complex, capable of combining movements of rotation and displacement (translation). These movements are possible thanks to the presence of two independent joints (right and left), but functionally related to each other. It is unique in many ways.

The TMJ on one side cannot function without movement of the joint on the opposite side. Both joints can act as a functional unit. Any movement or change in one TMJ will affect the other joint.

Any force that overloads the joint complex or a disturbance in the normal functional relationship between the mandible and the TMJ can result in pain, dysfunction, or both.

What is TMD?

It is a set of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures.

Dr Simone Carrara talks about TMD (in Portuguese)

Signs and Symptoms

The main signs and symptoms are: pain in the TMJ region, joint noise, face pain, ear pain, headache, difficulty and pain when chewing, muscle pain, nape and neck pain, limitation and lack of coordination of mandibular movements, tinnitus, ear fullness, vertigo.

Prevalence / Epidemiological Data

Dysfunction is more common among women, in a ratio of 5:1. Epidemiological studies estimate that 40% to 75% of the population have at least one TMD sign, such as TMJ noises, and 33% have at least one symptom, such as facial or TMJ pain.

15.6% of the world’s population needs TMD treatment.

Causes

The attempt to isolate a clear and universal cause of TMD has not been successful. Recent studies conclude that TMD has a multifactorial origin.

Some causes: trauma, bruxism, anxiety, depression, degenerative, neurological, infectious, rheumatic, metabolic diseases.

Treatment

The key is an accurate diagnosis, obtained from the history reported by the patient. The dental surgeon, specialist in the area, will be able to diagnose and treat the dysfunction.

The objective of TMD treatment is to control pain, recover the function of the masticatory apparatus, re-educate the patient and alleviate adverse loads that perpetuate the problem.

The undefined etiology, self-limiting character and very high efficacy recommend the initial use of non-invasive and reversible therapies for patients suffering from TMD.

Patient education, self-management, behavioral intervention, use of drugs, interocclusal splints, physical therapies, postural training and exercises make up the list of options applicable to almost all cases of Temporomandibular Disorders.

Frequently asked questions about TMJ / TMD treatment

Temporomandibular disorder is a collective expression that encompasses disorders involving the masticatory muscles, the TMJ and associated structures. Epidemiological studies estimate that 40 to 70% of the population have at least one TMD sign, such as TMJ noises, and 33% have at least one symptom, such as facial or TMJ pain. The prevalence of need for TMD treatment in the adult population was estimated at 15.6% and it is known that this need is increasing.

The most frequent symptoms reported by patients are pain in the face, TMJ, masticatory muscles, headache and ear pain. There are also otological manifestations such as tinnitus, ear fullness and vertigo. Signs are muscle and TMJ sensitivity to palpation, limitation and/or incoordination of mandibular movements and joint noises.

Parafunctional habits such as teeth clenching or grinding impair the TMJ. In addition to these, chewing gum, yawning a lot, biting objects, supporting the chin, bad sleeping posture also bring harm.

Yes, although the prevalence is lower than in adults. Painful bruxism occurs in 2.6% of children and pain resulting from TMD occurs in 7% to 17% of them. The important thing is to make an early assessment for a better prognosis.

TMD often goes unnoticed by most health professionals. This is mainly due to the fact that there are no complementary tests that conclusively indicate the dysfunction. Ideally, the diagnosis should be made by a specialist in Temporomandibular Disorders and Orofacial Pain (TMD and OFP) through anamnesis and physical examination, whenever the individual presents any of the signs or symptoms mentioned above.

There are several reasons: displacement of the articular disc, joint degeneration, hypermobility, change in the viscosity of the synovial fluid.

It depends on the type of popping and how the joint works. Therefore, evaluation and guidance by a specialist in Temporomandibular Disorders and Orofacial Pain (TMD and OFP) is indispensable.

The evaluation and treatment should always be carried out by a specialist in this area and if there is a need for another specialty to complement the therapy, the patient will be properly guided.

TMD is a chronic disease, so we do not consider the cure but the control. Some studies report the control of signs and symptoms in more than 90% of patients who receive conservative treatments in this specialty.

Yes. Approximately 86% of patients with Dysfunction have chronic headache and 82% have neck pain. More than 90% of patients who undergo the correct treatment protocol have significant improvement in these symptoms. The treatment of headache or neck pain is no longer allowed without the participation of a specialist in TMD and Orofacial Pain in the team.

No. Evidence-Based Dentistry (OBE) does not include the use of these techniques in the TMJ treatment protocol. This conclusion led to the creation by the Federal Council of Dentistry of a specialty dedicated to this pathology.

Some isolated cases require surgical intervention. The sooner the patient seeks help, the lower the risk of needing this type of therapy.

Bruxism is one of the most responsible for the destruction of the masticatory apparatus, which can cause damage to various structures. It can cause tooth wear and fracture, gingival retraction, TMJ alteration, muscle hyperactivity, headache, dizziness, tinnitus, damage to restorations.

No. However, the splint can eliminate or minimize the damage caused by bruxism. No resource, so far, is able to stop this habit. The patient who has bruxism must be continuously to ensure the longevity of their masticatory apparatus.

It is a removable device, usually made of acrylic resin that adapts to the surface of the teeth in one of the two dental arches.

  • Prevent damage caused by bruxism, such as tooth fracture, occlusal wear, abfraction and gingival recession.

  • Alleviate TMJ overhead.

  • Reduce the signs and symptoms of TMD.

  • Decrease muscle tension in the face and neck.

    The splints can be made in the upper or lower arches, some particularities guide this choice.

    They do not have the property of moving teeth, although the patient often has this perception due to the initial sensitivity that it can cause. There is no need to worry, this picture is expected during the adaptation period, which routinely lasts a week and eventually extends a little longer.

Because the non-rigid material will encourage the patient to keep testing and biting the splint, which will easily accept compression, thus increasing muscle activity and consequently the painful stimulus.

Our Experts

Dr. Simone Carrara

TMD Specialist | CRO: 2725 DF

  • Dental Surgeon Graduation UnB
  • Clinical residency in Switzerland
  • Specialist in TMD and Orofacial Pain
  • Specialist in Chronic Pain, USP
  • Improvement in Interdisciplinary Pain Management, USP
  • Author of the 1st TMD Consensus Term
  • Founding body of the Brazilian Society of TMD and Orofacial Pain (SBDOF)
  • Founder of the PACTO Program, exclusively for the treatment of patients with Temporomandibular Disorders
  • Laser therapist, by the International Academy of Laser in Dentistry, acronym in English IALD/SP

Dr. Rodrigo Fernandes

TMD Specialist | CRO: 10044 DF

  • Bachelor’s Degree in Dentistry, UnB
  • Specialist in TMD and Orofacial Pain, IEO – Bauru
  • Specialist in Oral Rehabilitation, Instituto ARIA – DF
  • Laser therapist, ARIA Institute – DF
  • Founding member of the Brazilian Society of TMD and Orofacial Pain (SBDOF)
  • Excellence Course in Composite Resins, Newton Fahl – Curitiba
    Improvement Course in Botulinum Toxin and Orofacial Fillers, ABO – GO
  • Visiting Professor at the University of Brasília, Prosthesis Area of Clínica Integrada II – 2017
  • PACTO Method Coordinator, Centro Odontologia Integrada Simone Carrara

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