Temporomandibular Joint Disorder (TMJ)

Treatment
Conservative, non-surgical treatments

In some cases, the symptoms of a TMJ disorder may go away without treatment. If they persist, your doctor or dentist will most likely recommend one or more conservative, nonsurgical treatments or behavioral interventions to alleviate pain, to correct dental problems that contribute to the disorder, or to change habits that exacerbate symptoms. Your doctor or dentist may suggest the following treatments or interventions:

• Breaking bad tension-related habits. Your doctor will probably ask you to be aware of daytime habits, such as clenching your jaw, grinding your teeth, or chewing on your lip or on objects. These habits should be replaced with good jaw "posture" — keeping the jaw muscles relaxed with the teeth slightly apart, the tongue lightly touching the roof of your mouth and resting directly behind your upper teeth.
• Avoiding overuse of jaw muscles. Your doctor or dentist will probably ask you to change diet choices or behaviors that overwork or strain your jaw muscles. Eating soft foods, cutting food into small pieces, avoiding sticky or chewy food, and avoiding gum will minimize muscle use and may help alleviate pain. When yawning, avoid opening your mouth too wide.
• Stretching and massage. Your doctor or dentist may show you how to do exercises that stretch your jaw muscles and how to massage the muscles yourself. He or she may also show you exercises to improve your head, neck and shoulder posture.
• Heat or cold. Applying warm, moist heat or ice to the side of your face may help you relax your muscles or alleviate pain.
• Anti-inflammatory medications. To reduce inflammation and lessen pain, your doctor or dentist may advise taking aspirin or another nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others).
• Biteplate. If your TMJ is misaligned, your dentist may recommend a plastic biteplate (splint), worn over your teeth, to help align your upper and lower jaws. A biteplate may also reduce pressure in the joint structure.
• Night guard appliance. If you grind your teeth in your sleep, a night guard appliance, which is a soft or firm device inserted over your teeth, can help prevent grinding and excessive wear of your teeth.
• Cognitive-behavioral therapy. If your symptoms of TMJ disorder are made worse by poorly managed stress or anxiety, your doctor or dentist may refer you to a psychotherapist with experience in cognitive-behavioral therapy. This approach includes interventions to help you be aware of and change behaviors, learn relaxations techniques, manage stress, and change unproductive or harmful thinking habits.

Other treatments
If non-surgical treatments or interventions don't alleviate the pain or discomfort of TMJ disorder, your doctor or dentist may recommend one of the following treatments.

• Corrective dental treatment. Your dentist may improve your bite by balancing the biting surfaces of your teeth, replacing missing teeth, or replacing needed fillings or crowns.
• Corticosteroid drugs. For significant pain and joint inflammation, corticosteroid drugs injected into the joint space may provide relief.
• Arthrocentesis. This procedure involves insertion of a needle into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts.
• Surgery. If the other approaches don't work, your doctor or dentist may refer you to an oral and maxillofacial surgeon. Surgery to repair or remove the disk between your mandible and temporal bone may be beneficial. When advanced osteoarthritis is present, a partial or total joint replacement may be recommended and beneficial to remove bone-on-bone contact and improve joint mechanics and motion.