TMJ Symptoms

123

Temporomandibular disorders often impair the quality of life of affected individuals. TMJ causes patient suffering and may "devastate its victim". In advanced stages, TMJ symptoms may include tooth sensitivity, abrasion, fractures, mobility or loss, dental caries, alveolar bone loss, headaches, earaches, hearing loss, and adverse irreversible effects on dental implants and aesthetic restorations.

The most promising and exciting new addition to the dentists' arsenal against TMJ symptoms is having Botulinum Toxin A (BOTOX®) injected into the painful muscles. A group of 46 patients with TMJ symptoms were measured for subjective and objective responses to treatment with botulinum toxin A (BTX-A). BTX-A injections produced significant improvements in pain, function, mouth opening, and tenderness to palpation. Many other studies have demonstrated similar benefits to TMJ patients. Botulinum toxin paralyzes or weakens the injected muscle but leaves the other muscles unaffected. The injections "block extra contraction [of the muscle] but leave enough strength for normal use," says Barbara Karp, M.D., deputy clinical director of the National Institutes of Health's National Institute of Neurological Disorders and Stroke. "Intra muscular injections of botulinum toxin re-establish the balance between masticatory closing and opening muscles. This relieves TMJ symptoms such as muscle pain, reverses masseteric hypertrophy with improvement of the face outline and restores normal kinetics of temporo-mandibular joints. Moreover, botulinum toxin injections eliminates habits of tooth grinding and clenching, and the consequences hereof. One single session of BOTOX® injections is curative of TMJ symptoms for 2/3 of the patients. Injections of botulinum toxin in masseter and temporalis muscles are an efficient treatment of bruxism and TMJ symptoms, cheap with no lasting side effect." Local site-of-injection side effects from botulinum toxin injections are rare, assuming proper technique is used.

Botulinum toxin has "an amazing safety record," says Bill Habig, Ph.D., the recently retired deputy director of FDA's division of bacterial products in the Center for Biologics Evaluation and Research. "Considering it's one of the most toxic materials known and there was a lot of concern about it, it's turned out to be very safe," he says. In 2003, less than two years after it was approved by the FDA for wrinkles, the US consumer spent more than $875MM dollars on BOTOX® injections. This is to treat a condition that does not affect ones comfort or health. Many dental patients who are already being treated with BOTOX® for wrinkles could be cured of their TMJ symptoms with a slight modification in injection protocol. Botulinum toxin's time to enter the field of dentistry has arrived. Despite the expense, many patients opt to invest in BOTOX® since it will make them feel better and look better.

To schedule a consultation regarding relief of TMJ symptoms, click here.

As we entered the 21st century, dental experts were still searching for a non-aggressive preventative treatment for TMJ and bruxism. Dr. Gordon Christensen states in an interview published in 'Dentistry Today' that "occlusion remains the major untreated disease in dentistry." Occlusal disease affects at least one-third of the population, and the longer it goes untreated, the worse it gets. Thus, by 40 or 50 years of age, most have worn their teeth to the degree that extensive and costly tooth restorations must be performed. For almost a century dentists have relied on splint therapy for TMJ and bruxism. Splints have the ability to align the jaws to each other and to protect the teeth. Much current research on the treatment of TMJ has been centered on the use of such dental appliances. Though covering or separating the teeth may be effective to prevent wearing down of teeth caused by bruxism, this treatment is often not effective for preventing and eliminating other symptoms of TMJ. Most splints are largely ineffective in treating TMJ.

Ice and heat therapies are used to reduce the jaw pain and muscle tension. Application of moist warm towels directly to the jaw joints (5-15 minutes), followed by cold or ice applications (a few minutes), and then repeating this combination 2-5 times per day is sometimes helpful in the short term. Wrapping the jaw in a hot moist towel and exercising it through a range of motion has been recommended. These jaw exercises may complement other approaches, but are not effective on their own.

Pain from TMJ has been related to depression or other emotional problems. Drugs are often prescribed for the stress and the brain malfunction etiological theories of TMJ. These include anti-anxiety agents, muscle relaxants, and other drugs. They are of limited value in the treatment of the great majority of chronic TMJ patients, and they often have untoward side effects. Commonly used antidepressants including Prozac®, Paxil® and Zoloft® may actually cause bruxism (tooth grinding) and associated headaches. Sufferers usually awaken in the morning with the headache and frequently have an accompanying sleep disorder.

Click here to schedule a complimentary TMJ Symptoms consultation.