TMJ Disorders: Conventionally Speaking
“You have several treatment options available to you,” my doctor said following the confirmation of the TMJ diagnosis.
I sat forward in the chair, “What are they?” I asked, really not knowing what to expect. And with that, he began a litany of prescriptions and procedures, many of which I didn’t know a thing about.
If your pain is diagnosed as TMJ, a similar list, outlining what conventional medicine can offer, may be presented to you. But I have to admit, it was difficult making an intelligent choice. I knew so very little about any of those options. That left me, in effect, at the mercy of the doctor. My initial decisions, at least, were based on his recommendations.
And while that is not necessarily a bad situation, the best possible scenario in the decision-making process is to not approach it blindly.
It’s always much better if you have at least some idea of what your doctor is talking about. This chapter covers that; it’ll give you a leg up on what your doctor may recommend you do for your pain.
Knowing ahead of time what he’s talking about gives you the opportunity to ask probing, intelligent questions. But more importantly, it allows you to be an active partner in the direction of your own health instead of merely a participant.
Got TMJ Disorder? Here’s What May Happen!
For some people, the symptoms of TMJ disorders disappear just as mysteriously as they appeared, even without any type of treatment. But if the symptoms won’t go away, your doctor or dentist will provide a treatment plan, or at the very least prescription medication, to help you deal with the pain.
Doctors have a variety of medications that can help you cope with the pain of TMJ disorders. The truth is you’ve probably already have used the first weapon in his arsenal of therapies: over-the-counter analgesic pain killers.
These are your standard over-the-counter, “let-me-reach-for-this” drug that most of us use. The most common of these is acetaminophen. You may know it better by its brand name, Tylenol. It works simply by blocking the transmission of pain signals to your brain.
And while we use this drug all the time, there is a danger in the familiarity that accompanies it. Many of us forget that it really is a medication, with potential negative side effects, just like any other pharmaceutical drug – either over-the-counter or prescription. This is doubly true when, as a society we seem to swallow these in an amazingly large quantity. In fact, you may be doing just that right now for your TMJ pain.
But just listen to acetaminophen’s major, potential adverse side effect: liver damage. You can indeed cause damage to your liver if you take too much of it at once, or you depend on it as a long-term treatment.
Taking 4,000 mg daily is considered excessive. Even if you don’t overuse it, you still may experience liver problems if you take this analgesic and drink alcoholic beverages.
Don’t think for a moment that just because you take straight acetaminophen your system isn’t somehow ingesting it, because it very possibly may be. It’s found as part of more than 600 other over-the-counter drugs, including many cold and sinus medications, as well as cough remedies.
If you’ve already used these products and found them lacking, don’t be surprised. Medical experts say this class of pain killers is not very effective for TMJ because of its neurological nature.
You may also have tried aspirin or even a host of NSAIDs – non-steroidal anti-inflammatory drugs. These are often confused with analgesics, but they work differently. Instead of blocking the transmission of the pain signals, they reduce the inflammation causing the pain. NSAIDs include ibuprofen. You probably have at least one bottle of this in your home right now under the brand name of either Motrin or Advil.
When OTC Isn’t Enough . . .
If over-the-counter pain medication doesn’t help, your health care provider may prescribe the off-label use tricyclic antidepressants. The term “off label” indicates that this drug is not intended to be used as a pain killer, but has proven effective in this instance.
And, indeed, for many individuals it seems to be the answers to their prayers. This type of medication has proven for some to be extremely helpful in easing the pain. He’ll probably recommend that you take them in the evening before you retire for the evening. If he’s prescribed either amitriptyline or nortriptyline, he’s giving you antidepressants.
Recently, in fact, the International Association for the Study of Pain recommended this class of drugs as the first choice to reduce pain caused by neurological issues, like TMJ.
Beware The Side Effects
But these drugs aren’t without negative side effects. You may notice an increase in your appetite, or experience dry mouth. Some people also experience constipation on this drug. A less common adverse reaction, but one you should be aware of, is the possibility of acquiring either a rapid or irregular heartbeat. Drinking alcohol while taking this medication may heighten the severity of any of these effects.
If you have cardiovascular disease or have experienced a stroke, you may still be prescribed them, but your health care provider will want to closely monitor your use of these antidepressants.
Similarly, if you suffer from hypothyroidism, inform your prescribing physician. This health issue combined with the medication needs to be monitored closely.
Muscle Relaxants: Short-Term Relief
We learned earlier that your muscle and bones work in tandem. Don’t be surprised then if you get a prescription for muscle relaxants. This type of medication may help for a few days — or even several weeks — to relieve the pain.
Bear in mind, though, that the use of these drugs doesn’t speak to the cause of your TMJ disorders. It does help to alleviate your pain symptoms. And for many, they are extremely helpful.
Are you considering taking muscle relaxants? Think long and hard before you make your decision. They are not only considered a controlled substance, but have been proven to be addictive. They have, in fact, become the most abused type of drug in the US today.
If you have past issues with alcohol or drug addiction, then you should steer clear of these drugs. Even if you have no previous addictive problems, you may still find yourself dependent at the very least, or addicted if you take them for a continued length of time for chronic pain. That’s one reason many physicians only prescribe them for short-term use.
In Addition to Addiction . . .
Obviously, addiction is the largest fear most individuals experience when they use muscle relaxants. But this type of drug also comes with other potential adverse issues. Some individuals, for example, experience stomach problems, including nausea and vomiting, when they take these drugs.
For others, the adverse effects can appear in the form of a dry mouth. But perhaps the most common effect accompanying their use is drowsiness. If you do use them, be careful, especially initially, not to drive until you can evaluate how your body reacts to this medication.
Many individuals also complain that their thought processes are foggy or cloudy. They lack the necessary concentration to think clearly. As a consequence, some even say their daily ability to function normally is affected while they’re on this prescription drug. Some persons notice that their decision-making powers are diminished.
There’s still one more caveat that needs to be mentioned before you decide to use this class of drugs. You must know that they may not mix well with other medications you’re using. Be sure to inform your health care provider of your entire list of medications you’re taking.
When mixed with other drugs, the power of the muscle relaxants may be diminished or even negated completely. But, more than that, the combination of this drug with certain others may even present itself as a dangerous situation.
Corticosteroid: Worth The Risk?
If the pain is severe, then you may undergo injections of corticosteroid drugs. These would be shot directly into the joint space. This provides the needed relief for many. The corticosteroid is an enormously powerful drug – one that should be used with extreme caution. It definitely has the potential to ease your pain, but it also carries very real negative side effects.
In fact, this class of medication comes with an extremely long and diverse list of possible side effects. Before agreeing to this treatment, you need to be fully informed of the potential hazards of this drug. The side effects include the following:
- Bruising easily (black and blue marks)
- High blood pressure
- Increased appetite
- Mood swings
- Muscle weakness
- Salt retention
- Stomach ulcers
- Slow-healing wounds
- Sweating excessively
- Water retention
- Weight gain
For this reason, many doctors use it sparingly and only for a very short period of time. Usually, it’s recommended after all other treatments have failed.
While corticosteroid injections help some individuals, many in the medical community question the lack of valuable guidelines regarding their use. What few guidelines exist they contend are “woefully inadequate.”
For the most part, the use of these injections – that are placed directly into the jaw – are based, according to many experts, more on anecdotal evidence than on any results for controlled scientific studies.
Botox and TMJ: An Unusual Approach?
Yes. Botox. You know it. It’s that “infamous” substance that has people around the world ridding their faces of wrinkles. If your doctor speaks of Botox to you don’t be astonished. It appears to have a good track record in helping alleviate the pain. It accomplishes this essentially because the substance relaxes tense jaw muscles.
It’s also recommended by many because it’s a non-invasive procedure. That means it’s an alternative to surgery. The goal of your health care provider should be to offer you all of the least invasive treatment options prior to recommending surgery. If you can in any way avoid surgery, that should be one of your goals.
The procedure, in essence, is simple enough. Once this area is sufficiently numbed, a doctor, specially trained in administering this treatment injects the substance directly into specific muscles affected by the TMJ pain – and only these muscles. The injections themselves are called “tiny.”
The specialist asks you to contract your muscles. He then determines the appropriate sites for injections. Typically, these areas are the temporals, frontals and the masseter. Only those areas receiving the treatments will be affected.
This treatment doesn’t take very long. It may be as short as 10 minutes, or as long as half an hour, depending on the number of muscles involved as well as the number of shots being administered.
Before you schedule your injections, though, you should be well aware of the dangers associated with Botox (you had to know I was going to tell you about the side effects!). The most common complaints associated with this therapy include headaches, nausea, and the temporary drooping of the eyelids. Some individuals have experienced respiratory infections, as well as a flu-like syndrome.
Additionally, you may experience discoloration and bruising at the sites where the injections were administered. Don’t panic. This occurs in some instances. If you’re either pregnant or breast feeding, though, you should postpone Botox therapy for your TMJ pain.
The What? The Occlusal Splint!
The occlusal splint is an example of another popular non-surgical remedy to your pain. It sounds quite impressive and complicated, but you might know it better under its more common name: the bite guard.
Ah! Now we’re talking. Some people, indeed, discover the much-needed relief they seek with the use of the occlusal splint. This bite guard is specifically created to prevent any further wear and tear on your joint.
You may also hear it referred to as simply a splint or even an appliance. This device, though, is nothing new, and has been used for more than 80 years for various problems relating to the mouth and jaw. It’s been used to treat the grinding of the teeth, the clenching of the mouth, as well as most recently, TMJ pain.
Many individuals find this mechanism extremely helpful; others don’t have good results with it. The guard, in fact, can actually lose its effectiveness over a period of time. And, as contradictory as this seems, some persons complain their symptoms worsen when they use the splint.
You’ll learn that this device comes in several different forms, depending on your individual needs. Some cover the top teeth; others fit over the bottom set of teeth.
The splint, though it may seem like an answer to your prayers, is not meant to be a permanent solution. Nor is the use of this device intended to alter your basic bite. If you discover this is occurring, then stop its use immediately and inform your health care provider.
Perhaps the best evidence for some for the use of an occlusal splint is the rest it provides your muscles. With this device in overnight, you’re simply not grinding your teeth in your sleep.
While it’s definitely a good approach, you do need to know a few of the disadvantages of the guard. First the guard may actually prevent your teeth from meshing together. And you also need to know that if you have sleep apnea, it may actually worsen the problem.
Is Surgery In Your Future?
It could be, depending on the cause and severity of your pain. One of the suggestions your doctor or dentist may give you is corrective dental treatment. The goal of this approach is to improve your bite through a variety of measures.
It could be that the actual biting surfaces of your teeth may need balancing, or it may be that missing teeth need to be replaced. The corrective dental treatment may be as simple as getting a crown or filling replaced. It must be mentioned that any of these treatments always have the chance of worsening your TMJ pain.
If your doctor recommends arthrocentesis, he’s actually recommending a simple procedure involving the extraction of fluid from the joint. Your doctor will inject a needle into the joint. Then the joint is irrigated in an attempt to remove debris and other inflammatory byproducts from the area.
Once the area has been sufficiently cleared, he may then inject either a form of lubrication into the space, or even medications of some sort, including corticosteroids.
Being a minimally invasive treatment, recovery time is short. At most, individuals need two days to recover from it. This procedure doesn’t work for every patient, though. Some individuals who receive it say it did nothing to relieve their pain.
If your doctor recommends this approach you need to consider it very carefully. It’s an approach that the national Institute of Dental and Craniofacial Research believes to be the most controversial yet. It actually suggests that surgery be performed when all other treatments have failed.
Arthroscopy: Increasing The Level of Invasiveness
In some cases of TMJ disorder, arthroscopy may be recommended. It’s a slightly more invasive treatment than arthrocentesis, though you’ll find it very similar.
In these cases, your surgeon uses a small camera to examine the interior of your jaw joint. Depending on what he finds, he may perform other procedures while he’s there. He may stitch your discs in place, or remove excess or loose scar tissue.
Performed on an outpatient basis, recovery time is longer than for arthrocentesis. Most people require at least a week before they can return to work.
Arthroscopic surgery leaves little in the way of scarring. In fact, in most instances, there is none at all. The required incision is typically less than five millimeters long, requiring only a very few stitches to close. If you notice any type of lingering marks, they most likely will be in the form of some temporary bruising in the area.
Arthroplasty: Open Joint Surgery
It very well may be that your TMJ pain can’t be resolved using the least invasive forms of surgery. In that case, you may find yourself a candidate for arthroplasty or open joint surgery.
Not only does this treatment give your surgeon the best possible view of your jaw, it’s the method of choice for the repair, removal or replacement of the articular disc, as well as general surgery to the bone.
Performed under either local or general anesthesia it, like the other less invasive surgeries we’ve discussed, involves making a small cut over the jaw, directly in front of the ear. This exposes the joint space, allowing the surgeon room (if you want to call that small area roomy!) to perform the necessary procedure.
What Can Be Performed Using Arhtroplasty?
Excellent question. You’d be surprised what can be done in such a small space. Your surgeon may deem it necessary to repair your disc. This so-called disc is actually a piece of cartilage located between the two bones of the jaw joint. Its purpose is to separate and cushion the bones, effectively preventing them from rubbing together, and, well, causing that pain you’re feeling!
What Is A Menictomy?
Wow! Another good question. If your surgeon mentions this procedure, then he’s talking about either the total or partial removal of the disc. It may be that this cartilage is so badly damaged that it just can’t be saved. The procedure by which this is accomplished is called a menictomy.
It describes either the partial or total removal of the articular disc and the consequential replacement of it with an implant. The implant consists of a synesthetic material which performs the identical function as the disc did. It prevents the joint bones from rubbing against each other.
Just when you think you’ve learned about all the possible surgeries that can be performed on your jaw joint, there’s another lurking around the corner. This one is called osseous surgery. If your surgeon mentions this, he’s not talking about replacement, but rather re-structuring or re-shaping the disc. TMJ pain can occur due to poorly formed bones in the joint area. This surgery attempts to remodel the bone to alleviate the problem.
Options, Options, Options!
As you can see, conventional medicine offers you many options in the treatment of your TMJ pain. Unfortunately, many of these choices involve some type of potential side effects, some degree of risk, or aren’t investigated completely enough to be certified as effective.
It wouldn’t be surprising for you to then read this list, thinking that there must be another way to treat your chronic problem. And you’re right – there is.
It’s a more integrative approach to your pain, which may involve changes in your daily habits, not only involving your posture and movements, but your dietary habits as well.
The rest of this book delves into how you may be able to avoid, or at least lessen, your dependence on prescription medications and conventional treatments by applying some of these more “unconventional” natural treatments.