TMD - TMJ JAW, MUSCLE, AND JOINT PAIN - HOW WE TREAT IT
TMD/TMJ pain has become one of our more prevalent contemporary health problems, almost an epidemic in a high pressure living and working environment like the Washington D.C. area. It is estimated that 90% of people who claim that they don’t clench or grind their teeth in actuality do clench or grind their teeth. The unsuccessful use of teeth as stress reduction tools has been around for so long it’s even referred to in the bible as the “Gnashing of teeth.” It is rarely an exclusively dental problem, but is instead related to an assortment of underlying medical and psychological conditions. Approximately 95% of the people who grind or clench their teeth (and I would estimate the percentage is higher still) do so because of outside sources of anxiety and stress that have nothing to do with teeth, jaws, bite relationships, or anything else dental. These are often family or work related issues - difficulties with a spouse, a parent, a child, a close relative, a job, a boss, a co-worker, a subordinate, an illness - problems that we can’t control or easily eliminate from our lives - for example, your in-laws are living with you. Since only 5% or less are actually of dental origin, determining the causes of most of them would be very time consuming and any treatment beyond the relief of the immediate pain symptoms will require an interdisciplinary approach in conjunction with several medical specialties.
I begin with the assumption that the real cause of the pain is not dentally related at all, and that a non-invasive, relatively inexpensive, removable appliance will determine in a just a few days whether or not I’m right. I give patients a money back guarantee in the event that I’m wrong, but very few of them have been returned. I have had extraordinary success in getting patients pain free; however, I have had virtually no success in getting dental insurance companies to cover these appliances so don’t plan on them paying for yours any time soon.
All but the most intractable cases can be managed with these simple, non-invasive appliances and other conservative treatments such as, medication, meditation, moist heat, jaw exercises, and changes in eating habits; for example, no Big Macs, no big yawns, and do your chewing on your plate with your knife and fork. These types of therapies are usually enough to keep the problem under control. Over the counter non-steroidal anti-inflammatory pain relievers (NSAID’S) such as Advil or Aleve have also proved to be effective, but there are limitations on how much or how long they can be taken safely.
Your appliance can be kept in its box or in water when not being worn. It should be rinsed after each use, brushed daily with a toothbrush or a small hand scrub brush, and occasionally soaked overnight in Clorox. It is virtually indestructible although I have had a few patients that actually ground through them. It may darken over time due to the nature if the material, but the color change won’t adversely affect it. It should be worn at night when sleeping and during the day in stressful situations such as driving on the beltway or, for some of us now days, just driving around town, but don’t try to eat with it and don’t wear it continuously or the teeth might eventually move. Appliances similar to these are sometimes used by dentists when they want to move teeth. The statistics on these appliances favor a successful outcome. Let’s hope it works for you.
R. K. Rosenberg, D.D.S.