(416) 538-8883
415 Bloor Street West Suite 300
Toronto, Ontario M5S 1X6

Treatment of TMD

Phase I - Diagnosis and Orthopedics

Once a thorough diagnosis has been made, the dentist will begin a personalized treatment program. Patients benefit from the non-surgical, conservative treatment our office provides.

Individualized therapy will include muscle spasm reduction treatments in conjunction with an easy to wear, comfortable dental orthotic, referred to as a splint. The orthotic covers the lower teeth holding the jaw in proper alignment, reducing tension in the muscles of the jaw joint, allowing healing to take place.

In addition to the lower orthotic in some cases, a second appliance may be required in the form of an ALF. The objective of the lower splint is to try and establish the correct position of the mandible to the maxilla in three dimensions; transverse, sagittal and vertical. The goal is to try and find a comfortable position for the lower jaw so that the patient can get some relief from the pain and muscle spasms. If the patient has a denture or a partial denture, the splint may be constructed over them similar to the method with natural teeth.

Once pain is controlled and the jaw joint is stabilized, the bite is balanced so the teeth, muscles and joints all work together in harmony.

Since most head, neck and shoulder pain originates from muscle instability or swelling and inflammation of the joints, we may employ various physical modalities to treat and help normalize these structures. This includes such things as ultra low frequency transcutaneous electrical nerve stimulation (TENS), moist heat therapy, vapor coolant sprays, and cold laser treatments.

It is important to assess the posture of each patient to determine whether or not the shoulders, pelvis and hips are level. Photos are taken of each patient to check for the above as well as to check for forward head posture. If there is a problem with the shoulders, hips or pelvis or if one leg is longer than the other or if any ankle or arch is collapsed, then a referral to a chiropractor or an osteopathic manipulation practice would be necessary.

To solve the problem of forward head posture which can cause cervical (neck) problems, orthodontics using functional jaw orthopedic appliances are recommended. These appliances such as the Twin Block, MARA or Herbst Appliance successfully reposition the lower jaw forward and improve the forward head posture.

Sometimes it will be necessary to refer patients to other health care practitioners to help relieve some of the muscle spasms including chiropractors, massage therapists, physical therapists, osteopathic therapists. craniosacral therapists, etc. The patient must be made aware of the fact that, although the majority of patients do improve substantially, there are still a small number of patients whose treatment is not effective.

The longer the disc is out of position anteriorly, the more the posterior ligaments get stretched and the more difficult it becomes for the posterior ligaments to reposition the disc to its correct position on the head of the condyle. These patients may require prolo therapy which will be administered by a specialist.

Some of these patients may have suffered traumatic injuries such as a blow to the head or have been involved in a car accident, which caused a whiplash injury. If the posterior ligaments, which help position the disc between the condyle and the temporal bone, have become stretched or torn as a result of a serious injury, then the prognosis for successful treatment is diminished.

Obviously, the sooner the patient can be treated, the higher the success rate. The length of treatment for phase I is different for each individual. On average, the treatment time is six months, but it can be as little as four months and as long as one year. Once it has been determined that the patient has reached maximum medical improvement, the patient will be weaned off the orthotic appliances. If the patient remains comfortable, and can function successfully, then no further treatment may be required. If the patient relapses and the pain returns, a second phase of treatment is required.

Phase II - Permanent Solution
  1. Orthodontics
  2. Following diagnostic splint therapy to solve the problem of dislocated jaw joints, most patients have a space between their back teeth. The jaw has been moved to a temporary position where it is pain free.

    If the patient moves the jaw back to the original pretreatment position, the pain will come back. Therefore, to obtain a more permanent solution, orthodontics is often the treatment of choice, placing braces on the teeth and using up and down elastics to allow the back teeth to touch so the patient will be able to chew properly and with no pain.

    This is a more permanent solution to jaw stabilization and TMJ health. This stage can last from 12 months to 18 months depending on the severity of the case. If the space between the back teeth is large (more than 3 mm.), then this is often the treatment of choice.

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  3. Crowns & Bridge
  4. If the space between the back teeth is minimal (less than 3 mm.) or if the back teeth have large restorations or missing teeth, then the best option might be to close the spaces between the back teeth with crowns and bridges.

    Click to learn more about crowns.
    Click to learn more about bridges.

  5. Overlay Partial Dentures
  6. If the patient has limited financial resources, often the treatment of choice would be the placement of an overlay partial denture over the lower back teeth in order to fill the spaces between the back teeth and to stabilize the jaw (TMJ).

  7. Complete Dentures
  8. If the patient has an old denture or dentures with the teeth all worn down, new dentures could be made with longer back teeth to fill in the spaces between the back teeth.

  9. Partial Dentures
  10. If the patient has missing back teeth, partial dentures could be made to fill in the spaces between the back teeth.

  11. Overdentures
  12. Overdentures sit on top of your own teeth to recreate the orthodic position with a more streamlined appliance.

The important aim of correcting your bite is to ensure optimal long-term health. If you have any of the signs or symptoms mentioned, discuss them with your dentist.

Although infrequent, surgery is sometimes required to correct a damaged joint. Ultimately, your dentist will stabilize your bite so that the teeth, muscles and joints all work together without strain.

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