For chronic TMJ syndrome, a team approach is usually required. This may include a dentist, ENT surgeon, pain specialist, physiotherapist, and a primary care physician. Modalities used to relieve pain and restore the function of the TMJ may include the use of splints, physical therapy, psychological counseling, acupuncture, hypnotherapy, and arthrocentesis.
Medications that may be used to relieve pain may include tricyclic antidepressants, muscle relaxants, and prescription-strength painkillers. Botulinum toxin (Botox) can be used alone or in combination with other treatments to relieve the muscle spasm and pain.
There are several types of appliances to treat bruxism. These splints are custom made and help redistribute the force of the teeth while biting. The doctor may fit you with a splint or bite plate. This is a plastic guard that fits over your upper or lower teeth, much like a mouth guard in sports. The splint can help reduce clenching and teeth grinding, especially if worn at night. This will ease muscle tension. The splint should not cause or increase your pain. If it does, do not use it.
Surgery is never the first choice of treatment for TMJ syndrome. Arthrocentesis entails the use of a needle to clean and irrigate the joint. During the procedure, the surgeon may inject a local anesthetic or a steroid into the joint. Arthroscopy surgery is done when there is suspicion of an internal problem with the TMJ. It does require anesthesia and has a high success rate in resolving pain.
Anyone with recurrent or chronic TMJ syndrome is referred for physical therapy. The therapist can help restore joint mobility, increase muscle strength, and relieve pain.
A variety of other treatments are also available for chronic TMJ syndrome and include friction massage, transcutaneous electrical nerve stimulation (TENS), and cognitive behavior therapy.
The National Institute of Dental and Craniofacial Research (NIDCR) advises that if surgery is recommended, you seek other independent opinions before proceeding. Generally, experts recommend the most conservative and reversible treatment possible based on a reasonable diagnosis.
NIDCR advises that other irreversible treatments have not been proven effective and may potentially worsen the condition. These include orthodontia to change the bite, restorative dentistry, and adjustment of the bite by grinding down teeth to bring the bite into balance.