Treatment time and cost vary according to the extent of dysfunction, the presence of simultaneous related dysfunctions such as neck injury or thyroid dysfunction, patient compliance and age. Children generally require only minimal treatment while geriatric patients generally heal far more slowly.

• Treatment for TMJ problems varies from simple measures to extensive therapy
• We treat the cause of your TMD problem (not just the symptoms).
• For each patient, we develop a complete, individualized, multi-disciplinary TMJ Rehabilitation Program that successfully treats TMJ-related pain and dysfunction -- without surgery or prolonged drug therapy!

The most common treatment is the repositioning appliance, or splint, which is used to change a patient's occlusion (bite) and jaw posture and help the TMJ function correctly. 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. 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. It is important to have a thorough examination since there are many different orthotics for TMD treatment. It is also important to assess the posture of each patient to determine whether or not the shoulders, pelvis and hips are level.

Physiotherapy modalities are often required to return the muscles to normal comfort and function. These might include moist heat, ultra-sound, transcutaneous electro-neural stimulation (TENS) or electro-galvanic stimulation (EGS).

The treatment, which we employ, is typically provided in up to two sequential stages. Most of our patients require only Stage I treatment to stop the pain, tinnitus, dizziness, etc. The procedures contained within these two stages are:

1. PHASE I DIAGNOSTIC PHASE (Temporary Solution)

PHASE I: The purpose of Phase I Therapy is to eliminate muscle spasms, TMJ swelling and dislocation (if possible), and generally reduce any type of pain. Phase I treatment for TMJ is conservative treatment, producing no irreversible changes. It usually involves the use of intraoral splints, exercises, medication, local anesthetic injections, injections of other medications, physical therapy and chiropractic treatment. Other disorders which mimic TMJ (for example, temporal tendonitis, Ernest syndrome) are often treated with Phase I therapy with medications, injections of local anesthetic and other medications, and soft tissue treatment. During this phase, orthopedic stabilization of the mandible is achieved using one of the more than 24 available splint-like devices called “oral appliances”. In addition to choosing the right device, each one must be precision fit with the position determined by clinical examination, dental history, medical history, and diagnostic imaging.

Most patients' conditions resolve with these procedures. However, if dramatic improvement is not experienced within a few months, we discuss the possibility of going on to PHASE II.

When there is an improper relationship between the upper and lower jaws and/or the upper and lower teeth, the patient is required to wear temporary oral appliances (orthotic or splint). This TMJ splint is usually worn over the lower teeth until the bite and position of the lower jaw is stabilized. The objective of the lower splint is to try and establish the correct position of the mandible to the maxilla in three dimensions; namely, 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.

Since most head, neck and shoulder pain originate from muscle instability or swelling and inflammation of the joints, various physical modalities can be used to treat and help normalize these structures. These include transcutaneous electrical nerve stimulation (TENS), moist heat therapy, vapor coolant sprays, and infrared treatments. These joints often get very tight in people with dysfunctions and various types of mobilization or stretching techniques are employed to gain normal function.

Sometimes it will be necessary to refer patients to other health care practitioners (chiropractors, massage therapists, physical therapists, craniosacral therapists, etc) to help relieve some of the muscle spasms. The patient must be informed 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.

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.

Along with Phase I therapy we also incorporate the following treatments
PHYSICAL MEDICINE treatments relieve pain, improve flexibility and increase range of motion. They can be delivered right in our office!

1. Physical Medicine Modalities - therapeutic devices which are utilized to aid muscles and joints to return to normal function and reduce pain.
2. Joint Mobilization Procedures and Physical Manipulation - active and passive movement of joints and muscles are employed to achieve or maintain normal motion, relieve spasm, and in some cases, to recapture displaced discs.
3. Medication - non-steroidal anti-inflammatory medication, analgesics, etc.
4. Ultrasound therapy-
5. Laser Therapy-stimulates cell and tissue function through photochemical and photobiological effects.
6. Iontophoresis - an electronic device which allows medications to pass through the skin into the muscle or joints without the use of an injection needle.
7. Injections of various muscles, tendons, ligaments and joints -different medications may be used to stimulate healing. Injury in these structures frequently results in pain being felt at distant sites (i.e., "referred pain").
8. Nutritional Therapies and Dietary Supplements include vitamins, minerals and other nutritional supplements to improve muscle function, reduce stress on muscles and joints, and improve biochemical and physiological processes.
9. Sleep Hygiene and Management of Sleep Disorders such as “bruxism” (i.e., excessive grinding and clenching of the teeth during sleep) that can put excessive pressure on the jaw joint and its associated structures and cause TMD symptoms to reappear and/or negatively impact health and wellness.
10. Prolotherapy threatments cause the proliferation (growth, formation) of new ligament tissue in areas where it has become weak. It is known as nonsurgical ligament reconstruction and is a treatment for chronic pain. Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament (“rubber bands” that hold bones to bones in joints) or tendon (connects muscles to bones) where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply, and flow of nutrients and stimulates the tissue to repair itself.

Many of our patients have been treated with oral orthotics(mouthpieces) before. Their treatment was unsuccessful. The key is the design of the mouthpiece
based on a very thorough diagnostic process. It is amazing the number of patients we see who have been treated with a mouthpiece and had no x-rays taken of their temporomandibular joints.

Near the end of Phase I, which usually lasts three months, a consultation appointment is held with the patient to discuss the success of Phase I and the various options for Phase II.
The vast majority of symptoms must be resolved in Phase I Diagnostic Phase prior to the initiation of Phase II Treatment Phase.

PHASE II TREATMENT - JAW STABILIZATION
(Permanent Solution)

The purpose of Phase II Therapy is to correct any residual discrepancies, if necessary, between the upper and lower jaws. Phase II Therapy may include adjustment of the dental occlusion, orthodontics, reconstruction of the teeth, surgery, or a combination of some of the above treatments. It is important to note that Phase II Therapy should not be attempted without successful Phase I Therapy modalities.
Phase II treatment is, by definition of the American Dental Association, non-reversible, invasive therapy. Adjustment of the occlusion (adjusting the "bite"), orthodontic treatment, the placement of crowns, and surgery of all types most certainly produce changes which can't be reversed. Therefore, it is most important that no one undergoes Phase II Treatment until a correct diagnosis is established and proven as the cause of the symptoms. Lastly, if a TMJ sufferer is experiencing severe emotional and/or psychological problems (which if often the case for many reasons), failure to address these most important issues will virtually guarantee a surgical failure. Psychological (as well as physical) problems must be considered as sources of unresolved pain complaints involving the TMJ or associated structures.

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.

Your health is your most priceless possession. It is worth the investment!