Temporomandibular Joint Disor... Health Article

Medications

Patients with TMJ can be given muscle relaxants if their symptoms are related to muscle tension. Some patients may be given aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) for minor discomfort. If the TMJ is related to rheumatoid arthritis, it may be treated with corticosteroids, methotrexate (MTX, Rheumatrex) or gold sodium (Myochrysine).

Physical therapy and mechanical devices

Patients who have difficulty with bruxism are usually treated with splints. A plastic splint called a nightguard is given to the patient to place over the teeth before going to bed. Splints can also be used to treat some cases of internal derangement by holding the jaw forward and keeping the disc in place until the ligaments tighten. The splint is adjusted over a period of two to four months.

TMJ can also be treated with ultrasound, electromyographic biofeedback, stretching exercises, transcutaneous electrical nerve stimulation, stress management techniques, or friction massage.

Surgery

Surgery is ordinarily used only to treat TMJ caused by birth deformities or certain forms of internal derangement caused by misshapen discs.

Prognosis

The prognosis for recovery from TMJ is excellent for almost all patients. Most patients do not need any form of long-term treatment. Surgical procedures to treat TMJ are quite successful. In the case of patients with TMJ caused by arthritis or infectious diseases, the progression of the arthritis or the success of eliminating infectious agents determines whether TMJ can be eliminated.

BOOKS

"Disorders of the Temporomandibular Joint." In Merck Manual of Medical Information: Home Edition, ed. Robert Berkow, et al. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Murphy Jr., William A., and Phoebe A. Kaplan, "Temporomandibular Joint." In Diagnosis of Bone and Joint Disorders, ed. Donald Resnick. Philadelphia: W. B. Saunders Co., 1995.

John T. Lohr, PhD

KEY TERMS

Arthrography—An imaging technique that is sometimes used to evaluate TMJ associated with internal derangement.

Bruxism—Habitual clenching and grinding of the teeth, especially during sleep.

Electromyographic biofeedback—A method for relieving jaw tightness by monitoring the patient's attempts to relax the muscle while the patient watches a gauge. The patient gradually learns to control the degree of muscle relaxation.

Internal derangement—A condition in which the cartilage disc in the temporomandibular joint lies in front of its proper position.

Malocclusion—The misalignment of opposing teeth in the upper and lower jaws.

Mandible—The medical name for the lower jaw.

Osteoarthritis—A type of arthritis marked by chronic degeneration of the cartilage of the joints, leading to pain and sometimes loss of function.

Rheumatoid arthritis—A chronic autoimmune disorder marked by inflammation and deformity of the affected joints.

Temporal bones—The compound bones that form the left and right sides of the skull.

Transcutaneous electrical nerve stimulation—A method for relieving the muscle pain of TMJ by stimulating nerve endings that do not transmit pain. It is thought that this stimulation blocks impulses from nerve endings that do transmit pain.