Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

Temporomandibular Pain: Diagnosis And Treatment

A few weeks ago a student from Boston College was referred to my office for the relief of pain involving the temporomandibular joint. Her symptoms had begun the day before and had increased over the course of the evening until she was in such severe pain that she couldn't attend classes.

Temporomandibular disorders (T.M.D.) refers to a collection of dental and medical conditions affecting the temporomandibular joint and/or muscles of mastication. The most common causes are of T.M.D. are:

  1. Congenital birth defects
  2. Trauma
  3. Degenerative arthritis
  4. Neurological disorders
  5. Anxiety, stress and/or tension
      

Initial therapy must be based upon a thorough and sensitive analysis of the patient. My patient demonstrated restricted opening to 24mm (normal range 35-45mm) with bilateral pain involving the left and right temporomandibular joint area. The patient, a freshman at Boston College, was from a small town in North Carolina and was home sick as well as having a difficulty time adjusting to college and to dormitory life. Upon obtaining a thorough history and examination, I was able to confirm that my patient had begun to clench and grind her teeth upon arriving at Boston College and the beginning of classes.

In the past the common treatment regime would consist of:

  1. A medical diet
  2. Moist heat packs and ice packs to the T.M.J.
  3. Medication i.e. NSAIDS (non-steroidal anti-inflammatory drugs)
      

The patient was immediately relieved of pain by Pulsed Radiofrequency supplemented by analgesic medication, modified diet and ice and heat to the area. Pulsed radiofrequency is a new treatment modality that creates a low level electrical stimulation in tissues. Studies conducted at the Gelb T.M.J. Center-Tufts University School of Dental Medicine have demonstrated positive results for the relief of acute T.M.J. dysfunction and pain. Relief of the acute pain and an improvement in the patient's restricted opening following pulsed radiofrequency therapy is anticipated.

The management and treatment of temporomandibular disorder (T.M.D.) is complex. For the patient with episodic sings and symptoms, a noninvasive, conservative approach should be implemented. The treatment regime of a modified diet, analgesic and opiate medications, ice and moist heat, and pulsed radiofrequency to the area has demonstrated significant patient benefit.

For the successful intervention and management of acute pain and restricted opening. The use of pulsed radiofrequency has been shown to be an innovative treatment modality.

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍