Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
STRESS, STRESS, STRESS:
The state of the economy, high unemployment, shorter days, the end of Summer, carpools, traffic, job security, STRESS, STRESS, and more STRESS. There are many different factors as to why patients are stressed which results in them being in pain. Your patients seek your help for the relief of their pain. What is your regiment for the treatment of temporomandibular dysfunction (T.M.D.)?
In the past the oral and maxillofacial surgeons who sub specialized in these problems were managing TMJ disorders with a range of treatment modalities including surgery. Long-term follow-up studies have rendered mixed success. With more cases, we are seeing that open joint surgery to correct pain and dysfunction is not necessarily the optimum treatment option.
Conservative methods: Many of our patients improve with more conservative therapy. In our practice, the majority of our patients receive a combination of conservative techniques. Included are: rest, reassurance, non-steroidal anti-inflammatory medications (NSAID's) and bite splints.
The use of NSAID's constitutes the initial TMJ pain therapy. TMJ must be differentiated from masticatory myofascial pain. Both can restrict mouth opening, but TMJ pain is associated with joint line tenderness whereas masticatory myofascial pain occurs in the masticatory muscles and involves trigger spots and muscle spasm sites. Low-dose tricyclic medications are also used on occasion.
A significant philosophic change in TMJ disorder management is that occlusal modification has no treatment benefit and should be avoided. Additionally, none of the bite splints are more useful than the others although the two-ply (hard exterior surface, soft inner surface) appliance subjectively is more beneficial to the patients seen in our office. Physiotherapy can also be beneficial on a long-term basis.
The more aggressive surgical approaches are all not without the potential of significant consequences. Rather than jump immediately into surgery, several non-surgical options are available. Referral to a pain management clinic should also be considered along with other conservative options.
The conservative management of TMJ disorders is expanding and achieving results better than those achieved with surgery in many cases. In the future, we need to develop better clinical guidelines. These guidelines would help the practitioner be better informed regarding the management alternatives.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery