Woman Holding Jaw in Visible Pain - Preventive and Avoidance-Based Temporomandibular Treatments

Preventive and Avoidance-Based Temporomandibular Treatments

Woman Holding Jaw in Visible Pain - Preventive and Avoidance-Based Temporomandibular Treatments

Preventive and avoidance-based treatments to combat or resolve temporomandibular disorders are essential to relieving chronic pain. These procedures can be administered based on the circumstances or levels of pain.

Self-limiting disease or non-progressive pain is an indication that treatment may not be needed. This is a logical approach to take when you are dealing with an acute trauma injury or anatomic anomali where the problem has subsided, but the patient is worried it might recur or get worse, such as an open locking disorder that has resolved. If the acute injury has caused pain or swelling, this approach is not indicated and treatment to manage the pain and swelling are indicated.

In cases where a TMJ osteochondroma has been identified radiographically, the treatment approach can be either one of the following:

  1. Watch and monitor growth with correction of the resulting asymmetry, if needed with orthognathic surgery
  2. Conduct a partial or full condylectomy with a total joint replacement, if needed

 

Watch and Monitor Approach

Watch and wait is an option because osteochondromas do not always continue to grow larger and larger over time. In many cases, they stop growing. If the osteochondroma does not substantially affect function of the TMJ and is not causing a substantial facial asymmetry, then it is prudent to watch and monitor the growth for progression.

This can be done with repeat CBCTs and or bone scans. Once growth has stopped, if needed, the facial asymmetry can be corrected with orthognathic surgery and orthodontics and no direct treatment of the osteochondroma is required.

The diagnoses that would link with this treatment procedure or protocol includes:

  1. Resolved but recent episode of open locking
  2. Resolving traumatic injury to the jaw without fracture or limitation of opening
  3. Some non-growing TMJ condyle osteochondroma that does not significantly alter function
  4. Non-progressive jaw bone, tissue or dental structural anomaly without major cosmetic concerns (e.g. malocclusion, facial asymmetry)

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Avoidance of TMJ Noises Protocol

This protocol involves avoidance of all jaw movements that cause joint noise (clicking and/or crepitation). To achieve reduced joint noises, this will involve substantially limiting jaw motion during chewing and talking.

The joint will still click if the patient opens wide, but it should be 2-3 times a day or less. In most patients with clicking there is risk of progression from DDWR into DDNR (called closed locking) and/or arthritic change in the TM joints. Clear explanation of these facts is recommended.

The diagnoses that would link with this treatment procedure or protocol includes:

  1. DDWR
  2. Episodic DDNR
  3. Osteoarthritis with crepitation of the TMJ.

 

Open Locking Avoidance Protocol

This treatment involves strict limitation of all wide opening jaw movements, yawning and use bite block during dental treatment. The yawning avoidance involves putting the chin down towards the chest during the yawn or placing your fist under the chin to effectively stifle the yawns maximum opening.

In cases of a generalized joint or connective tissue hypermobility, there is no reliable surgical or medical treatment other than avoidance. The primary method of treatment is stifling yawns by putting the head down (chin on chest) or placing the fist under the chin during a yawn if the patient can’t look down (e.g. while driving). In addition, the patient needs to avoid all food related wide openings by cutting or tearing all food into more bite-size portions.

The diagnoses that would link with this treatment procedure or protocol includes:

  1. Open locking of the TMJ
  2. Open dislocation of the TMJ (3) TM joint hypermobility

 

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About Dr. Glenn Clark

Glenn Clark, DDS, MS is an expert on sleep apnea, orofacial pain and oral medicine, and Temporomandibular Joint Disorder (TMJ). Dr. Clark serves as the Director for the Advanced Program in Orofacial Pain and Oral Medicine at the Herman Ostrow School of Dentistry of USC.