Treatment - ICCMO.IT

The goal of TMD treatment is to achieve the greatest possible improvement in comfort and normal function. For some patients, this ideal outcome can be fully realized. For others, depending on the nature and stage of their condition, effective management becomes the primary objective.

The appropriate therapy is determined by the specific nature and severity of each patient's condition. For some, a simple treatment focused on muscle relaxation and inflammation reduction is sufficient. For others, a more comprehensive diagnostic and treatment approach is necessary.

Once a TMJ TMD diagnosis is made and a treatment plan is decided, the first therapeutic step is to relax the masticatory (chewing) muscles, which are often hyperactive, fatigued, or in spasm. This is achieved through TENS, or Transcutaneous Electrical Neural Stimulation. This procedure utilizes a minute electrical current generated by a 9-volt battery to relax the facial muscles.

TENS therapy typically lasts for about an hour, though sometimes longer. Patients experience a series of rhythmic taps on their cheeks and can read or nap comfortably during the session. It's akin to an electronic massage for the facial muscles. This method is often preferred over medication, which can relax muscles throughout the body and lead to unwanted side effects. TENS comfortably and effectively relaxes the facial and jaw muscles with minimal electrical stimulation.

Following the TENS procedure, the jaw's resting position is recorded, as are any changes in muscle resting activity observed with EMG (Electromyography). The arc of jaw movement during TENS is also recorded on a computer to assist the doctor in selecting a new treatment occlusal (bite) position close to the mandible's natural rest position. This information serves as a "roadmap to health" for the entire temporomandibular system, encompassing muscles, nerves, joints, and teeth.

Using the data gathered from the computerized recordings of jaw movement and muscle function, and the registration of the new bite position, the doctor constructs a tooth-colored orthotic appliance (orthosis). This appliance is crafted with detailed tooth anatomy to provide a stable biting position. Commonly referred to as a "splint," the orthosis fits comfortably over the lower back teeth and extends behind the front teeth, where it can remain discreetly for several months. Worn 24 hours a day, this precise appliance is only removed for cleaning the teeth and the splint itself. The orthosis allows the jaws to come together in a muscularly healthy position, retraining the muscles to move along a more natural, muscle-guided pathway into the new occlusion. Patients often report significant symptom improvement within a month of wearing this comfortable appliance.

After three months of full-time splint use, patients are asked to return for a second computerized study of their jaw and associated muscle function. Based on the test data and the patient's reported symptom improvement, the outcome of the initial treatment is evaluated, and options for additional therapy are discussed.

After three to six months of wearing the splint, a patient may choose to maintain the new, healthy biting position through various methods: dental restorations, reshaping of certain teeth, or the use of a removable, durable long-term appliance. Another option to establish the new bite is a process called passive eruption. This involves removing the splint's plastic covering over the rearmost tooth on each side, allowing the last upper and lower teeth to naturally erupt further, as they did when they first emerged. If successful, this process is repeated by uncovering the next pair of teeth once the rearmost teeth reach the new bite position.

Some patients opt not to wear the orthosis full-time or to permanently alter their natural occlusion. Instead, they may use the orthosis part-time or discontinue its use entirely unless symptoms recur. If symptoms do reappear, the orthosis can be used again.

A very small percentage of patients with TMJ/TMD require evaluation and potential surgical intervention for their condition. Except in cases involving severe traumatic injury that prevents jaw function, surgical intervention is typically not indicated as an initial treatment. If conservative treatment, such as splint therapy, has not led to comfort and proper jaw function, a surgical evaluation may be appropriate.

Given the complex interconnection of the temporomandibular joints with the joints of the upper cervical spine and skull, a neuromuscular dentist may, when necessary, collaborate with upper cervical chiropractors, physical therapists, massage therapists, and myofunctional therapists. Such multidisciplinary efforts can significantly enhance positive outcomes in the treatment of TMJ TMD disorders. When indicated, the dentist will refer a patient for medical evaluation, which may include specialties such as neurology, otolaryngology (ENT), ophthalmology, internal medicine, rehabilitation medicine, and pain management.

Dental occlusion refers to how the upper and lower teeth come together. Neuromuscular occlusion occurs when this dental occlusion is synchronized (coordinated) with healthy, relaxed masticatory (chewing) muscles. The concept of neuromuscular occlusion has applications in treating both general dental patients and those suffering from TMD.

Both general dental patients and those with TMD may not have a comfortable, stable, neuromuscular occlusion. Their muscles can be overactive when they should be at rest, and may be weak or uncoordinated when chewing food or even swallowing saliva. This condition of the muscle system can predispose a healthy person without current symptoms to future TMD.

Patients whose dental occlusion requires major alteration, such as with dentures or extensive dental reconstruction, can benefit from improved muscle function. Creating a muscularly healthy neuromuscular occlusion, using the computerized measurement instruments described here, can be a valuable aid in achieving improved dental occlusion with comfort, function, and overall health.

The rest position of the jaw is the state where the upper and lower teeth are not in contact, which occurs most of the time. At true rest, which is the ideal jaw position a person should maintain except when eating and swallowing, the mandible is suspended in space, anchored at the two temporomandibular joints. The jaw is held in place by a set of both opening and closing muscles on both sides of the head, all of which are at their full resting length. Think of it like the ropes that hold a hammock between two trees. In this jaw rest position, the upper and lower teeth are usually separated by about one to two millimeters of space.

At the true rest position, all the muscles that support and move the jaw are relaxed. This should be the case most of the time. It's similar to the two sets of muscles attached to your arm: one pulls the arm upward, the other pulls it downward. When your arm is truly at rest, hanging at your side, both sets of muscles are relaxed and at their resting length. Returning to the jaw muscles, the jaw moves from its rest position only during function, such as speaking or eating. When eating or swallowing saliva, the jaw moves upward and forward to bring the teeth together. This is called occlusion. Each time swallowing occurs—around 2,000 times throughout the day and night—the jaw is normally braced against the skull through the teeth to allow the swallowing reflex to happen.

However, if the distance between the upper and lower teeth when the mandibular muscles are completely at their resting length is more than two millimeters, the distance and/or time needed to reach occlusion is too great. Because of this excessive space between the teeth, people develop an adaptive, accommodative, false resting (pseudo-resting), or partially resting accommodative position of the jaw to maintain the typical one to two-millimeter resting space between the teeth. This keeps the muscles in a constant state of work, not rest. If the muscles that posture (hold the jaw up) and move the jaw are not allowed to fully rest, tension can build, leading to muscle fatigue, dysfunction, and sometimes spasm. This is a key to understanding one of the ways in which Temporomandibular Disorders (TMD) can occur. It's one of the common hidden causes of TMD or a predisposition to developing TMD.

A good, healthy, comfortable bite involves far more than just how the upper and lower teeth fit together or the aesthetics of the teeth. When the dental occlusion is synchronized with healthy, balanced muscle function, muscles can fully rest at the mandible's rest position and work effectively with balanced strength when needed during chewing. The creation of a neuromuscular occlusion is a key element in the treatment of those Temporomandibular Disorders caused by an unhealthy dental occlusion. A comfortable bite is synonymous with a healthy, neuromuscular occlusion.