Expert: Steven C. Scherr, D.D.S. - 12/13/2007

Question
Hi, I desperately need some advice on how to manage TMJ pain! One of my dentists had me using all these appliances, including a bionator, night guard (which I still use) and an ALF. I stopped trusting him and went to a new ortho who says I should start with physiotherapy. I have to wait until February for my first appointment and I'm wondering what I can do for the pain in the meantime. My jaw pops and clicks and is incredibly sore often. It always gives me a headache in addition to jaw aches which is very frustrating. The other problem is that because of the misalignment of my jaw which is what is causing the TMJ pain, I constantly bite my inner cheek with my back molars. I have a permanent lesion on my cheek that I don't know what to do about. The physiotherapy won't help, the only thing I can see as helping is more appliances. Any advice from your experiences?

Answer
Meredith,

I am sorry to hear that you are in pain.  I will not be able to get you more comfortable from afar.  The best I can do is try to provide some direction.  There are more than 50 different types of TMJ problems.  They are not all managed the same.  The most important step is to determine the cause of the pain so that it can be addressed properly.

TMJ pain can come from inside the jaw joint itself, from the muscles that move the jaw, or both.  At least 80% of TMJ pain is muscle related.

A well made and properly adjusted guard can be an important part of successful therapy, but it is rarely the entire solution alone.  Clenching and/or grinding of the teeth places strain on the jaw joints, muscles and teeth.  This often contributes to damage and pain.  The purpose of the oral guard is to redirect the damaging force of clenching/ grinding in a way that is better accepted by the body.  You can think of the guard as instant orthodontics in that it artificially creates an ideal bite relationship while used.

Clenching and grinding can also occur during the awake hours.  A guard will not help during the day (unless it is worn then too).  Daytime clenching and grinding are habits, much like finger nail biting is a habit.  With help, one can learn to break the day clenching/grinding habit.

Medication may be needed to reduce swelling and inflammation and for the temporary relief of pain in order to jump start the healing process.  Most TMJ problems have been building up for years, and there is no magic pill.  Healing takes time.

Physiotherapy means different things to different people.  If you mean physical therapy, this can also be a helpful adjunct.  Postural correction, deep heat, range of motion, and muscle balance exercises can help promote healing.  Some aids like transdermal electro-neural stimulation (TENS) are unproven, and may provide no more than short term benefits.

A well coordinated program of oral guard therapy, physical therapy, and medication management as needed provides the greatest benefit.  Your cooperation with prescribed exercises and appliance usage is a critical component.

As to the lesion on your cheek.  It is best to have this checked by your dentist or an oral surgeon.  If the lesion is found to be benign and related to cheek biting trauma, treatment is often best deferred until the TMJs are stable and the offending bite is corrected if possible.  However, it is always best to confirm that the lesion is not malignant.

Meredith, I wish you well.

Steve