Temporomandibular Joint Disorder Treatments

Authored By: Lesley Ranft

• TMD Basics

Only a small percentage of TMJ cases require surgical intervention. Many bite corrections simply require orthodontics or restorations.

If your dentist determines that no structural disorder exists in the joint but that there are deflective interferences on the teeth affecting the bite resulting in improper jaw closure, you may undergo occlusal equilibration or your dentist may elect to correct the bite with an appliance.

Occlusal equilibration, which involves reshaping the biting surfaces of the teeth, is often the best choice for eliminating deflective interferences so that the jaw can close properly. A careful examination of both the joints and the occlusion is a critical step before a specific treatment is selected.

Once the lower jaw is able to close properly into position within the temporomandibular socket, you may find that your pain is relieved immediately. If your pain is not relieved, then the dentist may fit you for an occlusal appliance to cover the deflective interferences affecting the bite and allow for the lower jaw to be repositioned into the socket properly. If this relieves the pain, it is likely that your bite was causing the problem.

Many TMJ cases can be corrected with occlusal equilibration, particularly when performed by a dentist experienced in TMJ diagnosis.

Treatment for a Structural Disorder

If your dentist suspects a structural disorder within the joint itself and your pain is not resolved through the aforementioned treatment options, a panoramic X-ray may be ordered. In some cases, an MRI (magnetic resonance imaging) may help your dentist view the soft tissue area surrounding the disc joint. A CT scan to evaluate the bony areas of the jaw and hinge joint may also be ordered. Depending on what these images reveal, your dentist may recommend an intra-oral appliance, orthodontia or maxillofacial surgery. You may be referred to an oral surgeon or oral and maxillofacial surgeon who will further evaluate and treat TMJ.

Surgical Treatment

Surgery is considered usually after you have tried all other treatment options. All TMJ-related surgery is performed under general anesthesia. An oral surgeon may perform a minor procedure called arthrocentesis. During the procedure, your surgeon cleanses the joint by inserting needles into the joint area and dispensing sterile fluid. In some cases, the surgeon inserts a scalpel-like instrument inside the joint to remove any tissue adhesions and reposition the disc in the joint hinge.

The second type of surgery is arthroscopy. During this procedure, your surgeon makes an incision at the temple point in front of the ear to reach an endoscope into the surrounding area. The endoscope provides a visual guide so that your surgeon can remove any adhesions, treat inflammation or reposition the disc.

Alternatively, open-joint surgery may be performed. This may be the only option that provides access to deteriorating bony structures, tumors, severe scarring or chipped bone areas. Depending on the type of problem, your surgeon may use a scalpel to remove or re-sculpt the affected area.

TMJ Treatment Cautions

"Conservative" is the key word in TMJ treatment. TMJ treatment should be determined through consultation with a dental professional highly experienced in TMJ disorder. Ideally, your dentist would have expertise in evaluating jaw-to-bite relationships and in proper treatment procedures such as occlusal equilibration. Ironically, a TMJ diagnosis can be confirmed when the TMJ-associated pain is eliminated through proper procedures such as occlusal equilibration and intra-oral appliances.

Alternative Medical Treatment for TMJ

Alternative medical treatment for TMJ is considered less conservative and not necessary if you initially receive proper diagnosis and treatment. Alternative treatments include transcutaneous electrical nerve stimulation (TENS), ultrasound, trigger-point injections and radio wave therapy. TENS and radio wave therapy send low levels of electrical or radio waves of energy to the affected area in order to stimulate blood flow to the joint and surrounding area. However, these options do not treat the causes of TMJ and may provide only limited, temporary symptomatic relief.

Botox Treatment for TMJ

Once reserved for lessening the tell-tale signs of aging, such as annoying wrinkles and frown lines, Botox injections are being used more frequently as “off label” treatments for more troublesome maladies. In particular, some dental offices are providing Botox treatments for temporomandibular joint disorder (TMD) based on scientific studies which showed that patients who received the injections experienced significant improvements in pain, function, ability to open their mouth and levels of tenderness to palpation.

What’s Involved in Botox TMJ Treatment?

Botox is injected into the temporalis, medial pterygoid (deep jaw muscle) and masseter muscles that together move the jaw. Botox blocks nerve signals that cause uncontrollable muscle movements, essentially relaxing the muscles.

Botox injections take only 10 to 15 minutes and remain effective for anywhere between two and six months. Therefore, like its cosmetic counterpart, Botox TMD treatments must be repeated every few months. If you have TMD and your dentist determines that you are a candidate for this treatment, how often you’ll need to receive Botox injections to relieve symptoms will depend on the severity of your condition.

To achieve a successful outcome, it is important for your dentist to use the correct injection technique, as well as follow the appropriate dosage guidelines.

Cost of Botox TMD Treatment

The cost of the Botox TMD treatment will vary based on where you live and receive treatment and the severity of your condition (and therefore, how many/much Botox injections are needed). Botox treatment is usually charged on a per-visit basis.

Most dental insurance companies do not cover Botox TMD treatments because they are “off label,” optional treatments. Therefore, the costs associated with your treatment most likely will be out-of-pocket expenses. However, financing or payment plans may be available.

TMJ Treatment Costs

TMJ treatment costs depend on several factors, including the expertise of the dentist, the location of the dentist, the type of dental insurance you have, and the facility fees for procedures.

Depending on the type of dental insurance you have, insurance companies may offer a 15 percent reimbursement or up to a 50 percent absorption of the total procedure costs.

• TMD Basics

[Updated May 2009]

Back to Top