Pain due to inflammation of the temporo-mandibular joint (TMJ)
can be one of the most miserable conditions to experience and it is
certainly one of the most difficult conditions to treat.
By the time the patient is referred to this office, most of the traditional approaches have been tried. these include:
- Oral narcotics
- Oral anti-inflammatories
- Muscle relaxants
- (hopefully this one has not been done yet) Surgery to the TMJ.
- Transdermal medication delivery.
Each of these approaches has advantages, disadvantages, proponents and critics.
Splinting sometimes works, but it tends to be expensive, transient in
effect. Minimally invasive in nature, it rarely causes further damage,
but it can be an expensive approach to try. Effective in approximately
10% of TMJ sufferers, it is hard to get too excited about using it
2. Oral narcotics are effective in treating the
pain, but pain-killers, by nature, do not deal with the underlying
structural problem, nor do they deal with the inflammation and muscle
spasm that accompany TMJ pain. Further, the effects are transitory and
narcotics should be used periodically, or in a pulse-type application,
to prevent habituation and maintain therapeutic effect. Opiates are
best used in conjunction with muscle relaxants and anti-convulsants.
Oral anti-inflammatory medications are helpful to deal with the
inflammatory portion of the TMJ symptom complex. NSAID’s, as they are
often called, work differently on different patients, and there is
somewhat of a trial and error process to find the right NSAID for any
individual patient. NSAIDS have side-effects, and these side-effects
must be recognized and treated. Gastro-intestinal problems are common,
and if the patient tolerates the first 3 to 4 weeks, generally they
will tolerate long-term use.
4. Muscle relaxant use is
essential to treat the patient with TMJ. As a result of the
inflammation of the joint, the masseter and temporalis muscles will go
into spasm. This increases tension across the joint which in turn
increases compressive forces on the cartilage within the joint.
Deformation of the meniscal cartilage prevents normal joint function,
and relaxation of the muscle is essential for symptom management and
restoration of function. The splints work here, as well.
Anti-depressants have a place in the treatment of TMJ for a number of
reasons. First, sleep disorder is common as a result of the pain,
gritting of the teeth and headache. This sleep deprivation leads to
depressive symptoms in as little as one week. Anti-depressants assist
with the secondary depression, but clever choice of the anti-depressant
medication will result in secondary analgesia as well as secondary
muscle relaxant choices.
6. TMJ surgery seems to be helpful in a small minority of patients. This is a therapy of last resort.
Expensive and largely ineffective, patients tend to shy away from this option.
Transdermal medication delivery is a very effective approach to
treating TMJ. There are several very useful medications for treating
TMJ, and each patient is different in response.