Using Lifestyle Strategies
See your dentist, who may prescribe physical therapy exercises. There are a variety of exercises that can be used in the treatment of TMJ problems. The main aim of these exercises is to make use of your jaw muscles and to increase the jaw's mobility without fear of pain. Most exercises are focused on relaxing the muscles of your neck, your shoulders, and your jaw. Tension in any of these can worsen TMJ pain. If your dentist identifies "trigger points" for your TMJ pain (trigger points are areas of muscle that are prone to causing you pain), she may recommend that you see a massage therapist for help in loosening these muscles.
Avoid motions or activities that cause pain to your jaw. This may sound obvious, but avoiding triggers for your jaw pain, such as chewing gum, yawning, or even singing, can help to prevent worsening of the pain. Also, eating softer foods can help, as this decreases the stress and strain of chewing. Pencil biting, pipe smoking and other repetitive movements and positions (such as with playing certain instruments like the violin or viola) are also thought to be associated with TMJ. Opt for foods such as oatmeal, eggs, mashed potatoes, soups, and other options that are gentle on your jaw in order to decrease the pain.
Focus on good posture. Especially for those who work at a computer all day, getting up to move around and changing posture frequently is important. TMJ problems can be worsened by tense neck and shoulder muscles, which happens frequently to those who are poised over a computer keyboard all day. If at all possible, break up your workday by scheduling in a walk or other activity every couple of hours. This will give your neck and shoulder muscles a chance to relax, and may help to ease the discomfort in your TMJ. In addition, pay attention to sleeping positions. Sleeping on your side or stomach may put pressure on your jaw, exacerbating TMJ pain. Try to sleep on your back instead, and don't elevate your head too much.
Apply heat to relax your jaw muscles. Applying heat can increase the blood flow to your jaw muscles and help to relax them. Start by taking a warm, moist towel and place it on the side of your jaw. Apply the towel for five minutes or until you feel increased comfort. You can apply this warm, moist towel four to five times in a day. This procedure can help relieve discomfort and increase jaw flexibility.
Use ice packs to help relieve pain. Applying ice packs can reduce the inflammation and pain by constricting the blood vessels around your TMJ. Use a cold pack, take a plastic bag and fill it with ice cubes, or simply keep a towel in your freezer and apply it on your jaw and face. Apply it for 10 minutes each time, four to five times per day. Always wrap cold packs in a towel before applying them to your skin. Putting ice or a cold pack directly on your skin can cause frostbite.
Massage your jaw area to relax your muscles. Give yourself a gentle massage with your fingertips to relax your jaw muscles and to provide relief from muscle tightness. Take two fingers and apply firm pressure with your fingertips over your jaw area. Move your fingertips over the jaw areas in perpendicular and small sweeping motions. You can do this gentle massage for one to two minutes initially, and then three to five minutes on each side of your jaw. Always be gentle to avoid further problems and pain.
Get physically active. If you don't already exercise regularly, now may be a good time to start! Exercise produces endorphins, which are natural pain-killing chemicals in the brain. As a result, maintaining a healthy exercise regime can help to combat the pain in your jaw. A general guideline to follow is to do moderate-intensity aerobic exercise for 30 minutes at least five times per week, or 150 minutes total. Ideally, you want to choose sports that elevate your heart rate such as swimming, biking, speed walking, or running. In addition to aerobic exercise, try to incorporate two to three days of strength training, which will build muscle and improve bone density.
Using Medical and Dental Treatments
Take over-the-counter painkillers to reduce mild to moderate inflammation and pain. Using over-the-counter painkillers can inhibit the production of prostaglandin, the substance responsible for pain and inflammation in your body. Do not take these drugs continuously for longer than 10 to 14 days. Any of the following can be tried for pain control: Naproxen (275-500 mg twice a day). Naproxen works by inhibiting the release of inflammatory substances, COX-1 and COX-2. This is the medication of choice for treating joint inflammation, because it has been proven to be effective in joint diseases. Ibuprofen (200-800 mg every six hours). Ibuprofen provides fast-acting pain and inflammation relief when taken in liquid gel form. Acetaminophen (500-1000 mg every four to six hours). This does not help with inflammation, but can serve to combat pain.
Use muscle relaxants to relax your jaw muscles. These are available over-the-counter or by prescription. Your best bet is to speak to your dentist if simple over-the-counter painkillers have not been sufficient to control your pain. Your dentist can then advise you on which type of muscle relaxant is most effective, or he can recommend another treatment altogether depending upon the nature and severity of your TMJ pain. A short-term course of long acting benzodiazepines, such as Valium, can be used to treat severe acute TMJ symptoms.
Try taking tricyclic antidepressants. These drugs, in low dosages, can help to relieve TMJ-related pain. An example of this medication is amitriptyline (Elavil). Start from a low dose of 10 milligrams, to avoid side effects. The dosage can be increased over time until the pain is relieved. For patients who also experience anxiety and/or depression, treating the condition with methods such as medication or relaxation/stress management training can also be helpful for TMJ pain. Tricyclic antidepressants are generally considered after lifestyle changes, NSAIDs and muscle relaxers have shown to not be effective. Once the effective dose of the tricyclic has been determined, it is generally prescribed for up to four months and then tapered down to a lower dose.
Take corticosteroids to reduce severe inflammation. Corticosteroids mimic your body's natural adrenal production, causing a reduction in inflammation and pain due to TMJ. Steroids are used when other treatments for TMJ have failed to relieve your pain and discomfort. Your dentist can inject the corticosteroids into your TMJ joint, to help relieve severe pain.
Get an occlusal splint from your dentist to prevent teeth grinding and clenching. If you have the habit of clenching your jaws and grinding your teeth, your dentist can take a teeth impression and make acrylic splints to fit on your upper and lower teeth. TMJ is weakly associated with teeth grinding (bruxism). These splints help reduce your clenching and grinding habits by preventing the teeth from contacting each other. The shape of the splints also helps to keep your teeth in their appropriate positions and to correct bad bites. You can wear the occlusal splints throughout the day, except when you are eating. You can use night guards that are similar to splints during the night if you have a habit of grinding your teeth. Your dentist will advise you on the exact splints or mouth guards that will suit your TMJ problems. Using a splint in addition to making lifestyle changes is more effective in treating TMJ pain than using the splint alone.
Get trigger point injections. Trigger point injections involve using anesthetics to numb the highly-tensed muscles in your jaw. This will render the area numb for a few hours and relieve pain for days or months. This procedure also relieves pain immediately.
Try low-level laser therapy. Low-level laser therapy (LLLT) is an infrared light therapy that a doctor administers directly to your Temporomandibular Joint. This therapy also helps stimulate body recovery.
Have crowns and bridges put on to correct and adjust your bite. Replacing missing teeth by applying crowns, bridges, and grinding uneven surfaces helps to distribute the biting and chewing forces equally between all your teeth surfaces; however, correction and adjustment rarely provides full relief from TMJ problems.
Look into osteopathic manipulative treatment (OMT) to relax your jaw muscles and ligaments. In osteopathic manipulative treatment (OMT), your dentist uses special forceps placed in between your upper and lower teeth to gently open your mouth. The mouth is gradually opened more and more on each visit. With the help of OMT, your ability to open your mouth will improve, even without muscle relaxants.
Try TENS (Transcutaneous electrical nerve stimulation). In TENS, a current or pulse of electricity is applied by a device to stimulate your nerves and contracted muscles. This stimulation makes the muscles contract and relax, almost as if they were massaging themselves. TENS also stimulates the production of endorphins, which are natural pain-relieving agents. It is a non-invasive method, and 30 – 60 minutes in each session of TENS normally provides a good result.
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