Acute TMD (Temporomandibular Disease)

What is acute TMD?

Acute TMD is a general term used to describe pain that is coming from the jaw muscles, jaw joints, or surrounding structures.  The joint we are referring to is called the temporomandibular joint (TMJ) — the joint on each side of your head in front of your ears, where your lower jawbone meets your skull. This joint allows you to talk, chew, and yawn.  If not caused by an injury then most acute TMD are actually just flare-ups of chronic TMD.  TMD disorders can mostly be attributed to sore and over-worked muscles but there are many possible causes.  The acute phase is initially treated basically the same no matter the cause.

TMD Symptoms

  1. Facial pain. 40% get. Made worse
    by opening and closing the jaw.  Myofascial pain is very tricky and can present itself in very unusual ways.  Click here to learn more
  2. Headaches. Nearly 80% of TMD patients get
  3. Ear pain. 50% In front of and below your ear.  You can feel the joint moving with your finger when you open in this area.
  4. Dizziness 40%
  5. Fullness of ears or ringing in the ear=tinnitus or itchy ear
  6. Jaw popping or clicking  very common  more info here

Treatment for acute TMD

Once symptoms develop the best treatment consists of rest, heat or ice pack, ibuprofen, muscle relaxants, and stretches.  The application of heat (e.g. heat bag on cheek or near ear) will help reduce the severity and duration of the condition.  For some people an ice pack will do the same.  Additionally, control of symptoms with anti-inflammatory medication (ibuprofen) and muscle relaxants may be used.  Passive range of motion stretching needs to be done several times per day.  Passive range of motion refers to the moving of body parts without activating muscles to perform the movement.  In this case that means you use your hands to pull your lower jaw open as far as you can and holding it for 30 seconds.  Massaging the muscles will also help.

Bottom line for acute TMD treatment

First thing you need to do is have me check to see if your bite needs to be adjusted.  If there is one or two teeth hitting funny then slightly reducing them to make them hit right can eliminate your symptoms.  This process is called a limited occlusal equilibration.  This is rare and would likely only need to be done with new dental work was recently done.  If that is fine then……….
1.  Take 600mg ibuprofen three times a day until symptoms are gone, up to 10 days.
     Sometimes I recommend the 3x3x3 rule instead, because it is very easy to remember and follow.
2.  Use heat or ice pack 10-15 minutes at a time 1-10 times a day
3.  Take Flexeril (cyclobenzaprine) 10mg at night.  Can take 10mg in morning too but has side effects!
4.  Stop chewing gum, ice, or any chewy or hard foods.  Massage the sore muscles.
5.  Passive stretching 2-5 times a day.  Holding 30 seconds each time.
6.  If the pain is persistent and continues for more than 10 days I want a phone call.
7.  Unfortunately once you start getting acute TMD you will experience more issues in the future so typically either an NTI night guard or a traditional night guard will be made depending on your clenching/grinding habits. flexeril main side effects are drowsiness, dizziness and lightheadedness

do not take flexeril with alcohol or if have taken MAO inhibitors within 14 days

 

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