You have probably heard the terms “TMJ” or “TMD” used in various conversations or even in the Melbourne media. Here is all you need to know.
TMJ is an abbreviation for Temporomandibular Joint, which is the formal name for your jaw joint(s). TMD stands for Temporomandibular Disorders, which is a collective term for the muscle and/or joint symptoms that commonly arise when there is TMJ pain and dysfunction such as chronic headaches and jaw pain.
The dental profession is in the midst of a transition regarding TMD treatment. This has stirred up a controversy within the profession over how best to relieve TMJ pain. On one side you have those subscribing to the newer methods of conservative, less invasive approaches; on the other side you have those who are sticking with more traditional and often irreversible treatments. Therefore, what happens to you if you have a TMD problem could depend on whom you consult for diagnosis and treatment. That’s why it’s so important for you to become an educated consumer regarding this particular type of healthcare.
The options that Beacon Cove Dental are able to offer follow a model of care that ensures that aggressive and expensive treatment is a last resort.
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Common options include:
- Changes to your eating habits
- Stretching the jaw muscle with set exercises
- Medication such as a muscle relaxant injection to relax the muscle
- A plastic appliance such as a dental splint that is worn at night
- Orthodontic (braces) adjustment to change the way your teeth bite together
The temporomandibular joints connect your mandible (lower jaw) to your skull on both left and right sides, which makes the lower jaw the only bone in the body with completely symmetrical joints at both ends. There is a ball-and-socket relationship between your jaw and your skull on both sides, but the unique part is the presence of a cushioning disk between the two surfaces in each joint. Each TMJ has a disk between the ball (condyle) and socket (fossa), and this sometimes ends up being an especially important area when trouble arises.
The formal name for TMJ problems is Temporomandibular Disorders, or TMDs. Using the term TMDs allows us to point out that there are several different kinds of problems. This fact has huge significance when it comes down to what happens when things go wrong, and what can be done about it, since the nature of the problem will often differ greatly from one TMD sufferer to another.
“It is strongly recommended that, unless there are specific and justifiable indications to the contrary, treatment of TMD patients initially should be based on the use of conservative, reversible and evidence-based therapeutic modalities.Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time. While no specific therapies have been proven to be uniformly effective, many of the conservative modalities have proven to be at least as effective in providing symptomatic relief as most forms of invasive treatment. Because those modalities do not produce irreversible changes, they present much less risk of being harmful. Professional treatment should be augmented with a home care program, in which patients are taught about their disorder and how to manage their symptoms.”
Related to TMD, is excessive clenching or grinding of the teeth, known as bruxism, is often caused by physical or psychological stress or a sleep disorder. If untreated, bruxism can lead to excessive wear on the teeth and may cause permanent damage to the teeth and jaw joints.
Treatment involves repairing damaged teeth (such as restorations, crowns, or inlays to replace the damaged tooth surface) and subsequently creating an occlusal splint (night guard) made from hard plastic that fits over the upper or lower teeth, and is worn at night to prevent further wear of the tooth surfaces.
TMJ disorders and muscle relaxant in Melbourne
TMJ disorders are not uncommon and have a variety of symptoms. Patients may complain of earaches, headaches and limited ability to open their mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing their mouth. What must be determined, of course, is the cause.
Our Beacon Cove Dental team are specifically trained in providing a muscle relaxant injection treatment for TMD and associated issues.
We work with you to determine the cause and offer a range of options in order to reduce and deal with the issue before it damages your teeth.
There are several options that can be used to immediately cease the clenching and subsequent headaches and jaw pain.
Muscle relaxant (Known commonly in the cosmetic industry) can lessen the destructive effects of grinding and cease headaches associated with TMDs.
An extremely dilute form of the muscle relaxant is injected to partially weaken muscles and has been used extensively in cosmetic procedures to relax the muscles of the face.
Bruxism can be regarded as a disorder of repetitive, unconscious contraction of the masseter muscle (the large muscle that moves the jaw). In the treatment of bruxism, a muscle relaxant weakens the muscle enough to reduce the effects of grinding and clenching, but not so much as to prevent proper use of the jaw muscle for eating.
A muscle relaxant treatment typically involves a number of small injections into the masseter muscles. It takes a few minutes per side, and you can start to expect feeling the effects as quickly as the next day, although 3-4 days is more common.
The optimal dose of the muscle relaxant must be determined for each person as some people have stronger muscles that need more muscle relaxant . This is why you should always see someone specifically trained in the application of muscle relaxant for treatment of clenching.
The effects last for about three months. Over time it is usually possible either to decrease the dose or increase the interval between treatments.
Our patients have had success with this treatment, it has relieved headaches associated with clenching as well as allowed their teeth to recover from constant grinding.
Therapeutic Muscle Relaxant in Dentistry
What is muscle relaxant?
Muscle relaxant is a prescription medicine which contains 100 units of muscle relaxant liquid and is a natural, purified protein that is used therapeutically in dentistry to relax facial muscles.
Currently muscle relaxant is approved by the FDA (US) to treat medical conditions such as:
- Strabismus and blepharospasm (cross – eye) since 1993
- Cervical dystonia (severe involuntary twitching of the muscles of the head and neck)
- Primary axillary hyperhidrosis (severe underarm sweating)
- Spacticity due to cerebral palsy in children
It is widely known for its uses in Cosmetic Work.
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How is it used in Dentistry?
Dentists who have undergone appropriate training can use muscle relaxant to treat muscular pain and headaches due to muscle contractions in the head and face, focussing on the TMJ area.
Muscle relaxant is used in dentistry to treat:
- Myofascial pain
- Headaches originating from chewing muscles
- Trismus (inability to open jaw)
Severe, undiagnosed Grinding and clenching can lead to:
- headache and pain
- associated muscle hypertrophy (enlargening of the masseters, temporalis)
- exacerbated by external factors such as fatigue, stress, and emotional extremes
Currently in Dentistry, chronic sufferers can choose to relieve these headaches by:
- Physical therapy
- Nerve blocks
- Massage therapy
- Psychiatric therapy
- Continual use of analgesics (pain relief medications: panadol, neurofen)
- Use of muscle relaxants
- OR therapeutic use of muscle relaxant
Current management by dentists for muscle aches (caused by grinding/clenching/bruxism)
- Occlusal adjustments/rehabilitation
- Full mouth rehabilitation
- Continual use of pain killers
Therapeutic muscle relaxant allows pain to be treated effectively and simply.
Any surgical or invasive procedure carries risks. Before proceeding, we recommend that you ask questions, reveal any associated issues and seek a second opinion from another qualified health practitioner.
How does muscle relaxant work?
The National Headache foundation classifies approximately 90% of all headaches as muscle contraction headaches.
Since muscle relaxant relaxes part of the facial muscles, they cannot be contracted fully therefore the pain is minimized.
What does the treatment involve?
Muscle relaxant is generally administered by a very fine needle into the muscles that are causing the pain (eg. Masseters, temporalis, frontalis) with selected appropriate dose so that only part of the muscle is treated. The rest of the muscles still can function normally therefore chewing is mostly unaffected.
No anaesthetic is required since the procedure has minimal discomfort (a slight sting at the injection site). The treatment generally takes around 15 minutes for a full treatment.
The muscle relaxant treatment takes around 2-4 days to begin taking effect and up to 7 days for the full effect to be felt.
How long does it last?
This varies from individual to individual but usually 3-4 months. Repeat injections may result in the effects being prolonged.
What are the Side Effects?
The amounts are carefully measured appropriately for your case and the injection site is very localized therefore the side effects are minimized.
Possible side effects include but are not limited to:
Headaches, pain, burning/stinging, swelling, redness, bruising around the injection site.
Side effects are minimised by using a trained professional.
Contraindications to using muscle relaxant:
- Pregnancy or breastfeeding
- If you have had muscle relaxant in the last 2-3 months
- Allergy to albumin
- Immunization to muscle relaxant
- Have an infection, skin condition or muscle weakness at the site of injection
- Have Eaton-Lambert syndrome, Lou Gehrig’s disease or myasthenia gravis.