TMJ Treatment
Get relief from TMJ pain and symptoms from New York’s TMJ Specialists
What is TMJ?
TMJ refers to the temporomandibular joint, which is the bone structure, muscles and connective tissues that surround the jaw and control chewing. Disorders of this joint are referred to TMJ Dysfunction or TMJ Disease.
The TMJ is one of the most complicated joints in the human body. It can move in 3 dimensions unlike any other joint in our body. Because of the complex movements of this joint, small issues can manifest into large problems rather quickly. If you are experiencing clicking in one or both joints, muscle pain or tension, and/or headaches, ringing in the ears (tinnitus), neck and shoulder pain - you may have a serious TMJ disorder that should be evaluated as soon as possible.
How did i get tmj?
TMJ “Clicking” Occurs When the Disc Slips Off of the Lower Jawbone
In most cases TMJ Dysfunction (TMJD) is due to a discrepancy in how the teeth fit together in a comfortable biting position and the “orthopedically-stable” position, or a position in which the jaw joint is properly supported by muscles and ligaments in our skull. This discrepancy causes muscles that move the lower jaw to spasm or tighten. Some of these muscles are connected to a disc that helps cushion our lower jawbone against our skull. When these muscles tighten, the disc is not allowed to move properly and as a result, a “click” may be felt or heard upon opening and closing. This click is your lower jawbone jumping off of the disc - a serious condition that can lead to arthritis and degenerative joint disease - and a condition that needs to be treated immediately.
WHAT IS THE DIFFERENCE BETWEEN THE COMFORTABLE BITING POSITION AND THE ORTHOPEDICALLY STABLE POSITION?
The comfortable biting position is how our teeth fit together comfortably; however, even though teeth may fit together comfortably, the TMJ jaw joint might be out of place. When this happens, TMJ symptoms start - and usually the first symptom is an audible “click” when you open or close, or muscle pain around the TMJ jaw joint.
The orthopedically-stable position exists when our TMJ jaw joint is in the correct position in our skull with all of the jaw muscles in a state of release. In this position, all of the teeth should fit together perfectly. When the teeth do not fit together perfectly in this position is when our TMJ becomes a problem.
HOW IS TMJ TREATED?
There are many philosophies on how the TMJ is treated ranging from conservative therapy to surgical intervention. Dr. Gulizio - our TMJ specialist - believes in a conservative approach to TMJ treatment. Depending on the severity of your condition, he may recommend one or more of the following treatment modalities:
Myofascial release
Bite splints
Physical therapy
Prescription trigger point injections
Medication
Simple Injections
Myofascial Release for TMJ Pain
Myofascial release involves gentle manipulation of the muscles associated with the TMJ jaw joint.
Myofascial release is a procedure performed by a trained professional to help release the muscle strain associated with TMJ disorders. Although it will improve the pain and symptoms associated with TMJ pain, myofascial release will not eliminate the cause of TMJ disorders. It is important to understand that “self-massage” in and or around the TMJ may actually may TMJ symptoms worse - the muscles implicated in TMJ pain are delicate and difficult to pinpoint correctly. Additionally, there are ligaments around the jaw joint that should not be manipulated by massage. Ligaments - unlike muscles - do not stretch, but rather elongate. Once ligaments have elongated they no longer protect the TMJ jaw joint from slipping out of position and corrective therapy must then be focused on muscle stabilization.
Once you have been evaluated by Dr. Gulizio, he will formulate a treatment plan for you that may include myofascial release in addition to the implementation of a TMJ bite splint.
TMJ Bite Splints and Orthotics
A TMJ bite splint is a removable appliance made to release the muscle strain and tension in the area of the TMJ jaw joint. This device helps to “reset” the TMJ jaw joint into the correct position within the skull, thereby eliminating the pain associated with TMJ disorders.
TMJ splints are not nightguards as they function very differently than a nightguard appliance. A nightguard will only help protect your teeth from wear during clenching and grinding, but it will not fix your TMJ symptoms nor will it help correct TMJ dysfunction.
TMJ bite splint therapy requires a visit to our clinic on a monthly basis. These visits are usually very quick and they allow Dr. Gulizio to evaluate the progress of your TMJ treatment. It is important to understand that although a bite splint may eliminate your TMJ pain entirely, additional treatment may be needed to correct the position of your teeth so that your TMJ jaw joint remains stable and pain-free.
TMJ Splint: Unlike a nightguard, this device helps reposition the lower jaw to release muscle strain & set the TMJ jaw joint into the correct position.
Physical Therapy
Dr. Gulizio typically advises that all patients undergoing splint therapy strongly consider working with a physical therapist. Most TMJ disorders are highly correlated with muscle instability in the neck and mid- to lower-back regions. Working with a physical therapist will help to expedite the success of splint therapy treatment.
Trigger Point Injections and Medications
Usually the last resort for TMJ treatment, trigger point injections of anesthetic or steroids may be considered. Additionally, oral medications to help muscles around the TMJ jaw joint to relax may be prescribed.
Dr. Gulizio usually avoids trigger point injections and medication as a first-line choice for TMJ treatment. He has found that patients undergoing splint therapy in combination with physical therapy find relief in as little as a week. In situations where there has been a change in the anatomy of the jaw joint due to trauma or damage from letting TMJ go on too long, medications may be beneficial in the initial stages of TMJ treatment. Patients with complex TMJ dysfunction who exhibit signs of osteoarthritis and/or neurogenic disease are best attended to by an orofacial pain specialist.
Injections for TMJ MUSCLE Pain
Common injectable treatment for TMJ therapy has been shown to be safe, effective and predictable. In combination with splint therapy, Injectables help to expedite muscle release in and around the TMJ jaw joint and to decrease the force that the chewing muscles can exert on the teeth, and, indirectly, on the TMJ jaw joint itself.
It is important to understand that injections for TMJ disorders are not curative, that is, it will not fix your TMJ problems. It will help the muscles around your jaw joint release from tension, allowing the bite splint to work more quickly and effectively. Usually 30-40 units of injectable freezers per side are injected. This procedure is painless and quick. For optimal results injections must be done every 3 months for a minimum of 1 year for optimal results.
“TMJ sufferers, Dr. Gulizio is your guy. He’s head of NYU’s post-doctoral program for occlusion (jaw alignment) and esthetics. Do yourself a favor & make an appointment; you don’t have to live in pain. I wish I’d found him sooner. I was debilitated by TMJ pain before I came to Core Smiles.”
How can I be evaluated for a tmj disorder?
Our TMJ specialist in NYC, Dr. Michael Gulizio, will take a thorough medical and dental history, assess your diet, daily habits and review any medications you are currently taking. He will then examine your bite and jaw joints using 3D scanning technology. Based on Dr. Gulizio’s assessment, he will then determine which course of treatment is best for you. Dr. Gulizio’s initial approach is always conservative treatment using physical therapy techniques and a TMJ bite splint. For patients with complicated TMJ disorders, medications and/or trigger point injections may be considered to relieve jaw joint pain and muscle spasms - these are best handled by an orofacial pain specialist.
What are the costs involved?
Consultation
A consultation fee of $500 is required to secure an appointment with Dr. Gulizio. This fee ensures that Dr. Gulizio can dedicate ample time to accurately diagnose and provide personalized treatment recommendations tailored to your specific TMJ condition, ensuring you receive the most effective care available.
TMJ Appliances
After a thorough diagnosis, Dr. Gulizio will likely recommend a customized occlusal appliance tailored to treat your TMJ condition, offering relief and promoting long-term oral health. The cost for these appliances typically ranges from $1500 to $3000. Furthermore, Dr. Gulizio may prescribe an MRI, which is usually a covered expense by most medical insurance plans, ensuring a comprehensive and accurate diagnosis for effective treatment planning.
