Temporomandibular Joint (TMJ)
TMJ Treatment in Somerville MA
Visit Structure for TMJ Consultations:
“TMJ” is a catch-all phrase that is often used to describe many different symptoms related to the temporomandibular joint. It is better thought of as TM-D for a temporomandibular disorder, of which there are many. It would take pages to describe all of the various disorders, but some common symptoms are:
- Pain in the jaw or ear when eating
- Limitation or restriction of opening the mouth
- Feeling of locking or hyperextension of the jaw (especially when yawning or opening wide)
- Clenching or grinding of teeth
- Difficulty biting or chewing through food
- Popping or clicking in front of the ear with jaw movement
- Tension in the jaw muscles
- A need to shift the jaw around to find a comfortable position
- Neck pain
The temporomandibular joint (TMJ) is a very complex structure and is made up of the mandible (lower jaw) and the base of the skull (temporal bone). The mandible rotates and slides against the temporal bone to open the mouth, chew, speak, and perform many other functions that are necessary for life. It is a delicate balance between the tissues of the joint itself and the muscles and ligaments that allow the joint to move. A very large part of the brain is dedicated to how the joint functions.
Many different problems or diseases can impact the joint. Most commonly, there is a muscular problem in which the jaw muscles are overactive and therefore cause muscle cramps. These cramps lead to pain, injury to the muscle, and decreased function. The cause is related to many factors and ultimately can lead to issues in the joint itself. The joint itself can have arthritis or inflammation that causes pain or alters the movement of the joint.
What can be done to help with TMJ Disorders?
There is no established cure for TMJ disorders, but for most people, a TMJ disorder is manageable. The most critical step in treatment is just like any medical condition and requires a thorough evaluation of the symptoms, detailed physical examination, and assessment of quality-of-life impact. From there, imaging may be required (MRI, panoramic X-ray, CT-scan) or another testing.
Once a diagnosis is made, a number of different treatments can be employed. For almost all of our patients, we initiate what is called “conservative treatment” which is a way of saying therapy that is non-surgical and easy to accomplish. For many patients, this will alleviate many of the symptoms. We may also recommend other treatments such as massage or physical therapy, most of which you can do yourself.
Why do you need to see a doctor for TMJ?
One of the reasons we are the best in delivering TMJ care is that we are able to evaluate you in a medically comprehensive manner. There are many factors that lead to your TMJ disorder, and as a physician and surgeon, Dr. Osborn is able to go from the very simple to the most complex. Dr. Osborn is the only provider in the Northeast who does a full range of treatments, including medical management, Botox injection, non-surgical injection, and comprehensive surgical care (arthroscopy, open-joint, total joint). In addition, Dr. Osborn is an expert in the management of a diverse array of facial pain conditions, neuropathic pain, and headaches. He is the only one in the country who provides combined TMJ and migraine surgical and injection therapy.
Dr. Ella Osborn is a Board-Certified orthodontist who works in conjunction with Dr. Tim Osborn to provide a balanced bite. While we know that for most patients the alignment of the teeth is not a CAUSE of TMJ disorders, it can be a contributing factor. Any joint is prone to overload, and when the bite is not balanced, the joint itself can have an uneven function. This imbalance can lead to mechanical changes in the joint that may lead to deterioration. Dr. Ella can show you how your teeth interdigitate with our digital scanner and determine if your treatment would be assisted by orthodontic care.
What are next steps for my TMJ disorder?
If you have jaw pain, clenching, headaches, noise in your jaw joint, or other symptoms of a TMJ disorder, we can help. In order to help accomplish your goals, we have a number of options for consultation. Unfortunately, TMJ disorders are not considered “medically necessary” and we will collect payment at the time of your evaluation. If you have health insurance, we can submit a claim on your behalf or help you use your HSA.
Tier I (Screening): In this visit, we will assess your symptoms, history, and perform a focused examination to see if you would benefit from a more formal evaluation. We have you fill out a brief questionnaire, assess the impact on your quality-of-life, and provide you with a tentative diagnosis. In most people, a trial of a muscle relaxant medication or anti-inflammatory may be warranted, and we will initiate that treatment. The entire visit takes about 15 minutes and gives some answers as to your individual case. For many patients, this level of evaluation and a brief course of treatment will be all that is needed. If the medication was used successfully, you can work with your primary care to continue that treatment if needed.
Tier II (Moderate Complexity): This is for patients who went through Tier I treatment or have had evaluations and treatment by other providers. We perform a more in-depth assessment of your individual case, review any records, history, and a full-depth physical examination. We will also perform a digital scan of your teeth so we can assess your bite. If any imaging like an MRI is necessary, we will work with you to obtain it. This visit will be about 45 minutes.
Tier III (Complex): This is for patients who have a long history of a TMJ disorder, headaches, facial pain and have had prior treatments such as multiple evaluations, prior surgery, joint replacement, splints, physical therapy, or extensive dental work. Many patients in this tier have had prior interventions without comprehensive evaluation and planning. This visit will include a review of records from prior doctors, imaging, or other treatments. Complex facial pain is generally not something that can be “cured” but we will work with you to find a plan that gives you some alleviation. This visit will take about an hour, includes a digital scan, and coordination of any ongoing treatment. We will also thoroughly evaluate you for any possible systemic causes or contributing conditions.
Botox Injections for TMJ
Dr. Osborn is the only provider in the Northeast who does botox injections for a combination of TMJ, headache, and neuropathic pain. One of the pioneers in this treatment, we will tailor our injection strategy to balance your needs, budget, and work with you to find a treatment that works best. There are a few options for obtaining botox for injection; we can write you a prescription, use ours at cost, or for some insurances, we order it and you pay your co-pay. Our fee for injection is the same.
Nightguards for TMJ
For some patients, a custom splint can help balance out your bite and relax your jaw muscles. This is something that most of our patients have already tried with their dentist as they need frequent adjustment, but we are happy to make one if it seems the best treatment.
Dr. Tim Osborn is a uniquely trained craniofacial surgeon with expertise in surgery of the temporomandibular joint, the base of the skull, neurologic surgery of the cranial nerves, headaches, and facial pain. His broad training in surgery, medicine, and dentistry affords you a unique perspective on your condition. Many of his patients have had numerous evaluations, treatments, and complicated issues that his experience and expertise are often able to help. Facial pain disorders and headaches are very isolating and patients may feel like nobody understands. There is often no visible sign of the pain or understanding of the impact that this has on quality of life. You will be listened to and we will do whatever we can to help.
To read more about TMJ Disorders, click below to download the information from the National Institue of Health.