1. Instruct the patient
to follow a soft food/no-chew diet for approximately one month. This will
include avoidance of foods of various textures including:
2. Instruct the patient
to use a soft, cold compress over an inflamed temporomandibular joint
10-15 minutes per application, 3-4 times per day. Your examination should
enable you to accurately identify joint inflammation and thereby guide
this recommendation. For inexpensive, effective tools for examination
as well as products that will help patients follow your home care instructions,
e.g. cold compresses, click
While much of what we have presented in this website has emphasized the mechanical, neurologic and muscular issues of TMD, inflammation of the temporomandibular joints is what drives most TM joint driven disorders (see TMD Training System for graphic pictures of inflamed TMJ's viewed through the arthroscope during surgery). That said, nutritional advice should be incorporated into any TMD treatment plan. The nutritional suggestions should address at least these two issues:
Obviously there are
many nutritional needs not mentioned here, but these two factors should
always enter into case planning. Please
contact me for suggestions about products that satisfy these needs and
have proven to be effective in management of TMD.
The information in this section will be of most use to those health care practitioners who know how to do a thorough exam and make an accurate diagnosis. The training necessary to perform an accurate 5 minute exam, which will effectively guide your treatment and recommendations, can be found in Dr. Steigerwald's TMD Training System. This tool not only demonstrates and describes examination techniques but trains you in TMJ manipulation/mobilization. The video/workbook will also help you locate the source of the symptoms and identify the pathology. Upon completion of this physical management section you will see that the suggested treatments are simple, time efficient, effective and billable.
TMD surfacing following whiplash is frequently a result of an injury to the temporomandibular joint complex. Pain and/or stress mediated clenching may onset or escalate following the whiplash event and aggravate the injured tissue. While these joint injury cases require diagnostic accuracy, relatively simple steps taken soon after the injury may intercept a degenerative process that might otherwise become disabling.
Treatments for the TMD range from home care to surgery.
PHOTOTHERAPY (Light Therapy)
Phototherapy (light therapy) has proven to have a wide range of positive affects on the repair and regeneration of tissue without raising tissue temperature. Wavelength determines depth of penetration with deeper penetration associated with longer wavelengths. The picture below is of a patient being treated with the phototherapy applicator of the Solaris physiotherapy unit (suggested dosage: 1-3 J/cm). I suggest using phototherapy (light therapy) immediately following distraction/mobilization of the TMJs. When you have completed the distraction/mobilization procedure, place cotton rolls between the patients' upper and lower molars to keep the joint distracted/unloaded during the phototherapy (light therapy) application. The same technique can be used for pulsed Ultrasound applications.
Only pulsed diathermy should be used over and around the temporomandibular joints when joint inflammation/effusion is suspected. Treatments usually range from 6 to 10 minutes per side with settings of 15 to 30 watts. Duration and intensity should be inversely proportional to the degree of inflammation in the joint. This is an ideal treatment for the acute inflammatory response to injury.
Microcurrent stimulation can be used with either pad or probe technique for dysfunctions of the temporomandibular apparatus. Various protocols are cited for this type of treatment. Some of the more popular involve probe stimulation of accupoints with biphasic microcurrent at settings from 0.03 up to 6 Hz and generally at low outputs of approximately 25 micro amps. These accupoints are stimulated for anywhere from 5 to 30 seconds. Microcurrent can be delivered to the temporomandibular joints locally by placing the pads over the preauricular regions and using settings of approximately 25 to 75 micro amps at 0.03 to 6 Hz for 10 to 15 minutes. Once again, this is a biphasic current setting. In treating one temporomandibular joint and an area considered to be affected by inflammation in this joint such as the ipsilateral cervical or upper trapezial musculature the biphasic mode may be abandoned and the positive pole placed at the temporomandibular joint proper with the negative pole placed at the temporomandibular joint proper with the negative pole placed on the affected region.
Cold compresses can be effectively used over the inflamed temporomandibular joints 15 minutes per application following other therapeutic modalities. Instructions should then be given to the patient to continue cold compress application at home 3 to 5 times per day depending on the degree of inflammation. It must be considered here that the temporomandibular joints are very capable of maintaining a perpetuated, acute, inflammatory state for some time following the actual precipitation of the inflammation. Acute inflammations have been observed arthroscopically in temporomandibular joints injured some 14 months prior. This should be considered when any form of physiotherapy is applied with specific reference as to the benefit of heat vs. cold.
refer to the TMD Training System for training
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