Temporomandibular Disorder

WHAT YOU SHOULD KNOW:

• Temporomandibular (tem-po-ro-man-DIB-u-lar) disorder, also called TMD, is a condition that affects the temporomandibular joint (TMJ) and the structures around it. These structures include the muscles, nerves, and tendons of the jaw, face, or neck. The TMJ connects your mandible (jawbone) to the temporal bone of the skull (head). The jaw is a long bone that forms the chin and holds the lower teeth. It goes up towards the ear on both sides of the face. The TMJ contains a small cartilage disc that keeps the temporal bones and jaw bones from rubbing on each other. The TMJ and jaw muscles help in opening and closing the mouth, and are used particularly with chewing.
  
  
• The most common cause of TMD is a cartilage disc that may have moved out of its proper position. Signs and symptoms may include teeth grinding and clicking or popping sounds when the jaw opens or closes. Your jaw may lock and you may also have headaches, or jaw, ear, or facial (face) pain. An arthrogram, x-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) may be used to diagnose TMD. Treatment includes the use of splints or mouth guards, medicines, surgery, rehabilitation, and behavior therapy. With treatment, TMD may be cured and further problems may be prevented.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Treatment for a TMD may cause unpleasant side effects. Medicines may cause you to have nausea (upset stomach) or vomiting (throwing up). You may bleed or get an infection if you have surgery. If left untreated, your condition may get worse. You may have trouble breathing, eating, drinking, talking, or opening your mouth. TMD may also cause bleeding, deformity, or infection. If not treated early, permanent injury, such as nerve damage or paralysis, may happen. Early diagnosis and treatment of TMD is very important. Call your caregiver if you have concerns about your condition, treatment, or care.
  
  

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Diet:

• You may not be able to eat solid foods for a period of time. You may only be allowed to drink liquids to rest your jaw or they may be the only things you can swallow. You may need to use a straw to help you drink. You may drink water, broth, apple juice, or soda. You may also suck on ice chips or eat gelatin.
  
  
• As you improve, you may be given soft foods that are easier to bite, chew, or swallow. Some examples are applesauce, bananas, cooked cereal, cottage cheese, eggs, pudding, and yogurt. Ask your caregiver for more information about what foods or liquids you are allowed to eat or drink.

Ice and warm compress:

Apply an ice pack on the swollen part to decrease swelling, pain, and redness. Put crushed ice in a plastic bag or an ice pack and wrap it with a towel. Place the ice bag on the injured area for 15 to 20 minutes every hour as long as you need it. If ice is out on the injured area for too long or if it is slept on, it may cause frostbite.

After the first 24 to 48 hours, you may use heat to decrease pain or swelling. Heat brings blood to the injured area and helps it heal faster. Use a heating pad, moist warm towels, or a hot water bottle. Do this for 15 to 20 minutes out of every hour as long as you need it. Do not sleep on the heating pad or hot water bottle. This could cause a bad burn.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may be given the following medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
  
  
• Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
  
  
• Steroids: This medicine may be given to decrease inflammation.

Tests:

You may be given dye for some of the tests that may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies or medical conditions. You may need any of the following:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Arthrogram: An arthrogram is an x-ray of the joint using dye. The dye helps your caregiver better see the joint and the area around the joint.
  
  
• Bone scan: This is a test to look at your bones. You are given a small amount of dye through an IV, and pictures of your bones are taken. Caregivers can look at the pictures for broken bones, infections, and other problems.
  
  
• Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your head. It may be used to look at your jawbone, muscles, or nerves. You may be given dye to drink or in an IV before the pictures are taken.
  
  
• Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your head or jaw. During an MRI, pictures are taken of your bones, muscles, nerves, or blood vessels. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
  
  
• X-rays: You may need to have x-rays of your skull, jaw, or teeth. X-rays may tell how bad your condition is and what is causing the problem.

Treatment options:

You may need any of the following:

• Aiding devices: Splints may be used to support your jaw. They may also be used to keep your jaw from moving. Mouth or bite guards may be worn to avoid clenching or grinding of your teeth while you are sleeping.
  
  
• Surgery: Your caregiver may need to do a surgery to return your teeth, jawbone, or TMJ to its normal position. Surgery may also be needed to correct a deformity or fix damaged tissues in your mouth or jaw.
  
  
• Therapies:
  
  
  • Behavior modification: Behavior modification therapy teaches you how to change your behavior by looking at the results of your actions. With "behavior mod" therapy, you learn that certain behaviors (actions) have good or bad results. These results may make you feel either good or bad about yourself. Most people feel good about themselves when they use good behaviors. Good behaviors are often rewarded.
    
    
  • Rehabilitation therapy: Physical therapy may be needed once the swelling and pain are gone. Exercises that increase range of motion of the jaw may be done as the pain decreases. This helps to bring back the strength and power of your jaws and mouth. A form of exercise therapy may also be used to help you avoid overusing your jaw muscles. You may also be taught how to properly bite and swallow. You may have speech therapy if you are having problems with speaking.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Temporomandibular Disorder (Inpatient Care)