In the management of TMJ problems, there are no clear answers about the most effective options for management. Fortunately, most patients have simple problems that can be managed noninvasively.
Nonsurgical treatments include:
Load Reduction: Establishing a non-chew diet of liquid or pureed foods and controlling bruxism. This will rest the affected muscular/articular structure for a short time followed by a gradual return to normal diet.
Appliance Therapy: Night guards, splints, orthodontics or bruxism appliances can be effective in treatment of disc dysfunction most linked to disorders with muscle-related symptoms.
Physical Therapy: May help relieve pain and restore normal muscular function and range of motion of the TMJ. Usually used as an adjunct therapy, PT when combined with other treatments may help reduce inflammation so that repair to tissues may be accomplished.
Behavior Modification: Involves changing maladaptive habits which stress the TMJ. Certain habits (e.g. gum chewing, chewing ice and clenching) may cause biomechanical strain on masticatory structures.
Pharmacological Treatment: Controls pain and inflammation in chronic pain situations. Your physician may also choose to dispense antidepressant drugs to control nightime bruxism, which may aid in relieving TMJ disorder symptoms.
It is the group with permanent intracapsular mechanical abnormalities that presents the greatest variety of structural problems. As such, it is not possible to treat all patients with the same surgical technique: technique selection must fit the patient's problems. Indeed, there is room for arthroscopy, disk removal, and disk repair for the treatment of TMJ pathology. Thus far, no technique clearly stands out as superior to any other.
Microscopic disk preservation surgery is one approach that may be applied to disk displacement. When the complexity of structural deformation is clearly understood, it is apparent that disk preservation means entirely different things to different surgeons. However, with magnification of up to 10x from a surgical microscope and with improved illumination, the structures of the TMJ take on added complexity. With this improved visualization of the surgical pathology, one can gain a better appreciation of the endpoint for the surgical repair. That endpoint is the normally structured joint, and perhaps microscopic surgery, better than any other technique, allows for the re-creation of near-normal structural anatomy of the intra-articular and extra-articular structures of the TMJ.