In the world of TMD (temporomandibular disorder), there are many ways to treat the problem, but it must always begin with a good diagnosis. First and foremost are an MRI and CBCT X-ray of the joints and surrounding areas. The MRI is a magnetic imaging device that looks directly at the discs in the jaw joints. This high-tech machine looks inside the joints and produces soft tissue images to help with your diagnosis. The CBCT is the X-ray machine that uses low-dose radiation to look at the bones inside the skull, the cervical spine, the teeth and the condyles. These tools are what we use to come up with a diagnosis and then a plan to help you get better.
In many cases, the ALF wire is a really great device to help in so many ways. It will help position the tongue to the roof of the mouth, which helps with better nasal breathing. It also promotes better swallowing. With good tongue positioning and better swallowing, you will breathe better as time goes by. This is one reason the ALF is very helpful.
Another appliance called the Gelb is an orthotic device that makes sure the condyle (hard bone) does not bang into the soft tissue disc. This appliance is helpful for so many people, as it helps avoid the need for TMJ surgery in many cases. The idea is that you wear the Gelb for a year, maybe more, to give the discs a chance to get back into the proper position. In almost all cases, pain is reduced, and the person also sleeps better.
One of the most interesting bits of technology we have is the Fotona laser. This is a nonsurgical laser that penetrates deep into the tissue to reduce pain and inflammation. It stimulates the regeneration of damaged tissue. This device has been amazingly successful with our patients who need some degree of relief right away. In addition, the laser has a specific protocol that helps to reduce fat in the tongue, along with lifting the palate area to improve symptoms from sleep apnea. This, too, is a nonsurgical procedure and fairly easy to do in almost all cases.
Of course, it should always be mentioned that you can use things like BOTOX® and other injectables to mitigate pain, however, our office prefers to fix the actual problem, not just mask it over. Other techniques, like arthrocentesis, are available. This involves flushing the joints to remove toxins. It does not fix anything, but it likely buys a little more time for those who are not ready to treat the problems.
Technology has greatly improved over the past decades. There are more and more modalities of treatment offered. The ALF and Gelb are the time-honored, traditional approaches. This appliance therapy has been around since before the ’70s. The fix takes time to implement, whereas the injectables are a quick source of pain relief. Ultimately, the patient will decide the technology for their health!