Allan K Bernstein, DDS
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2034 E Southern Ave Suite H, Tempe, AZ 85282  l   Phone: 480-820-6800
Two convenient ways to contact us: Phone: 480-820-6800   l 
Temporomandibular Joint Disease Frequently Asked Questions
Welcome
Frequently Asked Questions about Temporomandibular Joint Disease

Click on a question to view the answer.
What causes TMD?
How do I know if I have TMD?
How is TMD treated?
What does the oral appliance/splint look like and how does it fit?
Do I eat with my splint?
I wear dentures; can I still wear an appliance/splint?
How long will I have to wear my appliance?
Will my insurance cover my appliance and follow-up visits?
Will I need to see any other health providers while I am wearing my splint?
What is BIOFEEDBACK and how can it help with my TMD?
When is physical therapy indicated and how does it help?
If I want or need to have orthodontic treatment, what do I do first, the orthodontic treatment, or the TMD treatment?
What can I expect at my initial examination and how long should I allow?
If I decide to proceed with TMD treatment with an oral appliance, what is the success rate?
I think I have TMD. What can I do until I can get in to see the doctor?
Will my problem get worse if I do not have treatment?

Welcome
WHAT CAUSES TMD?
Severe injury to the jaw or temporomandibular joint from a heavy blow or a whiplash-type accident (because of the close relationship of the cervical muscles to the base of the jaw) is an obvious cause. However, TMD also develops when there has been no obvious injury. Although experts have no specific answers as to why TMD develops in the absence of obvious injuries, they do agree on probable contributing factors such as clenching or grinding the teeth, stress (an aggravation), congenital factors, or arthritis. Despite experts´ lack of agreement on the exact causes, there is no disagreement that TMD is real and deserving of medical attention.
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Welcome
HOW DO I KNOW IF I HAVE TMD?
Any of the symptoms below might indicate you have TMD. For an accurate diagnosis, contact a dentist or doctor with expertise in the field of orofacial pain.
  • Pain in your jaw joint region with or without clicking or popping.
  • Limited movement or jaw locking.
  • Painful clicking, popping, or grating sounds in your jaw joint when opening or closing your mouth.
  • A change in the way you feel your upper and lower teeth fit together.
  • Frequent headaches, earaches (after ear infection has been ruled out).
  • Simple clicking in your jaw that occurs without pain is quite common and generally not a cause for concern.
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Welcome
HOW IS TMD TREATED?
There are a number of treatment options ranging from least to most invasive. The least invasive is a change to a softer diet, combined with use of non-steroidal medication which reduces the inflammation that commonly occurs with TMD. If this does not adequately relieve your discomfort, an oral appliance (oral orthotic or splint) is usually recommended. Splints allow the temporomandibular joint to heal by reducing the loading on the joint. Splints also help to relax the jaw musculature and protect the tooth surfaces from the impact of grinding. Oral appliances are conservative, reversible, and considered the standard of care before any irreversible or more invasive treatment is recommended. Surgery is an invasive procedure and considered only after all conservative efforts have been exhausted.
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Welcome
WHAT DOES THE ORAL APPLIANCE/SPLINT LOOK LIKE AND HOW DOES IT FIT?
The TMD appliance is made of clear acrylic and attaches to your teeth with four metal ball clasps. Most patients wear only an upper or lower appliance - not both. The appliance looks somewhat like an athletic mouth guard or orthodontic retainer but covers only the chewing edges of the teeth; consequently, it is barely visible to others. With a little practice, patients learn to speak normally while wearing the splint. You can remove and reinsert the splint/appliance by yourself.
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Welcome
DO I EAT WITH MY SPLINT?
Not generally. You can easily remove the splint to eat and re-insert it when you have finished your meal.
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Welcome
I WEAR DENTURES. CAN I STILL WEAR AN APPLIANCE/SPLINT?
Yes. With little exception, a splint can be made to fit over your upper or lower denture. An impression is made of your denture, and the splint is fabricated just the same as if the impression was made of your natural teeth.
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Welcome
HOW LONG WILL I HAVE TO WEAR MY APPLIANCE?
Although the length of treatment depends on each individual patient's progress, you can anticipate wearing your splint full time for approximately 2 to 4 months. After full time use, and depending on your individual problem, you may be instructed to reduce wearing your splint to sleeping hours only.
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Welcome
WILL MY INSURANCE COVER MY APPLIANCE AND FOLLOW-UP VISITS?
Most insurance companies now recognize TMD as an important medical problem, and consequently have made provisions for coverage. While different insurance companies have set different maximum limits for the coverage of TMD, some plans have no limits at all. Your best strategy for accurate information about what your plan will cover is to contact your carrier directly.

Since treatment for TMD is directed to the temporomandibular joint rather than to the teeth, TMD is usually considered a medical rather than a dental problem. Thus, first check with your medical insurance about TMD coverage. If that plan does not cover it, then check your dental plan. If, for example, you have Cigna, PacifiCare, Blue Cross of AZ, Humana, or Medicare (do not rule out any others), you may very well have benefits for a TMD splint. The best way to find out is to call your carrier.

If you are covered by an HMO, you may need a referral from your primary care physician before you can see a TMD provider. Again, the most efficient way to get accurate information about coverage options is to call your carrier and ask whether you are covered for TMD appliances and treatment.
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Welcome
WILL I NEED TO SEE ANY OTHER HEALTH PROVIDERS WHILE I AM WEARING MY SPLINT?
Possibly, and depending on your progress. The need for referrals is determined on an individual basis. Two treatment modalities commonly used concurrently with splint therapy are Biofeedback and Physical Therapy.
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Welcome
WHAT IS BIOFEEDBACK AND HOW CAN IT HELP WITH MY TMD?
Biofeedback is a treatment technique that uses signals from sensors attached to your body to teach you how to control various body states. For example, sensors placed on your neck can be wired to change the volume of an audible tone depending on the tension in your neck muscles. As you implement the relaxation techniques you learn from the biofeedback therapist, you can monitor the tension in your neck and fine-tune your ability to let go of tension by learning how to intentionally change the volume of the tone. After enough practice, you should be able to intentionally relax those muscles even without the biofeedback equipment to guide you.

The clenching and grinding that typically accompanies TMD is an acquired habit that may be stress-related, or secondary to sleep disorders or medications. Learning, via biofeedback, how to intentionally relax the muscles of the head and neck can be very helpful. As a result, biofeedback is often used concurrently with splint therapy.
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Welcome
WHEN IS PHYSICAL THERAPY INDICATED AND HOW DOES IT HELP?
Selected patients may be referred to a physical therapist for treatment to reduce musculoskeletal pain, particularly when symptoms involve the cervical and shoulder region. Often, if the neck and shoulders remain symptomatic, they may refer pain to the TMJ area and its associated structures. Physical therapy may be quite effective for TMD patients when used concurrently with splint therapy. Treatment modalities may include ultrasound to stimulate the circulatory system and decrease inflammation, hot or cold packs, electrical muscle stimulation, massage, and exercise (in the office as well as a home program.)
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Welcome
IF I WANT OR NEED TO HAVE ORTHODONTIC TREATMENT, WHAT DO I DO FIRST, THE ORTHODONTIC TREATMENT, OR THE TMD TREATMENT?
Treatment for TMD will most often be recommended before proceeding with orthodontic treatment. Your orthodontist will want to make sure your temporomandibular joints are stable before permanently moving your teeth.
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Welcome
WHAT CAN I EXPECT AT MY INITIAL EXAMINATION AND HOW LONG SHOULD I ALLOW?
As a rule, plan on being in the office for approximately 1 1/2 hours. Your paperwork may be sent to you before your visit to save time. The paperwork will have a series of questions to help the doctor in his or her assessment (e.g., symptoms, medications, medical history, prior treatment, etc.). The major part of your examination will involve measuring your jaw's range of motion, palpating the muscles of your facial and cervical regions for pain or tenderness, assessing your occlusion and the soft tissues of your mouth, reviewing radiographs taken in or out of the office, and checking for TMJ noises such as popping, clicking, or grating. If splint therapy is recommended, impressions will be made of your teeth and sent to the laboratory for fabrication of your appliance.
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Welcome
IF I DECIDE TO PROCEED WITH TMJ TREATMENT WITH AN ORAL APPLIANCE, WHAT IS THE SUCCESS RATE?
Studies have shown a variety of results. Generally, 80% of the patients treated conservatively obtain an 80% or greater improvement.
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Welcome
I THINK I HAVE TMD. WHAT CAN I DO UNTIL I CAN GET IN TO SEE THE DOCTOR?
Chewing may be painful so limit yourself to soft foods. Do not try to stretch your mouth open to take large bites (such as biting into an apple). Beyond that, avoid any activities that hurts.

Apply ice and or heat to the joint. Ice helps reduce swelling and heat helps the muscles to relax. Alternate 10 to 20 minutes applications of ice with applications of moist heat for the same length of time.

For the ice applications, you can wrap a towel around a bag of ice or bags of frozen corn or peas, as well as gel packs.

Use a towel dipped in warm water to apply heat. If you choose to warm the damp towel in the microwave, be very careful to ensure that it is not so hot that it irritates your skin. Use the over-the-counter pain medications you are accustomed to. Ibuprofen, for example, helps to reduce inflammation and pain. Check with your medical doctor if you have any questions about what you should or should not take to reduce your pain.
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Welcome
WILL MY PROBLEM GET WORSE IF I DO NOT HAVE TREATMENT?
The answer to this question is, "It could." The ultimate goal is to avoid a more debilitating osteoarthritic condition that causes permanent damage to the joint. For example, while simple popping or clicking usually does not warrant treatment, if the popping or clicking is accompanied by pain and decreased mobility, it may be risky to avoid treatment. The best course of action, when in doubt, is to seek the advice of an expert.
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