Temporomandibular Disorders, Dental Care and You

The daily routine of brushing and flossing your teeth can be difficult when you suffer from Temporomandibular Disorders (TMD). A study published in the Journal of Orofacial Pain states that patients felt their TMD symptoms made it difficult for daily routine mouth care at home. Also, the study found 63% of patients reported a change in seeking routine professional dental care due to their TMD.  Since oral hygiene can become compromised due to limited range of motion and/or pain, regular dental visits become even more important in maintaining your oral health.

The TMJ Association developed this guide to provide you with oral hygiene self-care tips you can do at home as well as suggestions for future dental appointments. Maintaining your teeth and gums on a routine basis should reduce the risk of dental disease and the need for invasive dental treatments

In order to maintain healthy teeth and gums, daily self-care is essential. If you are not removing plaque on a daily basis, a professional cleaning will only be temporarily effective.  By keeping your teeth and gums in good condition and following proper hygiene instruction, future dental visits will be more comfortable, and dental disease will be prevented. The following are suggested daily self-care methods that may work for you.

  • Use of a soft toothbrush. These range from adult to children’s sizes to small one-ended brushes, and those with greater flexibility. It is recommended that you replace your toothbrush every 3 to 4 months. A worn toothbrush may not clean effectively and may harm your gums.
  • Power-assisted and sonic toothbrushes offer a means to maintain hygiene if a regular toothbrush is difficult to use and if the electric motion of the brush does not cause discomfort to your jaw.
  • Toothpaste designed to reduce sensitivity, such as Sensodyne®, may reduce discomfort.
  • Flossing is the preferred method for cleaning between the teeth.  If you cannot open your mouth wide enough to floss your teeth, alternatives include rubber tip stimulators, interdental brushes, or floss holders. Your dentist or hygienist should guide you in selecting an instrument that is right for you and provide proper instruction on how to use it.      
  • Ask your dental provider if a commercial oral irrigator may be useful for your oral hygiene.   
  • In addition to brushing and flossing, an antiseptic mouth rinse may be recommended to kill bacteria that can cause decay and gum disease.
  • Fluoride rinses after each meal and prior to bed may be recommended if cavaties are an ongoing concern. Your dentist may recommend using a prescription high-fluoride toothpaste.
  • Salt or baking soda and water solutions can be used as a rinse at home following dental and dental hygiene procedures.  It is easily prepared, inexpensive, and may be effective in reducing gingival swelling. If you are on a low-salt or sodium-free diet you should not use a salt water rinse.
  • If you are experiencing dry mouth, your dental team can help. Saliva plays a very important protection role in the body. It not only keeps your mouth moist, it also helps to protect your teeth from decay, helps prevents infections, and heal mouth sores.
  • If your mouth opening is very limited, foam instruments called “toothettes,” or moist cotton gauze squares, can be rubbed along the teeth and gums to achieve some plaque removal, the effect on dental or gum disease is limited, but if dipped in an antiseptic mouth rinse the oral bacteria may be affected and dental disease risk decreased. This may be prescribed by your dentist. 
  • Appliances such as splints and partials should be brushed daily with a soft brush and mild dish soap or should be cleaned with a product such as Polident® or Efferdent®.
  • If you have arch bars/wires or other appliances, it is very important to clean the area between the appliance and your gums. Your dental providers may recommend a soft brush or a bi-level brush with a middle row that is shorter and can be applied directly over the fixed appliance. Power-assisted brushes with soft bristles, a light stroke, and at low speeds can be very effective for cleaning around appliances and keeping your gums healthy.  Other aids to clean between your teeth include floss threaders and interdental brushes.  

A dental procedure may trigger or increase your TMD symptoms. So it is imperative that the dental professional understand your oral disability, is willing to work with you, and will listen to your concerns. Regular dental cleanings may prevent infrequent, long, or difficult treatment sessions. Keep in mind that each individual is unique and what works for one person may not work for another. Together you, your dental team can determine what is best for you. The following suggestions may help improve your next dental visit.

  • If this is your first visit with this dental office review the office website, speak with the receptionist, and consider interviewing the dentist or dental hygienist before you schedule an appointment. The interview will serve many purposes including developing rapport and open communication with the dentist and dental hygienist about your oral disability.  It is also an opportunity for the dentist and hygienist to discuss their treatment plan with you and the types of procedures you can expect during your future visits. By knowing what is expected, you will feel better prepared and relaxed during your appointments. This can be discussed as part of the initial visit when oral health is assessed and a dental treatment plan is developed. Check with the office to see if there will be an additional charge for this visit.    
  • Discuss the appointment length with the office. Depending on preference, appointments may be long or short. Some patients prefer longer appointments to get everything done during one appointment; others prefer shorter and multiple appointments which may be important for people with TMD.
  • Contact your insurance company to determine coverage for dental services.
  • Consider scheduling your visit at the end of the day to allow rest after the appointment.
  • Use heat and/or ice before your dental treatment to help reduce any pain or swelling. The dentist may prescribe medications to use prior to or following the dental visit.
  • Medications to relieve inflammation, muscle spasm and pain can be taken before your dental appointment. These can range from over-the-counter analgesics to prescription pain medications or muscle relaxants. Caution: If you do use medication, consider having someone drive you to the appointment. Also discuss any medications you take with your primary care physician to be certain they don’t interact with any other medication you may be taking for your dental visit. Finally, these medications may block the pain thus decreasing your ability to protect your TM joint during the dental visit.
  • If you are usually anxious before your dental appointments, talk with your primary care doctor about this. He or she may recommend relaxation medication, self-hypnosis, biofeedback, or other techniques to reduce anxiety.
  • If you have a heart condition or a prosthetic joint (including TMJ implants), it’s best to consult with your physician and dentist to determine if antibiotic premedication is necessary for you. For some conditions, medication taken prior to dental treatment may reduce the risk of infection and serious complications.
  • Inform your dental team if you are anticipating surgery for a joint replacement. All needed dental work such as extractions or periodontal treatment should be completed in advance of your surgery.
  • Inform your dental team of any changes in your medical or dental history as well as current medications, including over-the-counter drugs.
  • Determine if you are at increased risk for tooth decay by discussing this with the dental team. Sealants and fluoride treatments and other interventions may be options in reducing certain types of cavities.
  • Use caution when opening your mouth to avoid overextension and possible hypermobility. Hypermobility means your joints are loose and move a lot, and can lock if the mouth is open too wide. Utilization of a mouth prop or device, such as the Restful Jaw®, will help protect the jaw during a dental visit.
  • Communicate with the dental provider that you will give a signal (such as holding your hand up) when you need to rest your jaw.  
  • Ask for rolled-up towels or pillows to place behind your neck or back to avoid discomfort.
  • If your teeth are sensitive, let your dental provider know.  It may be possible to use a desensitizing agent and make adaptations to water temperature or application of air. 
  • Request applications of topical anesthetics and, if needed, local anesthesia to lessen the pain.
  • If you have breathing or swallowing difficulties, you may be more comfortable with the chair in a semi-upright position. 
  • If your eyes are especially sensitive to the dental light, consider bringing sunglasses to wear during treatment.  The use of glasses will also protect your eyes from any debris or particles produced during a dental procedure.
  • Ice or heat applications to the jaw.
  • Continue using medications to relieve inflammation, muscle spasms and pain.
  • Schedule your next cleaning appointment to help maintain your oral health. Research has shown a link between oral health and overall health and its relationship to systemic diseases.

American Dental Association. Antibiotic Prophylaxis. Retrieved June 23, 2015 from http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis.

DePalma, A.  TMD Challenges.  Contemporary Oral Hygiene, Vol. 3, No. 3, March 2003.  

DePalma, A. Temporomandibular Disorders. Access, Vol. 7, No. 7, August 1993.

Fernandes, P, Velly AM, Anderson GC. A randomized controlled clinical trial evaluating the effectiveness of an external mandibular support device during dental care for patients with temporomandibular disorders. Gen Dent. 2013 Sep-Oct;61(6):26-31.

Humphrey SP, Lindroth JE, Carlson CR. Routine dental care in patients with temporomandibular disorders. Journal of Orofacial Pain. [2002, 16(2):129-134].

Klasser, GD., Gremillion, HA., Epstein, JB. Dental treatment for patients with neuropathic orofacial pain. JADA. 144(9):1006-1008 2013.

National Institutes of Health.  TMD Disorders. [Brochure]. Bethesda, MD, March 2010.

Wilkins, E. Clinical Practice of the Dental Hygienist 8th ed., Philadelphia: Lippincott Williams & Wilkins, 1999.

Warren, P. A Practice-based study of a power toothbrush: Assessment of effectiveness and acceptance. JADA.  131, March 2000.


One thought on “Temporomandibular Disorders, Dental Care and You”

  1. I just got diagnosed with TMJ today. Does my SLE and Fibromyalgia have anything to do with this? Since 2015 I had 8 months in hospital and 5 major abdominal repairs due to Lupus. I had a lot of Anastesia and pain medication. I almost died due to bleeding out but they held me down on surgical table for 8 hours and stopped the bleeding. Since these surgeries my teeth are rotting, breaking off, hurting, I have muscle facial spasms and pain in my face I can barely brush my teeth. Please can you help me to understand how I can control this for me?! Thank you

Leave a Reply

Your email address will not be published. Required fields are marked *