TMJ Treatment
Jaw Pain Relief That Works

TMJ treatment begins with a detailed clinical examination. We palpate the masseter, temporalis, and pterygoid muscles bilaterally for tenderness — noting the location, severity, and character of any pain. We assess the temporomandibular joints themselves for clicking, crepitus, or deviation on opening. Range of motion is measured: maximum mouth opening (normal is >40mm), lateral excursions, and protrusive movement. Cervical spine and facial muscle tension are also noted, as TMD commonly involves muscle groups beyond the jaw itself. This examination produces a clinical picture that guides every subsequent decision.

The relationship between bite mechanics and TMJ stress is central to our treatment approach. We use T-Scan digital bite analysis or detailed articulating paper assessment to identify premature contacts, heavy occlusal loading on specific teeth, and lateral excursive interferences that force the jaw into abnormal positions. Casts mounted on an articulator allow us to examine bite relationships in three dimensions. We review X-rays for signs of occlusal wear, and the clinical tooth wear pattern is documented as an objective indicator of bruxism intensity and direction.

A custom hard acrylic occlusal splint (night guard) is the cornerstone of TMJ treatment at PAAD. Unlike over-the-counter guards — which are poorly fitted, provide uneven bite contacts, and can sometimes worsen symptoms — our custom splints are laboratory-fabricated from precise impressions of your teeth and adjusted to achieve even bilateral contact and correct condylar seating. The splint protects tooth surfaces from bruxism damage, reduces muscle load by eliminating occlusal interferences, and allows the condyle-disc complex to decompress in a therapeutic position during sleep.

For patients with severe bruxism, masseter hypertrophy, or chronic jaw pain that has not fully resolved with splint therapy, masseter Botox injections offer significant additional relief. A small amount of botulinum toxin is injected into the masseter muscles bilaterally — reducing their maximum contractile force by 30-50% over the following weeks without affecting normal chewing function. The effect lasts 3-6 months and is renewable. Patients often report the best relief they have experienced in years — including reduction in morning jaw soreness, headaches, and facial pain. We use Botox as a therapeutic tool, not cosmetically.

In some cases, specific occlusal contacts that trigger muscle splinting or abnormal jaw positioning can be addressed by carefully reshaping tooth surfaces — a procedure called occlusal equilibration. This is a conservative, targeted procedure performed after splint therapy has demonstrated where the ideal jaw position lies. It is not appropriate for every TMD patient and is only recommended when the bite cannot be corrected by splint therapy alone. We monitor all TMD patients at regular intervals, tracking symptoms, splint wear, and any changes in tooth wear patterns.