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Scientific News: Sleep and TMD

Dr. Anne Sanders was kind enough to write the following synopsis of a recent study on sleep and TMD.     A recent study of the OPPERA group reported in The Journal of Pain, sheds new light on the understanding of poor sleep in relation

TMJA Office Update - Spring 2016

After President Obama submits his budget to Congress, the work of Representatives and Senators begins. It is at this time that we tell our elected officials what YOU, TMJ patients, need to have addressed. The past two months have been busy ones outsid

National Pain Study Released

The Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services recently released the National Pain Strategy, outlining the federal government's first coordinated plan for reducing the burden of chronic pain that affects millions of Americans. Developed by a diverse team of experts from around the nation, the National Pain Strategy is a road map toward achieving a system of care in which all people receive appropriate, high quality and evidence-based care for pain.

New Safety Warnings Added to Prescription Opioid Drugs

The U.S. Food and Drug Administration (FDA) has issued a consumer warning regarding several safety issues with the entire class of opioid pain medicines. The new safety risks include potentially harmful interactions with numerous other medications, problems with the adrenal glands, and decreased sex hormone levels. The FDA is requiring companies to make changes to the opioid medication labels warning consumers of these risks as described below.

Unclear Results of Botulinum Toxin Therapy for TMD Pain

Increasingly, clinicians, research scientists like myself, and advocates at The TMJ Association are asked, "What about Botox® therapy for treatment of my painful muscles? Does it help?"

ARTHROCENTESIS

  • Jun 18, 2014

Arthrocentesis is often the first surgical procedure that will be done for a patient who has a displaced disc. It can be done as an in-office procedure, when it involves merely the placement of two hyperdermic needles into the joint, or as an outpatient procedure in the hospital if it is done arthroscopically. In the office, it can be done either under local anesthesia and IV sedation or general anesthesia. In the hospital, it is generally done under general anesthesia as an outpatient. When done with hyperdermic needles, the surgeon cannot visualize the joint. However, the literature shows that the results are similar to those obtained when the procedure is done arthroscopically.

Once the joint is numbed or you are put to sleep, the needles or the arthroscope are placed into the joint, and it is flushed with a sterile saline solution or a lactated Ringers solution. The purpose of this procedure is to remove tissue breakdown products and reduce inflammation. The surgeon will generally also manipulate the jaw to remove scar tissue adhesions that may have formed. Removal of adhesions is also done arthroscopically. At the end of the procedure, some surgeons inject a steroid into the joint.

Some surgeons claim that the disc can be repositioned arthroscopically. However, this is generally not possible. As long as there is good jaw mobility, most patients can function without the disc in normal position because the retrodiscal tissue adapts and acts as a pseudodisc.

When you get home (a few hours after the procedure), your joint and the surrounding area will be numb. If your doctor has given you a prescription for pain medication, this would be the best time to take it, as the pain will begin when the numbing medication wears off. You might have some swelling for a few days; however, most people are back at work after two to three days. There are generally no limits on physical activity or use of the jaw; usually the surgeon will recommend a jaw exercise program. You may be told to maintain a soft diet for a little while, but chances are you are already on one.

Latest Scientific Research for Arthrocentisis:

  • Arthrocentesis and Lavage for Treating Temporomandibular Joint Disorders
    "When the joint between the lower jaw and the base of the skull is not working well, the signs and symptoms such as movement problems, noises (clicking or grating), muscle spasms or pain could take place. It is so-called temporomandibular joint disorders. A range of treatment options for treating temporomandibular joint disorders are available such as arthrocentesis and arthroscopy. The review found that there is no enough evidence to judge whether arthrocentesis is more helpful for people with temporomandibular joint disorders than arthroscopy. Reported side effects were mild and transient."
  • Arthrocentesis With or Without Additional Drugs in Temporomandibular Joint Inflammatory-Degenerative Disease: Comparison of Six Treatment Protocols  Although the washing out of the temporomandibular joint (TMJ) associated with arthrocentesis has been shown to be helpful in the management of inflammatory and degenerative conditions, there is a question of whether the additional use of a corticosteroid or hyaluronic acid (HA) improves the results.
     
    In this randomized blinded study, 72 patients with osteoarthritis of the TMJ were randomly assigned to treatment by a single arthrocentesis, a single arthrocentesis followed by injection of either a steroid or high or low molecular weight hyaluronic acid, or by five weekly arthrocenteses followed by injection of a steroid or one of the two forms of HA. When the patients were evaluated for the presence of pain at rest, pain on chewing and chewing efficiency after three months, the results showed no difference among any of the groups. This would indicate that arthrocentesis was the effective modality and that the adjunctive steroid and HA were of no clinical value.

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