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TMJ is the initialism for temporomandibular joint, which connects your lower jaw (the mandible) to your skull at the temporal bone. This joint controls many jaw functions, like chewing. If the chewing muscles or the joint itself are causing you pain you may have temporamandibular disorder, or TMD. TMD can be caused by stress, continual clenching of the jaw muscles, or teeth grinding.

At Pasadena Orofacial Pain Associates, Dr. Cebula provides the care of a board-certified orofacial pain specialist with two years of post-doctoral training at UCLA. As a patient in our practice, you will receive the highest quality non-surgical management of your TMJ Disorder delivered in as conservative manner as possible. Using the biopsychosocial method of pain management, Dr. Cebula will use both pharmocological and non-pharmocological modalites including behavior modification and physical therapy to provide the most effective care. This often means that TMJ surgery will not be necessary to manage your TMD.

Once a diagnosis of TMD has been made, Dr. Cebula will customize a personalized treatment plan to meet your needs. This most often will include self-directed physical therapy in combination with NSAID medications as well as instructions to promote healing of your jaw and avoidance of future injury. In cases where muscular pain is more severe and there is a limitation of mouth opening, a skeletal muscle relaxer may be prescribed to improve your pain and range of motion.

Occlusal appliances, also known as splints, can be useful treatment for patients suffering from TMD pain, limited mouth opening, or dislocation of the TMJ. A stabilization splint which covers all of the teeth in the upper or lower arch can be a very effective means of protecting your teeth and TMJ from clenching and grinding activity while sleeping. Daytime splint wear is almost never necessary, as most patients can be taught to relax the jaw naturally during the daytime hours. Jaw relaxation and keeping teeth apart during the day is the most effective and simple means of preventing excessive trauma to the teeth and TMJ and helping with pain relief.

Splint therapy may be ineffective for patients with undiagnosed sleep apnea and could potentially make the condition worse. Proper screening and referral to a sleep disorders specialist when appropriate, can help determine if a mandibular advancement device is a better alternative to splint therapy. Splint therapy can be effective for patients with sleep apnea when positive airway pressure such as CPAP or BiPAP are being used together with a splint.

Trigger point injection therapy involves insertion of a needle into painful muscular knots called taut bands. This is performed by the dry needling technique using a needle only, or the wet needling technique with an anesthetic such as lidocaine or an acetylcholine-blocker such as BOTOX. Trigger point injection therapy is indicated for painful trigger points that are unresponsive to anti-inflammatory medication and physical medicine modalities such as stretching, aerobic exercise, deep breathing, and use of moist heat and ice. They are also useful as a diagnostic aid for musculoskeletal pain.

When conservative therapy (such as physical therapy or NSAID medications) is unsuccessful in treating TMD, Botulinum Toxin A (BOTOX) can be an effective means of managing more advanced cases of TMD where masticatory muscles are overactive or muscular pain is severe. BOTOX is a natural protein that is produced by the bacteria Clostridium botulinum which is commercially purified and administered by injection. Injection of BOTOX into the muscles responsible for clenching and bruxing will cause relaxation of the muscles and reduction of pain. Like most medications, the effects of BOTOX eventually wear off and may need to be repeated every 10-12 weeks if symptoms persist.

Snoring is a vibration of soft tissues in the upper airway and is commonly a symptom of sleep apnea when a partial obstruction exists. Snoring can be effectively treated with an oral sleep appliance in the presence or absence of apnea.

Cessation of breathing during sleep may be caused by an airway obstruction, central nervous system disorder, or a combination of the two. Obstructive sleep apnea (OSA) is the most common type, and is usually caused by a anatomic collapse in the volume of the airway, typically due to the size and position of the tongue and soft palate. OSA may be managed with a positive pressure device such as a CPAP or BiPAP, an oral sleep appliance, or surgery.

An oral sleep appliance is made up of two splints which fit on the upper and lower teeth and reposition the lower jaw slightly to increase the volume of the airway. These devices are very effective for treating snoring and mild to moderate apnea. Even patients with severe apnea can receive some benefit from wearing an oral sleep appliance with or without CPAP/BiPAP.

For those who cannot tolerate CPAP/BiPAP wear and are unwilling or unable to undergo surgery to manage their apnea, an oral sleep appliance may be the best treatment option. Oral sleep appliances are the best non-surgical alternative to positive airway pressure devices and are an excellent adjunctive therapy for CPAP/BiPAP users to lower the opererating pressure of their device. Dr. Cebula has extensive experience with the fabrication, delivery, and follow-up with oral sleep appliances, and understands the importance of working closely with each patient and their referring doctor.

As a Board Certified Orofacial Pain specialist, Dr. Cebula screens every patient for signs and symptoms of sleep apnea. Patients are first evaluated by answering several questions pertaining to sleep apnea in their health history prior to their examination. During the patient exam the anatomy of the airway will be assessed as well as size and position of the tongue, palate, and jaws. If an overnight sleep study has not already been performed, further screening with a pulse-oximeter or home sleep test may be necessary prior to treatment.