TMD treatment in Cologne – symptoms, diagnostics & splint

In Cologne, JUST KFO – Dr. Steinmaier & Kollegen (Hauptstraße 50, Köln) specializes in the treatment of TMD (temporomandibular disorder) and jaw joint pain. The team of specialists in orthodontics analyzes jaw joint and muscle complaints using digital functional and jaw joint measurement and fabricates individual occlusal splints in the practice’s own in-house master dental laboratory. Common reasons for consultation include jaw popping, jaw or facial pain, teeth grinding (bruxism), tension, and restricted mouth opening. The practice has published five peer-reviewed articles on the diagnosis and treatment of temporomandibular disorders — in the Journal of Aligner Orthodontics (2018, 2019) and in Informationen aus Orthodontie & Kieferorthopädie (2020); they are publicly accessible via ORCID 0000-0002-2054-8992 . You can book an initial consultation with functional analysis online.

TMD stands fortemporomandibular disorder(often called TMJ) – a dysfunction in the interaction between the temporomandibular joints, chewing muscles, and teeth. Typical signs include jaw pain, clicking or grinding in the joint, tension extending to the neck and temples, and teeth grinding; chewing, speaking, and mouth opening are frequently restricted. Possible causes include misaligned teeth, stress, muscle tension, or injuries. Treatment depends on the cause and may include physical therapy, relaxation exercises, pain management, and, if needed, an occlusal splint or orthodontic correction. Behind the umbrella term TMD are around 37 different clinical conditions from four groups – temporomandibular joint, chewing muscles, headache, and adjacent structures – and accordingly, what someone experiences and what helps in an individual case varies considerably.

The complaints are varied and differ from person to person. Common signs:

• Pain in the temporomandibular joints, the chewing muscles or the face
• Headaches or migraine
• Teeth grinding or clenching (bruxism)
• Limited jaw movement, for example when opening or closing
• Popping or grating in the temporomandibular joint
• Tension in the neck and shoulders
• Ear pain or tinnitus
• Dizziness
• Dental problems such as wear, loosening or sensitivity

If a TMD is suspected, an orthodontist who specializes in TMD can clarify the diagnosis. More than 80 percent of patients with a TMD report neck pain in addition to their jaw complaints – which is why we always look at the jaw, head and neck together.

For a first idea of whether your complaints fit a TMD, try our TMD self-test.

Treatment depends on the diagnosis and the complaints. Possible components:

• Orthodontics: where misaligned teeth are the cause, to correct the position of the teeth and jaws
• Exercises and physical therapy: relax the chewing muscles and improve mobility
• Pain management: medication temporarily eases pain and muscle tension
• Behavioral changes: reducing stress, adjusting diet or sleeping position
• Occlusal splint: reduces the pressure on the temporomandibular joints
• Surgery: only in rare cases, for example after severe injuries or with tumors

Which combination makes sense follows from the diagnosis – which at our practice includes a digital functional analysis.

We always start with reversible measures: Clinical guidelines recommend initially using reversible methods for TMD – temporomandibular disorder, often called TMJ – such as bite splints, occlusal splints, and accompanying physical therapy before invasive interventions. The bite splint is by far the most common treatment tool; we always combine it with counseling and self-exercises because studies show this approach performs better than the splint alone. In studies involving around 500 patients, physical therapy and bite splints achieved roughly equal results in pain relief. How well a splint works varies from case to case: In a systematic review of masticatory muscle pain, symptoms disappeared completely in 17 to 59 percent of those treated with a relaxation splint, while 13 to 26 percent experienced no improvement.21

When improvement occurs varies from case to case: some patients notice relief in the first few weeks with the splint, while for others it takes longer for the muscles and joint to adjust to the new position. If no improvement occurs, the splint is readjusted or the diagnosis is expanded.

A TMD usually cannot heal completely on its own – that requires professional diagnosis and treatment. However, you can alleviate the symptoms yourself: avoid overloading the jaw, reduce stress, practice relaxation exercises, maintain a healthy diet, and get sufficient sleep. Early evaluation helps identify the cause and tailor treatment accordingly. In cases of mild symptoms, the situation often improves through education and consistent self-exercises; if pain persists for longer than about six weeks, you should have the cause evaluated.

There is no fixed healing time – it depends on the cause, the severity and your individual symptoms. The goal is to reduce the symptoms and slow further progression. Often the symptoms improve after a few weeks to months; if the condition is chronic, it takes longer. Regular check-ups are important so that the treatment can be adjusted if needed. Splint therapy is usually planned for three to six months, and after about six weeks we review together whether the symptoms are moving in the right direction.

Yes, TMD can be painful. Pain in the jaw, head, face and ears is common – often stronger when chewing, during teeth grinding or when pressure is placed on the jaw. In addition, there is frequently muscle tension in the jaw and neck area, and sometimes tooth discomfort as well. If jaw, head or facial pain persists, you should have the cause examined – early treatment reduces pain and prevents further damage. Not every TMD hurts: jaw popping on its own, without pain and without any functional impairment, is considerably more common than the painful form, which affects about ten percent of adults in Germany.

TMD usually has several causes at once – physical and psychological ones together. Stress, anxiety or depressive strain can trigger or intensify it, because tension in the jaw and neck area overloads the chewing muscles. It is not, however, a purely psychological illness: misaligned teeth, trauma or other physical factors also play a role. Treatment that takes both sides into account therefore makes sense – supplemented, for example, by relaxation techniques, meditation, yoga or psychotherapy. TMD is not a purely psychological illness, but for many of those affected stress and tension are a contributing cause – which is why, before treatment, we also record how much the pain burdens you in everyday life, for instance on a scale from 0 to 10.

If left untreated, the symptoms can get worse over time. Pain in the jaw and head can become chronic and radiate into the neck, back and shoulders. Jaw mobility can deteriorate (problems with chewing, speaking and opening the mouth), and clenching and grinding can wear the teeth down more or loosen them. Ringing in the ears, sleep problems and psychological strain are also possible; where nighttime snoring or pauses in breathing occur as well, we additionally look at the mandibular advancement device for sleep apnea. Having the cause clarified in good time helps prevent long-term damage. Some symptoms improve without treatment as well – in follow-up studies, however, around a quarter of those affected were unchanged or still in need of treatment after two and a half years, which is why we do not simply wait and see but review the situation after about six weeks.

Where there is a medical need, statutory health insurance covers part of the cost of TMD treatment – for example physical therapy with a corresponding prescription. How much depends on the type and severity of the condition and on your plan; individual services such as the special functional analysis remain private. In our practice we work with a DMD bite splint based on a digital measurement of the temporomandibular joint – this is a private-pay service and costs approximately 1.500 to 3.000 Euro. Private health insurance has its own terms. Please clarify the scope with your insurer before treatment begins and, if necessary, obtain confirmation of coverage – only your health insurer can give binding information.

The cost depends on the type and severity of the condition, the treatment method and its duration. In our practice, conservative therapy is the main focus: its core element is the DMD bite splint based on a digital measurement of the temporomandibular joint – it costs approximately 1.500 to 3.000 Euro. Depending on the findings, functional diagnostics and accompanying physical therapy may be added. We set out the exact scope in advance in a transparent cost plan; regarding coverage, please check with your health insurance before treatment begins.

Any dentist is allowed to treat TMD. Specialists and orthodontists, however, have additional training and more experience in diagnosing and treating temporomandibular joint disorders – as well as suitable equipment such as magnetic field-based DMD measurement or cone-beam CT (DVT). If TMD is suspected, it therefore makes sense to consult an experienced orthodontist who examines the problem specifically and develops an individually tailored treatment. The German recommendations on TMD treatment are jointly supported by six professional societies – from functional diagnostics and orthodontics through to physical therapy -, and this very cooperation is what TMD treatment requires.

TMD is best diagnosed by an experienced orthodontist or TMD specialist. This includes a thorough examination of the temporomandibular joint (jaw joint), the chewing muscles and the teeth, supplemented by clinical function tests, imaging (e.g. cone-beam CT/DVT) and magnetic field-based DMD measurement of the jaw joint. Because the symptoms are complex and often hard to classify, this experience matters – it allows for an accurate diagnosis and an individually tailored treatment. The course is monitored regularly and adjusted if needed. The basis is a standardized clinical examination following internationally agreed criteria, which identifies the most common painful forms with over 85 percent accuracy; a mouth opening of less than 40 millimeters, for example, counts as restricted.

Some exercises can relax the chewing muscles and improve jaw mobility:

• Stretching: slowly open and close your mouth while gently pressing your hand against the lower jaw; or open your mouth and tilt your head back slightly.
• Loosening: let the lower jaw hang loose and move it slowly to the right/left and up/down.
• Tongue: press the tongue against the palate and slowly draw it back.
• Relaxation: yoga, progressive muscle relaxation or breathing exercises release tension.

Not every exercise is right for everyone – have their suitability checked in advance with your doctor or physical therapist. In studies, coordination exercises for lower jaw movement in particular have proven useful – usually at least three times a day over one to three months.

The exact causes have not been conclusively researched; usually several factors act together:

• Stress: increases muscle tension in the jaw area
• Misaligned teeth: a poor bite overloads the jaw
• Grinding/clenching: places lasting strain on the chewing muscles and the temporomandibular joint
• Injuries/trauma to the temporomandibular joint or the chewing muscles
• Arthritis and other inflammatory joint diseases

Because the causes differ from person to person, an accurate diagnosis is the basis of treatment. A temporomandibular disorder (TMD) almost never has a single cause: teeth grinding and clenching play a major role – depending on the measurement method, roughly one in four to five adults grinds their teeth at night -, and stress, sleep problems and, in individual cases, misaligned teeth such as a one-sided crossbite are added to this.

A simple night guard primarily protects the teeth from nighttime grinding.2 A therapeutic functional splint for TMD goes further: It is custom-made following a functional analysis, relieves the temporomandibular joints, relaxes the masticatory muscles, and guides the lower jaw into a favorable position. It addresses function, not just tooth protection – whether tooth and jaw position is actually the cause in an individual case is determined only through functional diagnostics.

Between the condyle and the articular fossa of the temporomandibular joint lies a small cartilaginous disc, the articular disc. In disc displacement, this disc has slipped out of its normal position, usually forward. Orthodontists distinguish two forms: In disc displacement with reduction , the disc springs back into place when the mouth opens – this is the typical clicking. In disc displacement without reduction , it remains in front of the condyle; the mouth can then often only be opened to a limited extent, sometimes with pain.

Diagnosis is made through examination of jaw movement and digital joint measurement, and in unclear cases through an MRI scan. Treatment depends on the findings and may include a splint, physical therapy, and targeted exercises. Clicking without pain and without restriction does not need to be treated in every case – but it should be evaluated if it occurs newly or changes. You can find suitable exercises in our article on jaw relaxation exercises.

Costen syndrome is an older term for symptoms originating from the temporomandibular joint and manifesting at the ear: ear pain, tinnitus, a feeling of pressure, or dizziness without any identifiable cause in the ear itself. ENT physician James B. Costen described this connection in 1934. Today, these symptoms are grouped under the term temporomandibular disorder (TMD); the name Costen syndrome still appears in older medical reports and referrals. Those who find no cause for ear symptoms at the ENT specialist are therefore often in the right place with an orthodontist.