The temporomandibular joint (TMJ) is the area where the jaw meets the skull. These joints are are some of the most used in the body. When they cause pain or limit function, they can severely impact a persons overall quality of life.
We are here to help.
The temporomandibular joint (TMJ) is where the jawbone (mandible) connects to the skull and is one of the most frequently used joints in the body. Just like other joints in your body, your jaw joint can have problems. Luckily most of the problems are temporary and very responsive to common sense solutions. For a sudden onset of discomfort or soreness in the jaw, conservative treatment such as jaw rest, anti inflammatory medications and stress reduction can make you feel better.
A TMJ disorder is anything that persistently interrupts the normal functioning of your jaw joints. Pain or dysfunction that is persistent through conservative treatments may warrant a further evaluation by a specialist. Common disorders are muscle hyperactivity/spasm/inflammation, tendonitis, a decoupling of the movement of your disc to your jaw and skull (internal derangement) or inflammation of the joint capsule.
Worrisome symptoms that may warrant a more urgent evaluation to a surgeon are face weakness, complete inability to open your mouth, weight loss (not explained by diet), or facial numbness.
Mild cases of TMJ disorder are treated with conservative measures such as jaw rest, massage, or over-the-counter pain medications. Symptoms can also be exacerbated by stress, so stress management is recommended to reduce the severity of TMJ symptoms.
If these measures do not improve the patient’s condition, further treatments may be necessary. These include physical therapy, dental guards/splints, acupuncture, massage, chiropractor care, botox, or prescription medications. Such treatments are usually provided by a physical therapist, primary care doctor, rheumatologist, ENT specialist, or a dentist. There are dentists that specialize in this through extensive training or through an oral medicine residency.
Surgery may be a consideration if certain problems exist or if nonsurgical care has not improved the situation.
Arthroscopy is a minimally invasive procedure where two small incisions are made at the joint. The first incision allows for a camera to be inserted. This allows the surgeon to visualize the joint structure and identify the issues. The second incision is to allow small surgical instruments to be used to clear scar tissue, release the capsule or inject medications. This is a very good option for joints with less arthritis present.
Arthrocentesis is a minimally invasive procedure where one or two needles are inserted into the joint and fluid is injected into the joint. This washes away inflammatory byproducts and lubricate the joint. We use saline, steroid, blood or PRF to inject into the space. This is a good option for inflammatory arthritis flare ups and acute closed lock.
Arthroplasty is an open-joint procedure where the joint is surgically altered or reshaped to repair its structural problems. The disc can be removed if it is broken and abdominal fat is inserted to cushion the joint. If the disc is not broken, it can be repositioned and secured with a joint anchor. This is a good option for more severe arthritis and for joint tumors.
Joint replacement is a procedure where the damaged joint is replaced by a prosthetic joint. This procedure is usually reserved for chronic and severe cases of TMJ arthritis. It is an excellent option for some congenital problems, fusion of the joint to the skull (ankylosis), replacing previously failed devices, and severe fractures. This is an excellent option in otherwise hopeless situations.
There are some disorders where surgery is recommended early in the treatment plan. Here are some situations where you should visit us first:
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Did you know that the majority of American adults over age 35 are missing, at least, one natural tooth? What’s more is that 1 in 4 seniors age 74 and older are missing all of their permanent teeth. Although dentures and bridges are a prosthetic option, they do not provide the same benefits available with dental implants. Implant dentistry prevents others from recognizing teeth as ‘false,’ and it also prevents the jawbone from disintegrating and any remaining natural teeth from shifting.
Dental implants are devices inserted into your jaw bones to provide structural support for artificial teeth like crowns or bridges. Implants can improve your ability to chew, your cosmetic appearance, and your jaw bone health.
You may be a candidate for dental implants if you are missing one or more teeth. You will need a complete surgical consultation with X-rays to determine whether you are in good health and have adequate bone structure to support dental implants. We will also ensure that you do not have any existing health conditions such as gum disease that could complicate the procedure. In some cases where the bone is not dense enough to support an implant, surgical bone grafting may make it possible to support one in the future.
If your oral surgeon determines that dental implants are right for you, expect the procedure to require multiple visits over the course of several months. The first treatment visit is the one when implants will be surgically placed within your jawbone. You’ll be sedated and under anesthesia during the process to ensure your comfort. Once the implants are in place, an impression will be taken and used to form crowns or dentures that will be secured to implant abutments above the gum line.
The implants will need to heal for a period of 6 to 9 months before you can have your final crowns or dentures placed. During this time, it is common to experience some swelling and soreness, as well as bleeding and minor bruising near the surgical site. Your oral surgeon will recommend eating only soft foods during the first several days following implant surgery. It is also important to follow all instructions for post-surgical care, including cleaning the surgical site and using any medications as prescribed. Be sure to contact your surgeon if you experience any fever or discomfort that worsens after a few days.
If you have broken any of your facial bones, call us to schedule a visit today. It can be confusing navigating the urgent care/ER/trauma system and delayed care can negatively influence your outcome. We can help get you back to your preinjured self.
At our office, we believe in treating the injury to restore both the function and form of your face. There are nonsurgical options for some minimal injuries. If surgery is needed, we will discuss the pros and cons of a closed approach versus an open approach. A closed approach frequently involves wiring of the teeth together. If an open approach is best, you will be able to open and close your mouth following the surgery. We take special care to protect the nerves, muscles, tendons and ligaments in the treatment area while utilizing methods that minimize scarring after recovery.
Cracked, broken and dislodged teeth are very common injuries among people of all ages. While we have extensive dental training and experience under our belt, seeing a general dentist is best for teeth injuries. Sometimes bone and teeth are lost and we play a role in your multidisciplinary team lead by your general dentist. Our role is to perform complex reconstruction through jaw surgery, bone grafting and dental implants. We want to get you back to you.
If you or someone you know has suffered a facial trauma after an accident, seek emergency attention right away. While in the emergency room, you may be seen by a resident or a staff consulting surgeon. As a private practice, we can see you in our facility during business hours when you are discharged. Please let us know if the ER took CT scans so that we can review them with you at your visit.
Facial trauma is complex and the initial (primary) repair may need a second (revision) surgery. The injury we see most commonly for revision surgery are fracture dislocations of the TMJ. If your teeth were wired/banded shut and now your jaw doesn’t quite work right, please call us today.
Anesthesia is a safe and predictable aspect of the surgery process. We offer in office IV sedation and general anesthesia. There are some general prerequisites and instructions that patients must follow prior to anesthesia to ensure the safety of the procedure. It is important that all patients undergoing anesthesia thoroughly read and understand the directions we provide prior to the procedure and contact our office with any questions or concerns.
Intravenous anesthesia sedation is a very safe and effective means of preventing pain and reducing patient anxiety. We use this during more minor surgical procedures such as hardware removal, TMJ arthrocentesis, dental implant placement, or tooth extraction. Most frequently, this is administered by Dr. Bobek during the procedure. This has a relatively quick recovery and a lower cost. Think wisdom teeth removal or colonoscopy and it is this kind of anesthesia.
General anesthesia requires respiratory support. This is the level of anesthesia offered by Anesthesiologists at our Office Based Surgery Center or at the Hospital. This level of anesthesia causes a bit of a sore throat and typically takes longer to recover from. This allows us to perform complex jaw reconstructions and is absolutely necessary for orthognathic or TMJ surgery.
In most cases, patients will not be allowed to eat or drink anything after midnight the night before the surgery. This is to be sure the stomach is empty. A rare complication with anesthesia is that you may accidentally breathe in your stomach contents (aspiration.) Surgery will be rescheduled if you have breakfast. The good news is that clear liquids such as water, clear juice, or black coffee are fine up to 2 hours prior to surgery. If you have a later surgery, you can wake up early to have a light breakfast of toast or cereal 6 hours prior to surgery.
No. We require that all patients undergoing anesthesia at our office arrive for their procedures with a responsible adult driver. It is not possible for you to safely drive after your procedure, nor should you drive a vehicle or operate heavy machinery for at least 24 hours after your procedure. It is normal to remain drowsy during this time as your body gradually eliminates the sedative agents used during the procedure. If you do not have a car then we still need you to bring a responsible adult to help get you home on a ride share or public transit.
We recommend wearing loose, comfortable clothing when you arrive at our office. Contacts, dentures, and detachable bridgework must be removed prior to surgery. Please also avoid wearing makeup, fingernail polish and jewelry the day of the procedure.
Ask our team about our anesthesia options and costs.