Functional

Arthrocentesis is most useful in flareups of joint arthritis. There are four common situations:

1. Acute closed lock – this happens when your disc (the thing that pops in the jaw) to get stuck, limiting your ability to open your mouth. Often times this gets better with rest, stretching but if after 2 weeks it has not improved, arthrocentesis is very helpful.
2. Inflammatory arthritis flareup – people with juvenile idiopathic, rheumatoid, or psoriatic arthritis can have flare ups that respond very well to arthrocentesis and steroid injection.
3. Chronic TMD flareups – A derangement of the disc can be a lifelong problem and like other joints, wear and tear arthritis (osteoarthritis) can develop.  To help prolong more invasive surgery and to treat persistent episodes of pain, arthrocentesis can help.  We use steroid, prf or hyalagan to inject these joints. 
4.  Chronic dislocation – Some people have repeated visits to the emergency room because their jaw gets stuck open. If this happens repeatedly, we offer two options – blood injections or eminectomy.  Blood injections are done after arthrocentesis and are the more minimally invasive option. 

It depends. The envelope of discrepancy is an idea put forth by clinicians to visualize how far teeth can move with braces, with braces and tads/headgear, or with braces and surgery.  

Alternatives discussed include extraction of teeth (camouflage orthodontics) or utilization of temporary anchorage devices.  When considering alternative treatments, the functions of the core issue should be considered.

There are multiple options that we offer:

1. Saline – rinsing the joint with sterile salt water allows the inflammation within the joint to be washed out. This allows for a reset of the joint contents and an improvement in pain symptoms. 
2. Steroid – Corticosteroids can reduce inflammation in the joint and help with pain. With inflammatory arthritis, steroids can be very helpful. They may even soften scar tissue within the joint to allow your joint to be more mobile. The down side is that they can change the bone in unfavorable ways with repeated injections. 
3. Platelet rich fibrin (PRF) – This is a portion of your own blood that has concentrated growth factors to help the joint repair.  Your blood is spun in a centrifuge to split up the components.  Platelet rich plasma (PRP) has been used in the past as it contains growth factors, fibrin glue and platelets. PRF has become more popular because it has less processing and easier to use. 
4. Blood – Injecting your blood into your jaw joint may sound crude but it is helpful for chronic dislocation of the TMJ.  The idea is to form some scar within the joint to limit mobility and often times two or three rounds of blood injections are needed to help with chronic dislocation. 
5.  Hyaluronic acid – HA is sometimes used to provide lubrication to the joint.  For some people, they want us to use this and we can help!

Risks with arthrocentesis are very low. The most common risk is that your joint symptoms are either no better or minimally better with the procedure. Many people experience temporary eye lid weakness from the local anesthesia given during surgery. This resolves in a few hours.  Long term facial weakness, facial numbness, change in the way the teeth fit (occlusion), infection, or bleeding are all very rare (<1%.)  

This procedure is done under IV sedation in the clinic. The surgery is relatively short with most people being here for 45-60 minutes (10-15 minutes for procedure).  We recommend a soft diet and immediate movement of the jaw.  Most people have weakness in their eyebrow after this surgery. This is from the numbing medication There is swelling in the area that gets better in 1-2 days.