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.
- Pain around the jaw joints, jaw muscles, temples, ears, neck, or teeth
- Clenching or grinding
- Limited jaw opening
- Jaw locking
- Chronic jaw dislocation
- Headaches
- Ear pain, swelling, or ringing
- Change in the way the teeth fit
Nonsurgical
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.
Surgical
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:
- Ankylosis – fusion of your jaw to your skull
- Tumors – such as osteochondromas, synovial chondromatosis, pigmented villonodular synovitis, or benign jaw cysts that include the condyle
- Fracture – this is particularly true in fracture dislocations
- Development abnormality – things such as Hemifacial Microsomia, Condylar Hyperplasia or a patent foramen of Huschke
- Acute closed lock – this is a jaw joint that locks closed suddenly. Arthrocentesis is a minimally invasive solution to this and can be done in an office setting with relatively little risk.
- Failed TMJ replacement device
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