TMJ Disorders & TMJ Surgery

Temporomandibular joint (TMJ) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a "clicking" sound, you'll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for Temporomandibular Joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Chan can help you have a healthier and more comfortable jaw.

Trouble with Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.

Do You Have a TMJ Disorder?

• Are you aware of grinding or clenching your teeth?
• Do you wake up with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth?
• Does stress make your clenching and pain worse?
• Does your jaw click, pop, grate, catch, or lock when you open your mouth?
• Is it difficult or painful to open your mouth, eat or yawn?
• Have you ever injured your neck, head or jaws?
• Have you had problems (such as arthritis) with other joints?
• Do you have teeth that no longer touch when you bite?
• Do your teeth meet differently from time to time?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken or worn?

The more times you answered "yes," the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

“treatment always works best with a team approach of self-care joined with professional care.”

TMJ Treatment

There are various treatment options that Dr. Chan can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Chan will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.

The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

• Resting your jaw
• Keeping your teeth apart when you are not swallowing or eating
• Eating soft foods
• Applying ice and heat
• Exercising your jaw
• Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint or nightguard fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.

What about bite correction or TMJ surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed but are reserved for severe cases. Dr. Chan does not consider TMJ surgery unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.

The Different Types of TMJ Surgery

There are several types of TMJ (temporomandibular joint) surgery that may be recommended for patients with severe or persistent TMJ disorders. The type of surgery recommended will depend on the specific needs and condition of the patient. Below are the three main types of TMJ surgery.

Arthrocentesis

Arthrocentesis is a minimally invasive procedure that involves inserting small needles into the joint space to irrigate and flush out the joint. This procedure is typically performed under local anesthesia and can be done in an outpatient setting. Arthrocentesis is often recommended for patients with mild to moderate TMJ disorders who have not responded to other treatments.

Arthroscopy

Arthroscopy is a minimally invasive procedure that involves inserting a small camera and instruments into the joint space through small incisions. The camera allows the surgeon to visualize the joint and perform repairs or remove damaged tissue. Arthroscopy is typically performed under general anesthesia and can be done in an outpatient setting. Arthroscopy is often recommended for patients with moderate to severe TMJ disorders who have not responded to other treatments.

Open Joint Surgery

Open joint surgery is a more invasive procedure that involves making an incision in front of the ear to access the joint. This procedure allows the surgeon to fully visualize the joint and perform repairs or remove damaged tissue. Open joint surgery is typically performed under general anesthesia and may require a short hospital stay. Open joint surgery is often recommended for patients with severe TMJ disorders who have not responded to other treatments.

The type of surgery recommended will depend on the specific needs and condition of the patient. Patients should discuss the risks and benefits of each type of surgery with their oral surgeon to determine the best course of treatment.

Benefits of TMJ Surgery

TMJ (temporomandibular joint) surgery is a treatment option for patients with severe or persistent TMJ disorders that have not responded to other treatments. While surgery is not always necessary for TMJ disorders, it can provide significant benefits for some patients. Below are some of the benefits of TMJ surgery.

1. Reduced Pain. One of the most significant benefits of TMJ surgery is the reduction of pain associated with TMJ disorders. Surgery can address the underlying cause of the pain and provide long-term relief.
2. Improved Function. TMJ surgery can also improve the function of the jaw, allowing for proper alignment of the teeth and improved chewing and speech.
3. Improved Quality of Life. TMJ disorders can significantly impact a patient's quality of life, causing pain and discomfort that can interfere with daily activities. TMJ surgery can improve a patient's quality of life by reducing pain and improving function.
4. Reduced Need for Medications. Patients with TMJ disorders may require medications to manage their symptoms. TMJ surgery can reduce the need for medications, which can have side effects and be expensive over time.
5. Improved Oral Health. TMJ surgery can also improve oral health by correcting the alignment of the teeth and reducing the risk of dental problems such as tooth decay and gum disease.
6. Improved Sleep. In some cases, TMJ disorders can cause sleep disturbances and sleep apnea. TMJ surgery can improve breathing and reduce the risk of sleep apnea, leading to better sleep and improved overall health.
7. Long-Term Results. TMJ surgery provides long-term results that can last a lifetime with proper care and maintenance.

TMJ surgery can provide significant benefits for patients with severe or persistent TMJ disorders that have not responded to other treatments.Patients considering TMJ surgery should discuss their goals and expectations with their oral surgeon and carefully consider the potential risks and benefits of the procedure before deciding to undergo surgery.

Possible Risks and Complications of TMJ Surgery

TMJ (temporomandibular joint) surgery is a treatment option for patients with severe or persistent TMJ disorders that have not responded to other treatments. While TMJ surgery can provide significant benefits, it also carries certain risks and potential complications. Below are some of the most common risks and complications associated with TMJ surgery:

1. Infection. Like any surgical procedure, infection is a potential risk of TMJ surgery. While the risk of infection is relatively low, it can occur and can be prevented with proper surgical techniques and postoperative care.
2. Nerve Damage. TMJ surgery involves making incisions in the jawbone and repositioning the jaw, which can damage the nerves in the area. This can lead to numbness or tingling in the jaw, lower lip, or tongue. While these symptoms are usually temporary and resolve on their own within a few weeks or months, in rare cases, they can be permanent. More importantly, the facial nerve lies close to the TMJ and may be injured in the course of surgery resulting in weakness or paralysis of the muscles of facial expression. 
3. Implant Displacement. In some cases, TMJ surgery involves the use of implants to support the jawbone. While these implants are designed to stay in place, there is a risk of displacement, especially in the first few weeks after surgery. If the implant shifts or moves, it may need to be repositioned or removed, which can require additional surgery.
4. Scarring. TMJ surgery involves making incisions in the jawbone, which can result in visible scarring. While surgeons use techniques to minimize scarring, some scarring is unavoidable, and the extent of scarring can vary depending on the patient's skin type and healing ability.
5. Unsatisfactory Results. While TMJ surgery can provide significant improvements in the function of the jaw, there is always a risk that the patient may not be satisfied with the results. In some cases, additional surgery may be required to achieve the desired outcome.
6. Allergic Reaction. In rare cases, patients may have an allergic reaction to the implant material used in TMJ surgery. Patients should inform their oral surgeon of any allergies they have before the procedure.
7. Hematoma. Hematoma is a potential risk of any surgical procedure and involves the accumulation of blood under the skin. While the risk of hematoma is relatively low, it can occur and may require additional surgery to drain the blood.

Aftercare Tips for TMJ Surgery

After TMJ (temporomandibular joint) surgery, it is important to follow proper aftercare instructions to ensure proper healing and minimize the risk of complications. Below are some aftercare tips for TMJ surgery you should keep in mind:

1. Follow Your Surgeon's Instructions. Your oral surgeon will provide specific instructions for aftercare, including how to care for the incision site, medications to take, and when to return for follow-up appointments. It is important to follow these instructions carefully to ensure proper healing.
2. Rest and Limit Physical Activity. After the surgery, it is important to rest and limit physical activity for several days. Avoid strenuous activities, lifting heavy objects, and bending over.
3. Apply Ice Packs. Applying ice packs to the face can help reduce swelling and discomfort after the surgery. Use ice packs for 20 minutes at a time, several times a day.
4. Eat a Soft Diet. After the surgery, it is important to eat a soft diet for several weeks. Avoid hard, crunchy, or chewy foods that can put strain on the jaw. Stick to soft foods like soups, mashed potatoes, and scrambled eggs.
5. Practice Good Oral Hygiene. It is important to practice good oral hygiene after TMJ surgery. Brush your teeth gently and rinse your mouth with warm salt water several times a day to keep the incision site clean.
6. Take Pain Medication as Prescribed. Your oral surgeon may prescribe pain medication to manage any discomfort after the surgery. Take the medication as prescribed and do not exceed the recommended dosage.
7. Attend Follow-Up Appointments. It is important to attend all follow-up appointments with your oral surgeon to monitor your progress and ensure proper healing.
8. Avoid Smoking. Smoking can delay healing and increase the risk of complications after TMJ surgery. Avoid smoking for several weeks before and after the surgery.
9. Be Patient. It can take several weeks or months for the full results of TMJ surgery to be visible. Be patient and follow your surgeon's instructions for aftercare to ensure the best possible outcome.