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TMJ (temporomandibular joint) 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. Matouk or Dr. Sperling 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

There are various treatment options that Dr. Matouk and Dr. Sperling can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Matouk and Dr. Sperling 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.

Medical Treatment

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 (arthrocentesis) 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 nightgaurd 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 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. Matouk and Dr. Sperling do not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.

Although the term surgery is frightening to us all, it is sometimes the most efficient and effective treatment modality. Surgery, however, should not ever be taken lightly and should not be considered a panacea. As you have learned from our discussion above, there are certain forms of TMD, specifically MPD, that should never be treated with surgery. On the other hand, surgery can mean tremendous relief in the patient suffering from intractable anatomical disease or internal derangement (when the discs of our joints are functioning improperly).

Surgery can take many forms including:

Arthroscopic Surgery - A procedure performed through a small instrument with a tiny camera attached. The operator may merely loosen some stickiness in the joint or in some cases reposition a displaced disc with the assistance of a laser and operative or surgical arthroscopic techniques.

Open Arthroplasty - A procedure performed by making an incision most often in a skin crease in front of the ear. This procedure is normally aimed at repairing or repositioning a displaced disc but sometimes can result in disc removal (menisectomy). If a disc is removed there are many techniques used today to attempt replacement.

Total Joint Replacement - A procedure performed by sometimes making two incisions, one in front of the ear as in open arthroplasty and one just under the angle of the jaw. This procedure is reserved for more severe and chronic conditions that will not respond to other surgical treatment modalities.

The decision as to which of the above procedures the patient requires, is a decision made by the oral and maxillofacial surgeon. Additionally, some of these decisions cannot be concluded until the surgeon has observed the existing joint pathology in the operating room.

Surgery of the TMJ is almost always performed in a formal operating room as an ambulatory procedure. It is rare, today, that patients require an overnight admission unless a more complicated procedure was indicated or medical evaluation dictates that staying overnight is a prudent thing to do. Most patients will easily return to work in three to five days and suffer only moderate discomfort in the early post-operative period. All are generally restricted to a soft diet for six to eight weeks.

Surgical Outcome

The results from well performed temporomandibular joint surgery have been statistically proven to yield a significant restoration of joint function as well as an increase in overall patient comfort. As with all medical treatments, however, the outcome of surgery is dependent upon proper patient selection, proper surgical technique, and appropriate post-surgical follow-up. It is important to emphasize that surgery alone is not a cure for this form of TMD and that physical therapy and close monitoring of the dental occlusion (bite) are imperative in all cases. A team approach is universally necessary.

If you have further questions regarding this condition, wish to consult further with us or are in need of a second opinion, please do not hesitate to visit our consultation services section at the Center for Reconstructive Jaw Surgery.