Temporomandibular Joint Disorder
The temporomandibular joint (TMJ) is the joint which connects your lower jaw to your skull. TMJ disorders are a group of problems related to the joints themselves, the muscles that move the joint and the teeth. Symptoms of TMJ disorders may include:
- Popping or clicking of the joints
- Crunching noise in the joint
- Facial pain or frequent headaches
- Stiffness of the muscles around your jaw
- Locking of the jaw
- Limited opening of the mouth
- Clenching or grinding of your teeth
- Teeth occasionally meeting together differently
These symptoms generally surface when the joints and the muscles do not work in harmony, and are caused by a variety of problems (e.g., malocclusion, stress, trauma, etc.) Fortunately, we can offer treatment as a supplement to your current non-surgical care or for patients who have not seen improvement in their condition.
TMJ disorders are a very complex group of problems. No one treatment can resolve these disorders, and most commonly treatment requires time to be effective. Many times treatment is multi-disciplinary, in that it may require the involvement of multiple providers to give you the optimal results. It cannot be emphasized enough, treatment always works most effectively when you combine home care with professional care.
A variety of treatments are available for TMJ disorders. After an evaluation, a diagnosis will determine the most appropriate course. In most instances, the initial treatment goals are to relax the muscles and control the joint pain, commonly referred to conservative or non-surgical management. These include anti-inflammatory medications, steroids, or muscle relaxants. These medical treatments are always combined with some form of home care. Home care includes:
- Resting your jaw
- Eating a soft diet
- Applying warm and cold compresses
- Stretching your jaw
- Avoiding gum chewing or chewy foods
- Avoiding hard foods such as candy, nuts, and ice
As an additional form of treatment, physical therapy may be prescribed during the non-surgical phase of treatment. Moreover, your dentist may be asked to make a plastic appliance to be worn at night and/or during the day, sometimes called a splint or nightguard. Your dentist may also recommend an adjustment of your occlusion (bite) and even may recommend orthodontics.
The surgical phase of TMJ disorder treatment is only considered an option if: 1) the non-surgical phase has failed to provide relief; 2) if you continue to have difficulty opening your mouth; 3) if the joint is dislocated; or 4) if the joint has severe degeneration. Surgical options include:
- TMJ arthrocentesis
- TMJ arthroscopy
- Open TMJ arthroplasty
- Total joint replacement
Temporomandibular Joint Surgeries
The temporomandibular joint (TMJ) is the very complicated joint which connects the lower jaw to the skull. TMJ disorders are complex, and many different treatments exist. In general, most peoples “TMJ” problems lie outside of the joints (muscular, dental, etc.). In some circumstances, however, surgery may be necessary to address this problem. Surgery is only considered if the other contributing factors have been managed. The surgical options range from simple injections to total joint replacement.
The simplest and least invasive of these options is arthrocentesis. Arthrocentesis is performed in an office-based setting, typically under IV sedation. In essence, the affected joint is irrigated and manipulated. Medication or medications are then injected into the joint. The benefits of this procedure are an outpatient setting, very little downtime, and high success rate if a patient’s symptoms are isolated to the joint. The main downside is the unpredictability of how long relief will last, and the procedure may need to be repeated. The main upside though is that the procedure carries very little risk and is simple to perform.
The next surgical option is arthroscopy. Arthroscopy is similar to arthrocentesis in that the joint is irrigated and medications are injected. The differences are that it is performed in a hospital-based setting and a small camera is used to visualize the contents of the joint. By having visualization, it is possible for any scar tissue is be released and allow the joint to move more freely.
The next surgical option is arthroplasty. Arthroplasty is also a hospital-based procedure mostly performed on an outpatient basis. During this procedure, a small incision is made in front of the ear. The joint is then entered. The findings inside the joint will determine whether the existing cartilage is salvageable or needs to be removed.
Total Joint Replacement
The final surgical option is total joint replacement. Total joint replacement is reserved for joints that are beyond repair or have joint pathology (benign/malignant tumors). The prosthetic joints are typically made using a patient-specific process which requires a CT scan and planning. A laboratory will then design and fabricate the joint that is specific for that patient. The procedure is performed in a hospital setting and usually requires at least one night in the hospital.
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