Looking for information on treatment of jaw joint (TMJ) pain and dysfunction? Here’s everything you need to know about Temporo-Mandibular Joint treatment.
What and where are the TMJs?
The Temporo-Mandibular Joints (TMJs) attach the lower jaw (mandible) to the base of the skull. There are two joints (one on each side of the face) and they are located in front of the ears and ear canals. The TMJs are unique in that they are bimodal (allowing both hinge rotation and translation sliding) and also connected to each other via a single bone (the lower jaw). The TMJs are controlled by numerous facial muscles that help to control the movement of the lower jaw and guide the dental bite.
What Is A TMJ Disorder?
A TMJ disorder can produce either pain or reduced jaw movements or both. Facial pain maybe experienced in many different parts of the face (as dictated by muscle attachments to the lower jaw); is most commonly one sided (but can be both sides); is commonly associated with reduced movement of the lower jaw (mouth opening is affected).
Symptoms of TMJ disorder include consistent, intense pain when you move your jaw, painful chewing, stiffness and lack of mobility (reduced and / or painful mouth opening), clicking or locking of the TMJ, and inability to use your jaw’s full range of movement (especially when yawning or laughing).
What are the treatment options for TMJ disorders?
Most (95%) TMJ disorders will improve spontaneously with simple non-invasive therapies such as –
- Joint rest – reducing jaw movements to within the range of mouth opening that is comfortable.
- Soft diet – pureed or softened diet that doesn’t exacerbate the pain
- Simple analgesic (pain relief) medications – such as nurofen, brufen and paracetamol
- Heat or cold packs applied directly to the area of pain
- Review – simple (non-surgical) TMJ therapy will continue for 3-6 months before the patient will experience any improvement. At review, further modification to the therapy will be considered including the possible need for surgical intervention (in a very small number of patients).
Do I Need Jaw Surgery For TMJ?
Your Specialist in TMJ treatment is an Oral and Maxillofacial Surgeon, preferably with surgical experience and skills in TMJ surgery.
Dr Tite introduced TMJ surgery to the Gold Coast almost 20 years ago and remains the most experienced provider of TMJ procedures to date.
Surgical treatment may be recommended to correct your TMJ disorder if you experience:
- TMJ locking (inability to fully open or close the mouth)
- Continuous facial pain and or TMJ dysfunction (limited mouth opening), despite having trialled non-surgical therapies for at least 6 months.
- Intense pain that is unable to be eased using analgesic medications
- Inability or extreme difficulty eating or drinking because of jaw pain or immobility
- TMJ destruction via either trauma (facial injuries after car or motorbike accidents) or disease processes (Rheumatoid and osteoarthritis or tumours involving the TMJ).
- Facial deformities affecting the development of the TMJs (Hemi-facial microsomia, Goldenhar syndrome, TMJ ankylosis)
Your Specialist Oral and Maxillofacial Surgeon may advise against jaw surgery to fix TMJ if:
- Your TMJ symptoms respond to non-surgical therapies
- Your symptoms are inconsistent, with painful symptoms one day and no pain the next (this may be simply a case of fatigue in your TMJ)
- You have a full (unrestricted) range of mouth opening
- You aren’t medically fit enough to undergo general anaesthetic for the surgery.
In less severe cases, medication, physical therapy or lifestyle changes may help reduce TMJ symptoms.
Types of Jaw Surgery for TMJ
The most commonly performed procedures to treat TMJ disorders are:
- Arthroscopic jaw surgery
- Arthroplasty (Joint replacement surgery)
Arthroscopic Jaw Surgery for TMJ
Arthroscopy is the most common and least invasive jaw surgery for TMJ.
What does arthroscopic jaw surgery involve? Arthroscopy is a same-day surgical procedure performed under general anaesthesia.
During the surgery, the Specialist Surgeon will make two small incisions in the skin in front of the ear overlying the TMJ. A narrow port (called a cannula) is inserted through the skin and directed into the joint. The joint can then be directly inspected (via an arthroscope or small camera), manipulated and instilled with medications (pain relief and steroids).
This detailed examination helps the Surgeon understand the causes of TMJ pain and dysfunction, remove inflamed tissue, and encourage tissue healing (assisted with TMJ medication).
What is the recovery time for arthroscopic jaw surgery? Recovery time is fast. Generally, it takes several days for the pain and swelling to subside.
Arthroplasty (total TMJ replacement surgery) for TMJ
Arthroplasty, also known as total TMJ replacement surgery, is a moderately invasive surgery for TMJ. This procedure replaces both the ball (mandibular condyle head and cartilage disc) and socket (glenoid fossa) of the TMJ with a new custom made artificial TMJ constructed from titanium and high density plastic.
What does TMJ arthroplasty (TMJ replacement) surgery involve? Arthroplasty begins with an incision (above and below the ear) to expose and remove the defective TMJ; then subsequently insert the artificial TMJ. During the surgery, the surgeon may remove bony growths, excess tissue or some of the diseased bone. The TMJ replacement does not include any cartilage disc (in contradistinction to the native TMJ).
TMJ replacement allows the patient to regain comfortable functional movement (mouth opening) of the joint.
What is the recovery time for TMJ arthroplasty surgery? Recovery from arthroplasty for TMJ takes slightly longer than recovery for arthroscopic jaw surgery — typically about a week.
TMJ Joint Replacement Jaw Surgery
Total TMJ replacement is reserved for severe cases of TMJ disorder where:
- The joint or joint surfaces have degenerated from a traumatic injury or tumour involvement
- Severe osteoarthritis (age related joint dysfunction) or rheumatoid arthritis (auto-immune disease)
- Bone and tissue overgrowth that prevents the joint from moving (ankylosis – reduced mouth opening)
This is the most intensive surgery for TMJ, requiring a three-to-day stay in hospital.
How long will joint replacement jaw surgery take? TMJ replacement surgery usually takes 3-4 hours (asleep under general anaesthetic) to complete.
What is the recovery time for joint replacement jaw surgery? Initial jaw healing typically takes around six weeks after surgery, but complete healing can take up to 12 weeks. You will need to stay in hospital for three to five days, and it will take more than a month before you can resume normal activity. Plan for three to four weeks absence from work.
Stages of Jaw Surgery For TMJ
Stage 1 – Before Jaw Surgery For TMJ
Initial comprehensive surgical assessment by your Specialist Oral and Maxillofacial Surgeon will confirm whether isolated TMJ replacement surgery is indicated or whether other adjunctive procedures (such as facial reconstructive surgery) are to be combined with the TMJ procedure.
To plan for your TMJ surgery, X-rays, three-dimensional CT scans and 3-dimensional images of your teeth are required. To achieve the most optimal result, the Specialist surgeon will use computer based virtual surgical planning techniques to create both a customised surgical plan and guides. This process improves the accuracy of the replacement TMJ appliance and reduces both operative time and surgical complications.
Stage 2 – Jaw Surgery for TMJ
After accessing the TMJ, the surgeon removes the diseased TMJ (utilising the surgical guides made in Stage 1), reshapes the bone and then uses the next surgical guide to insert the TMJ replacement appliance. The new TMJ appliance is secured directly to the lower jaw with small titanium plates and screws.
Stage 3 – After Jaw Surgery for TMJ
Following your surgery, your Specialist Oral and Maxillofacial Surgeon will provide you with some guidelines to observe during recovery from surgery.
This will include:
What to eat after TMJ surgery: For the first few days, you’ll be restricted to soft, semi-fluid and liquid diet.
Oral hygiene guidelines: Oral hygiene is extremely important after TMJ surgery. Keeping your mouth and teeth clean will support faster healing and decrease the risk of infection. After each meal, snack and before bed, brush your teeth with a soft-bristled, child size toothbrush. Use a circular motion and angle the brush at 45 degrees toward the gum line. If brushing is impossible, wipe over your gums and tooth surfaces with a moistened cotton tip.
Exercise guidelines: Your Oral and Maxillofacial Surgeon may prescribe physical therapy and jaw exercises to help your jaw recover. Avoid strenuous activity.
Medication guidelines: Your surgeon will advise you on medications to control pain and reduce inflammation.
Do They Wire Your Jaw Shut After TMJ Surgery?
We’re often asked this question by prospective patients. Happily, wiring the jaws together is virtually never needed in contemporary practice. Occasionally, light elastic bands may be applied to your teeth to guide (not lock together) your jaws and dental bite.
TMJ disorders that require surgery are rare, most will respond to simple non-surgical therapies (that can be started via your General Dentist or Doctor).
Dr Tite will provide a surgical opinion for patients that have not improved after 6 months of non-surgical therapy.
Talk to the TMJ Specialists at Dental Implant & Specialist Centre to discuss surgical options for your TMJ by contacting them on (07) 5503 1744.