Temporomandibular joint and muscle disorders, commonly called TMJ disorders, are a group of conditions that cause pain and dysfunction in the jaw joint and in the muscles that control jaw movement. There are several treatment options available, depending on the cause and severity of ffeefqqthe disorder. We look at the symptoms, causes, and what’s involved in corrective jaw surgery or TMJ surgery, if required.
What 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), located in front of the ears and ear canals.
The TMJs are unique in that they are “bimodal,” which means they allow both hinge rotation and translation sliding. They are also via a single bone—the lower jaw. The TMJs are controlled by numerous facial muscles that help control lower jaw movement, and guide the dental bite.
What is a TMJ disorder?
A TMJ disorder can produce pain, as well as reduce the movement of your jaw (limited mouth opening). Individuals may experience pain in different parts of the face, including in the jaw joints themselves, and in the muscles that control jaw movement (temples of the skull / ears / upper neck region / cheek bones). Pain is also most commonly one-sided (although it can be on both sides of the face). It is typically associated with reduced movement of the lower jaw and affects the ability of a patient to open their mouth (hence causing problems with eating and speech).
Symptoms of TMJ disorder include:
- Persistent pain around the ears that is made worse with jaw movement
- Difficulty chewing a normal consistency diet
- Jaw stiffness with lack of mobility (reduced and/or painful mouth opening)
- Clicking or locking (open or closed) of the jaw
- The inability to completely use the jaw’s full range of movement, especially when yawning or laughing
What causes TMJ disorders?
The exact cause of a person’s TMJ disorder is often difficult to determine. Some people who have jaw pain also tend to clench, grind or gnash their teeth — a condition known as bruxism. Bruxism may not be evident (subconscious clenching of your teeth during sleep) or you may be aware (conscious bruxism) that you grind or clench your teeth during the day. Mild bruxism may not require treatment, however, if severe enough, it may lead to headaches, damaged teeth, and jaw disorders.
The temporomandibular joint combines a hinge action with sliding motions. The joint surfaces are covered with cartilage and separated by a small shock-absorbing cartilage disc, which normally keeps the movement smooth. Sometimes the cartilage disc moves out of position and leads to TMJ dysfunction.
TMJ disorders can also be due to:
- Either damage to or displacement of the disc
- Connective tissue disorders that affect the temporomandibular joint
- The joint’s cartilage lining being damaged by arthritis, including osteoarthritis, rheumatoid arthritis or inflammatory arthritis
- The joint being damaged by injury such as a blow or other impact
- Malformation of the TMJ anatomy from birth (Genetic predisposition)
What are the treatment options for TMJ disorders?
In 95% of cases, the pain and discomfort associated with TMJ disorders is temporary and can be relieved with self-managed care or non-surgical treatments. These include medication, physical therapy, or lifestyle changes.
Surgery is typically a last resort after other measures have failed, although some people with TMJ disorders may benefit from surgical treatments. Non-invasive therapies include:
- Joint rest—reducing jaw movements to within the range of mouth opening that is comfortable, and keeps your upper and lower jaw teeth apart when at rest.
- A soft-food diet—eating a pureed or softened diet that doesn’t exacerbate the pain.
- Medications to relieve jaw pain and/or relax muscles—including muscle relaxants, non-steroidal anti-inflammatory medications, or certain medications used to treat depression.
- Heat or cold packs—that relieve pain when applied directly to the site.
- TMJ physiotherapy—including acupuncture, relaxation exercises, posture improvement, neck treatment, TMJ joint mobilisation, TMJ movement pattern, timing correction, and TMJ stabilisation exercises.
- Wearing an occlusal splint or mouth guard—which can minimise jaw clenching or teeth grinding, especially at night.
What exercises can I do to improve my jaw function?
There are a range of exercises you can do yourself that may reduce jaw “clicking” and strengthen the muscles that pull your jaw backwards. They can also help relax the muscles that close your mouth and prevent the functioning of the muscles that pull the jaw forwards from side to side. This will reduce strain and allow your jaw to act more like a hinge. One of these involves:
- Setting aside two five-minute periods every day at a time when you are relaxed, for example, just before you go to bed or get up in the morning.
- Start by sitting upright in a chair.
- Close your mouth and make sure your teeth are touching but not “clenching”. Rest the tip of your tongue on your palate, just behind your upper front teeth.
- Keep your teeth together and run the tip of your tongue backwards towards your soft palate, as far as it will go.
- Force your tongue back to maintain contact with the soft palate and slowly open your mouth, but only until you feel your tongue being pulled away.
- Stay in this position for five seconds, then close your mouth and relax.
- Repeat the whole procedure slowly but firmly for the next five minutes.
- As you open your mouth, you should now feel tension in the back of your neck and under your chin.
- The first few times you perform the exercise, check in a mirror that your teeth move vertically downwards and do not deviate to either side.
- If you are performing the exercises correctly, there will be no noises like “clicks” from the joints. If there is, restart the exercise and continue practising until you don’t hear any clicking.
- It is recommended you don’t do these exercises for more than five minutes, twice a day for the first week.
- After that, do the exercises as often as you can. This will relax the muscles that close your mouth and help strengthen the ligaments around your jaw.
- You might find that TMJ dysfunction pain is worse for a while at first — this is because your body is unaccustomed to the movement. Over time this should subside.
- After two to three weeks, you should find that your muscles have been “re-trained,” and your jaw will open and close smoothly without clicking.
- If not, you should make an appointment with your Oral and Maxillofacial Surgeon for further advice.
Do I need jaw surgery for TMJ disorders?
Surgery is performed by an Oral and Maxillofacial Surgeon, preferably one with surgical experience and skills in TMJ surgery. Dr Tite, who works at our Gold Coast clinic, introduced TMJ surgery to the area almost 20 years ago and remains one of the most experienced providers of TMJ procedures to date.
TMJ surgery, including TMJ reconstruction surgery, may be recommended to correct your TMJ disorder if you experience:
- TMJ locking—the inability to fully open or close your mouth.
- Continuous facial pain and/or TMJ dysfunction—despite having trialled non-surgical therapies for at least six months.
- Intense pain—that is unable to be eased using analgesic medications.
- An inability or extreme difficulty eating or drinking—because of jaw pain or immobility.
- TMJ destruction via trauma—such as facial injuries after a car or motorbike accident.
- TMJ destruction via disease—such as rheumatoid and osteoarthritis or tumours involving the TMJ.
- Facial deformities that affect the development of the TMJs—including Hemi-facial microsomia, Goldenhar syndrome, and TMJ ankylosis.
When is surgery not recommended?
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 a general anaesthetic for the surgery.
Types of jaw surgery for TMJ
The commonly performed procedures for treatment of TMJ disorders are:
- Arthroscopic jaw surgery
- Arthroplasty (Total joint replacement) jaw surgery
Arthroscopic jaw surgery
An arthroscopy is the most common and least invasive jaw surgery for TMJ. It is a same-day surgical procedure performed under general anaesthesia. During 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 which is typically assisted by TMJ medications. Recovery time is generally short (several days) as the pain and swelling subsides.
Arthroplasty (Total Joint Replacement) jaw surgery
Arthroplasty 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. The surgery begins with an incision (above and below the ear) to expose and remove the defective TMJ. The artificial TMJ is then inserted.
During the surgery, the surgeon may remove bony growths, excess tissue or some of the diseased bone. This TMJ replacement allows the patient to regain comfortable, functional movement of the joint, including mouth opening.
Stages of arthroplasty jaw surgery for TMJ
Stage 1 – Before jaw surgery
An initial comprehensive surgical assessment by your Specialist Oral and Maxillofacial Surgeon will confirm whether isolated TMJ replacement surgery is needed, 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 three-dimensional images of your teeth are taken. 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
After accessing the TMJ, the surgeon removes the diseased TMJ (using the surgical guides made in Stage 1), reshapes the bone, and then uses a secondary 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
Following your surgery, your Specialist Oral and Maxillofacial Surgeon will provide you with guidelines to follow during your recovery from surgery. These include:
- Dietary guidelines—for the first few days, you will be restricted to a soft, semi-fluid and/or liquid-only diet.
- Oral hygiene guidelines—it is essential these are followed. They include keeping your mouth and teeth clean to support faster healing and decrease the risk of infection. After snacks, each meal and before bed, you should brush your teeth with a soft-bristled, child-size toothbrush. Use a circular motion and angle the brush at forty-five degrees toward the gum line. If brushing is impossible, wipe over your gums and tooth surfaces with a moistened cotton tip.
- Exercise guidelines—strenuous activity should be avoided. Your Oral and Maxillofacial Surgeon may also prescribe physical therapy and jaw exercises to help your jaw recover.
- Medication guidelines—your surgeon will advise you on medications to control pain and reduce inflammation.
It’s also worth mentioning that in contemporary practice, the wiring together of a patient’s jaws is virtually never needed. Occasionally, light elastic bands may be applied to your teeth to guide (but not lock together) your jaws and dental bite.
This surgery is reserved for severe cases of TMJ disorder where:
- The joint or joint surfaces have degenerated from a traumatic injury or tumour involvement.
- The patient has severe osteoarthritis (age related joint dysfunction) or rheumatoid arthritis (auto-immune disease).
- Bone and tissue overgrowth prevents the joint from moving, including reduced mouth opening and ankylosis (the abnormal stiffening and immobility of a joint due to a fusion of the bones).
This is the most intensive surgery for TMJ and usually takes three to four hours to complete. The patient is under general anaesthetic and requires a three to five-day stay in hospital. In terms of recovery time, initial jaw healing typically takes around six weeks after surgery, but it will take more than a month before you can resume regular activity. Patients should plan a three to four week absence from work and complete healing can take up to twelve weeks.
Talk to the TMJ Specialists at Dental Implant and Specialist Centre to discuss surgical options for your TMJ, by contacting them on (07) 5503 1744.
- 2021, TMJ Disorders, Mayo Clinic
- 2021, Patient Information on Temporomandibular Joint (TMJ) Exercises, Melbourne ENT Group
- 2021, Bruxism (teeth grinding), Mayo Clinic