This article contains everything you need to know about TMJ surgery.
Jaw pain can be quite tricky. While its most common culprit is a problem in the jaw joint, also known as temporomandibular joint disorder (TMJ), the pain can radiate to other nearby parts of the body causing headaches, earaches, neck pain, and even shoulder pain. Many times, people even mistake pain in the jaw muscles as toothache. The worst thing about TMJ symptoms is not the excruciating pain, rather, it’s the fact that most people don’t know what to do since they don’t exactly know where the pain is coming from.
So what is TMJ disorder exactly? What causes it? More importantly, do you need TMJ surgery to treat it?
Understanding TMJ
The temporomandibular joints are the joints that connect your mandible (lower jaw) to the temporal bone (base and side of the skull), you have one on each side of your face. These joints act like a hinge that allows your jaw to move side to side and slide forward and back when you speak, laugh, chew, etc.
As with other joints in the body, the jaw joint is made up of bones, ligaments, muscles, and discs. When something goes wrong in any of its parts, you will notice it from the pain and difficulty of moving your jaw. Often this is caused by wear and tear due to bad habits such as jaw clenching and teeth grinding, excessive use such as chewing gum, or trauma from accidents or playing physical contact sports. But it can be caused by other factors too.
Whatever the cause, it is usually diagnosed as temporomandibular joint disorder (TMJD or TMD), or simply called TMJ after the joint.
What are TMJ Disorders and What Causes It?
Scientists are yet to pinpoint the exact cause of TMJ disorders, but health experts and dentists believe it starts from problems in the face and jaw muscles or with the jaw joint itself. Injury to the jaw and facial nerve, wear and tear, muscle disorders, improper bite alignment, and even arthritis can all cause painful symptoms and limits jaw movement.
The jaw movement combines hinge motion and sliding action. The jaw joint is separated by a cartilage disc that acts as a shock absorber for the two bones, while the surface with cartilage and facial muscles allows smooth movements. Sometimes, however, the cartilage gets worn from repetitive movements and the cartilage disc can move out of its position, leading to dysfunction and pain called TMJ.
In some cases, TMJ pain can be attributed to genetic problems. Many people who habitually grind their teeth and clench their jaws throughout the day or during sleep (a sleeping disorder called bruxism), also experience severe symptoms of TMJ disorders.
Some of the most common symptoms include headaches, earaches, facial pain, and tenderness or swelling in the jaw area.
In most cases, TMJ pain is temporary and may subside after a few days. However, many find pain relief from over-the-counter pain medications and doctor’s prescribed muscle relaxants. Some can manage the pain with the good old hot and cold compress, nonsurgical treatments, physical therapy like jaw exercises, and self-managed care. For those with severe TMJ disorder, however, TMJ surgery may be necessary.
Temporomandibular disorders are also attributed to:
• Connective tissue disorder (TMJ)
• Damage or displacement of the joint disc (TMJ)
• Trauma or injury
• Damage to the cartilage lining due to arthritis (rheumatoid arthritis, osteoarthritis, or inflammatory arthritis)
• Anatomical malformation of the TMJ (genetic disposition)
Signs and Symptoms of TMJ
Discomfort, pain, and limited movement are the three most common signs that there is a problem in your temporomandibular joint. It is usually common in those 20 to 40 years of age and affects more women than men.
These things can be temporary or may last for months, if not years, while pain and discomfort levels may differ from time to time.
Painful symptoms may also affect one or both sides of the face. Some of the common symptoms include:
• Jaw pain (pain, swelling, or tenderness in joint area)
• Limited jaw mobility that affects the way you speak, chew, or open your mouth wide
• Headaches, earaches, neck pain, shoulder pain
• Stuck or lock jaw (either from open or closed mouth position)
• Clicking or popping sound in the jaw joint when opening or closing the mouth
• Trouble chewing or biting food
• Tired feeling in the face
• Ringing of ears (tinnitus)
How is TMJ disorder diagnosed?
TMJ can be diagnosed by your dentist. Your dentist will check your jaw’s range of motion (opening and closing of your mouth, side-to-side movement), press on your jaw area, and feel the jaw joint as you move your jaw.
Your dentist may also request for X-ray to get a better look of your jaw joint and see any signs of damage. These may include:
• Panoramic x-rays – to see the broad overview of your teeth, jawbone, and jaw joint
• Cone beam computer tomography (CBCT) scan – captures thousands of images of your mouth, facial bones, teeth, and sinuses, and stitches the images together for a full 3D image. Also known as dental CT scan, this gives more detailed view of your facial anatomy
• Magnetic resonance imaging (MRI) scan – this may be used in some cases to see the soft tissues in and around the jaw joints, condition and position of the disc, extent of inflammation, and possible locking of the jaw.
Depending on your case, your dentist may also refer you to a specialist or dental surgeon for further diagnosis, care, and treatment. For more complex cases, you will be referred to an oral and maxillofacial surgeon, which specializes in treating skeletal conditions like TMJ.
Treatments for TMJ
In many cases, TMJ disorders, along with their painful symptoms, go away without treatment. If symptoms persist, however, and if the pain is affecting your daily life, then it would be best to consult your doctor and have the problem diagnosed and addressed. Doctors and dentists may recommend a variety of options, usually a combination of two or more at the same time.
Medications for TMJ
Medications for TMJ disorders are usually to address the pain and reduce swelling.
• Anti-inflammatory drugs and pain relievers – over-the-counter and prescription pain medications are usually given to patients to relieve pain. The latter is prescribed for a limited time since they are stronger than OTC drugs. The most commonly prescribed medication is prescription-strength ibuprofen.
• Tricyclic antidepressants – some patients may find relief using tricyclic antidepressants, like amitriptyline. This drug is usually prescribed for depression, but in low doses, they are good for managing pain associated with TMJ, controlling bruxism, and sleeplessness caused by excruciating pain.
• Muscle relaxants – relaxants help the facial muscles relax to relieve swelling. This is usually prescribed for a few days or a couple of weeks to relieve TMJ-related pain due to muscle spasms.
Management and therapies
Healthcare professionals will also utilize all non-invasive and non-drug therapies to treat TMJ disorders too, such as:
• Physical therapy – Jaw stretches and strengthening exercises are known to reduce pain related to TMJ disorders. Treatments may also include moist heat, an ice pack, and even an ultrasound (deep heat treatment to relieve soreness and improve the joint’s movement).
• Oral splints – Better known as occlusal appliances, these are types of mouthguards especially designed for TMJ. It’s a removable dental appliance that can be worn on both upper and lower teeth (like a regular mouthguard), and works by improving jaw function (so it can move smoothly), relieving pain, improving jaw alignment, and reducing the pressure caused by habitual jaw clenching and teeth grinding.
• Counseling – Learning how to manage TMJ disorders starts with behavioral changes. This means avoiding the behaviors and bad habits that aggravate the pain, such as biting on fingernails or hard objects like pencils, ice, leaning on your chin, excessive jaw clenching, and teeth grinding.
• Radio wave therapy – This treatment involves the use of low-level electrical stimulation to the jaw joint to improve blood flow in the area and provide pain relief.
TMJ Surgeries and other Procedures
What kind of surgery do they do for TMJ? Well, it depends on a lot of factors. Doctors and patients have a lot to choose from based on the specifics of the case.
While most TMJ surgeries are considered a minimally invasive procedures, they are still treated as the last resort. These surgeries are used when TMJ symptoms persist and disrupt the life and well-being of the patient.
If TMJ is constantly causing you excruciating pain to the point that it is affecting your daily life, and pain medications and other conservative treatments don’t seem to provide relief, then you should talk to your dentist or oral surgeon about surgery.
There are many different surgical treatments used for TMJ, such as:
• Arthrocentesis – this is considered a minimally invasive form of surgery for TMJ. It involves the insertion of really small needles straight into the joint to irrigate the fluid and remove inflammation byproducts and other debris in the temporomandibular joints.
• TMJ arthroscopy – arthroscopic surgery is another minimally invasive type of TMJ surgery that involves making a small incision near the ear. This is where the surgeon will insert a tiny tube-like instrument ((cannula) affixed with a scope on its tip. With the help of the scope, the surgeon will be able to see joints thoroughly and look for signs of damage and wear and tear that is potentially causing pain. From here, the surgeon can also extract inflamed tissues and start potential realignment of the jaw joint.
This surgical procedure has far fewer risks and complications than open-joint surgery and total joint replacement. Recovery from this procedure usually only involves dealing with stiffness and swelling, which goes away after a few days. However, this procedure has some limitations as well.
• Open-joint surgery – if the TMJ-related symptoms persist even after conservative treatments, and the surgeon determines that the problem is caused by a structural issue in the joint, then they may suggest arthrotomy, or better known as open-joint surgery. Basically, it will confirm exactly what the problem is and treat it at the same time.
Open joint surgery is aimed to repair or replace the joint. However, it is a high-risk procedure that should be discussed with your surgeon thoroughly.
• Total joint replacement – for cases where jaw joints have degenerated due to trauma, injury, cases of osteoarthritis, or bad cases that led to irreparable damage to the joint, oral surgeons may advise for total joint replacement.
Total joint replacement surgery is an extensive procedure that requires a hospital stay of 3 to 5 days. Surgeons also recommend jaw wiring control jaw movement or shut the jaw for a short period of time. This procedure, however, can provide significant improvements in the range of motion of the jaw, and speech, and even improved diet after getting a total joint prosthesis.
• Injections – some people may respond well to corticosteroid injections which are injected directly into the jaw joint. The benefits can last for several months but can have side effects when repeated too often.
In some cases, doctors may recommend the use of botulinum toxin type A (Botox) in the jaw muscles to relieve TMJ pain, especially when chewing.
• Modified condylotomy – this procedure address the TMJ problem indirectly by alleviating pain and minimizing the risk of jaw locking. The surgery is done in the mandible, but not in the jaw joint.
Frequently asked questions about TMJ surgery
Q. Are there any risks in leaving TMJ disorder untreated?
A. Yes, a lot actually. The pain can lead to insomnia, which can be dangerous for your general health. Painful symptoms can also contribute to feelings of anxiety and depression. Moreover, TMJ pain can even lead to excessive jaw clenching and teeth grinding, which can further lead to damage to the teeth, swelling, and asymmetrical muscle growth on the face.
Without corrective measures, TMJ disorder can cause permanent damage to your jaw (cartilage loss).
Q. How do I know if I’m a candidate for TMJ surgery?
A. Your dentist or oral surgeon will determine it for you based on your physical checkup, and CT and MRI scans. They will also consider your symptomatic history.
Your healthcare provider will consider TMJ surgery if you constantly feel intense pain and tenderness every time you move your jaw (open or close your mouth), have trouble eating, drinking, or talking due to jaw pain and immobility, and if you have structural damage in your jaw.
Q. Will doctors advise against TMJ surgery?
A. The surgery is considered a last resort. Thus, dentists and oral surgeons will advise against it if the symptoms aren’t severe, consistent, or causing any jaw movement problems. Instead, they would recommend conservative treatments like physical therapy, massage, pain medication, and lifestyle changes to alleviate the symptoms.
Q. Is there an effective treatment other than TMJ surgery?
A. Self-care, medications, physical therapy, and lifestyle change can all help address the painful symptoms of TMJ disorder. Some doctors may also suggest other conservative treatments such as acupuncture, biofeedback, and even mindfulness techniques like meditation. TMJ surgery is reserved for severe cases that don’t respond to conservative treatments.
Q. How soon can I recover after TMJ surgery?
A. It depends on the type of surgery. You can recover after a few days following arthrocentesis and arthroscopy surgeries. With arthrotomy and arthroplasty, you will need up to two weeks to fully recover. For joint replacement, however, you may need 3 to 8 weeks of recovery time.
Q. What to expect after TMJ surgeries?
A. You can expect bruising, swelling, tenderness, and jaw pain following most TMJ surgeries. You can use ice packs to temporarily relieve the pain the first day after the surgery, then use a warm compress 48 hours after the surgery to promote better blood flow in the affected area for healing.
Your jaw will stay swollen for a few days or weeks. You will be prescribed muscle relaxants and pain medication or OTC pain relievers to help manage discomfort and pain. Obviously, you will have to stay away from solid foods and stick to soft foods. Depending on your type of surgery, you may have to eat soft foods for a few days until you are fully recovered.
Your oral surgeon will also suggest or teach your jaw stretches and exercises to restore jaw function and range of motion after the first week following the surgery.
Most TMJ surgeries however have high success rates for treating pain and improving the range of motion of the joint jaw.
Conclusion on TMJ Surgery
As said repeatedly in this entry, TMJ surgery should be considered as the last resort. However, in some cases, TMJ surgery can be the best option. While they have high success rates, they don’t guarantee a cure. Thus, you may want to talk to different healthcare providers before deciding to go for surgery.
Take your dentist, TMJ specialist, and an oral surgeon’s advice and do your own dental and craniofacial research to educate yourself about the different surgical techniques and their associated risks, as well as recovery time so you can be confident in your decision.
