“TMJ” stands for TemporoMandibular Joint and “TMD” stands for TemporoMandibular Dysfunction of the jaw joint. The temporomandibular joint (TMJ) is a small joint located in front of the ear where the skull and lower jaw meet. It permits the lower jaw (mandible) to move and function.
TMJ disorders are not uncommon and have a variety of symptoms. Patients may complain of earaches, headaches and limited ability to open their mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing their mouth. What must be determined, of course is the cause.
What Causes TMJ Disorders?
Determining the cause of a TMJ problem is important, because it is the cause that guides the treatment.
Arthritis is one cause of TMJ symptoms. It can result from an injury or from grinding the teeth at night. Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth.
The disk can also develop a hole or perforation, which can produce a grating sound with joint movement. There are also conditions such as trauma or rheumatoid arthritis that can cause the parts of the TMJ to fuse, preventing jaw movement altogether.
The Role of the Oral and Maxillofacial Surgeon
When symptoms of TMJ trouble appear, an oral and maxillofacial surgeon should be consulted. A specialist in the areas of the mouth, teeth and jaws, the oral and maxillofacial surgeon is in a good position to correctly diagnose the problem.
Special imaging studies of the joints may be ordered and appropriate referral to other dental or medical specialists or a physical therapist may be made.
Range of Possible Treatment
TMJ treatment may range from conservative dental and medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory drugs for pain and muscle relaxation, bite plate or splint therapy and even stress management counseling.
Generally, if non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated. Surgery can involve either arthroscopy (the method identical to the orthopaedic procedures used to inspect and treat larger joints such as the knee) or repair of damaged tissue by a direct surgical approach.
Once TMJ disorders are correctly diagnosed, appropriate treatment can be provided.
Treatment can vary depending on the extent and cause of your TMJ issues. In general, the best treatments are a combination of self-care techniques and professional help. Some of the most effective self-care techniques you can use include
- Improving your posture (sitting up straight, not slouching, etc.,
- Resting your jaw by keeping teeth apart when not in use
- Using a mouth guard at night to prevent clenching
- Stress management techniques
- Doing exercises to stretch your jaw
- Avoiding very hard and chewy foods for a while
If these lifestyle changes alone can’t correct your condition, your doctor may prescribe anti-inflammatories, pain relievers, muscle relaxers, or other treatments. Orthodontics and jaw surgery are also options to consider when nonsurgical treatments do not effectively control your symptoms.
Pre operative instructions:
- You may not have anything to eat or drink (including water) for 8 hours prior to the appointment. For morning surgery, no food or liquids after midnight the night before surgery.
- No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
- A responsible adult must accompany the patient to the office, remain in the office during the procedure and drive the patient home.
- Plan to rest for the remainder of the surgery day. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
- Please wear loose-fitting clothing with sleeves that can be rolled up past the elbow and low-heeled shoes.
- Contact lenses, jewelry and dentures must be removed at the time of surgery.
- Do not wear lipstick, excessive makeup, or nail polish on the day of surgery.
- If you have an illness such as a cold, sore throat, or stomach or bowel upset, please notify the office.
- If you take routine oral medications, please check with your doctor prior to your surgical date for instructions.
- The use of alcohol or recreational drugs can have an adverse effect on the anesthesia medications that we use. Please discontinue the use of such for at least 72 hours prior to your procedure.
- If you were prescribed medications by your doctor, please closely follow the instructions for their use.
Instructions Following TMJ Arthrocentesis
You have just undergone temporomandibular joint arthrocentesis (washing of your joint). This handout is designed to explain your postoperative course, limitations and what to expect.
A small bandage will be placed over your surgical site. This should remain in place for one to two days days following your surgery. A small amount of blood may be noted on the bandage. This is Normal. The bandage will be removed at your post-operative visit.
Apply antibiotic ointment to the area two times per day. It is okay to shower and shampoo starting the next day.
Keep head elevated especially while sleeping or resting for at least 24 hours.
You should not experience any bleeding after removing the bandage. If you do experience bleeding, apply pressure with your thumb for ten minutes. If this fails to stop the bleeding, please call the office during business hours and emergency line after business hours
You can expect some bruising and swelling in the surgical site. Application of ice packs (20 minutes on and 20 minutes off at a time) for the next 24 hours is recommended, with care not to harm or freeze the skin especially while it is numb.