“TMJ” has become a ‘catch-all’ term that refers to pain and dysfunction of the jaw joints, jaw muscles and related structures. The acronym “TMJ” stands for temporo-mandibular joint, the anatomic structure that joins the lower jaw to the skull. When problems related to pain and function develop in these structures, there are several possible causes and many effective treatments. Like other areas in medicine and dentistry, proposed treatments should be based in current research and science and are best carried out by experienced clinicians.
Bruxism and oral appliances
If a patient clenches or grinds their teeth during sleep, this is called bruxism. Untreated bruxism can result in dental injury and chronically inflamed and painful jaw muscles and jaw joints. Wearing an oral appliance during sleep may help, but not always. Often periods of clenching during sleep are associated with various sources of stress and may pass as the stress resolves.
Non-steroidal anti-inflammatory medications (drugs in the same class as Ibuprofen) are helpful in treating pain conditions of the jaws and associated soft tissues. As with other inflammatory medical conditions treated by these medications, their use must be monitored, and sometimes limited or avoided, depending on other co-existing medical diagnoses.
When a patient has chronic loss of jaw movement due to painful and inflamed muscles, physical therapy can be very useful in reducing inflammation and re-establishing normal range of motion. As with other musculo-skeletal problems that respond to physical therapy, the treatment usually consists of several visits over a few weeks and requires evaluation by the physical therapist at the outset.
Soft diet and Moist Heat
When any musculo-skeletal structure is chronically injured, resting the injured structure, and using the application of moist heat to improve healing blood flow can be very helpful. One way to rest the jaw and its associated structures is to limit chewing to a mechanically soft diet. Avoiding food items such as bagels, very chewy meats, nuts, etc. is helpful, as is keeping to soft foods such as well -cooked chicken or fish and steamed vegetables.
As with other joints in the body, the use of an injected cortico-steroid for a painful TMJ can be very helpful when other measures have failed, or there is a medical contra-indication for more conservative therapies such as the use of NSAID medication. Biologic materials, such as Platelet-rich Plasma and Hyaluronic Acid are helpful as joint injections in selected cases.
When the TMJ is injured and chronically inflamed, chemical inflammatory mediators can accumulate in the joint and contribute to chronic pain. Arthrocentesis is a procedure done under sedation in the office whereby the joint space is irrigated under light pressure with sterile physiologic fluid. The aim of this treatment is to rinse out the pain-inducing chemical mediators and disrupt early scarring. When performed for appropriate indications, arthrocentesis often produces a decrease in pain and an increase in pain-free function.
When an injured TMJ remains immobilized and painful for an extended period of time, scarring can occur inside the joint that limits function and that is unresponsive to the treatments outlined above. When this happens, arthroscopy is a minimally invasive way to release the scar tissue and re-mobilize the joint. Like arthroscopy for the knee, the procedure is done in an outpatient surgery center setting, with the patient going home the same day. Post-operative range of motion exercises is an important part of recovery and healing.
Open TMJ Surgery
Open TMJ surgery is most often done due to trauma and reconstructive surgical needs. Severe fracture-dislocations of the TMJ need to be treated with open surgery as do cases of severe joint positional instability. TMJ ankylosis (joint fusion with severe loss of movement) also needs to be treated with open surgery. TMJ ankylosis can result from trauma to the joint or from severe, prolonged joint arthritis. In these cases, a patient-fitted joint replacement prosthesis is fabricated and the diseased joint is removed and replaced with the prosthesis, as would be done for a diseased knee or hip.