Pain and swelling
Lock Jaw
Clicking, Popping and Grating Sound
Trouble with Jaw function
Many other conditions cause similar symptoms -- like tooth decay, Ear ache, sinus problems, arthritis, or gum disease. To figure out what’s causing yours, the Oral and Maxillofacial Surgeon will ask about your health history and conduct a physical exam.
They’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. They’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus they’ll test your bite and check for problems with your facial muscles.
In addition, radiographs (X-rays) may be taken to view the jaw joints and determine the extent of damage. These may include:
You'll probably first talk about your TMJ symptoms with your family doctor or dentist. If suggested treatments don't provide enough relief, you may be referred to a doctor who specializes in TMJ disorders.
What you can do?
You may want to prepare a list that answers the following questions:
· When did your symptoms begin?
· Have you ever had this occur in the past?
· Has your level of stress increased recently?
· Do you have frequent headaches, neck aches or toothaches?
· What medications and supplements do you take regularly?
· What to expect from your TMJ Specialist
Your doctor may ask some of the following questions:
· Is your pain constant or do your symptoms come and go?
· Does any activity seem to trigger the pain?
· Does your jaw click or pop when you move it? Is that clicking painful?
· Is it difficult to open your mouth normally?
Your Surgeon will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time.
TMD may be classified as articular (within the joint) or non-articular (outside the joint).
Articular Type
Non Articular Types
The common clinical and radiographic characteristics of TMJ ankylosis, particularly when occurring in children, include:
The most predictable treatment for the ankylosed TMJ patient includes:
Infection of the temporomandibular joint (TMJ) may result from direct extension of adjacent infection or hematogenous spread of bloodborne organisms. The joint area is inflamed, and jaw movement is limited and painful. Local signs of infection associated with evidence of a systemic disease or with an adjacent infection suggest the diagnosis. X-ray results are negative in the early stages but may show bone destruction later. If suppurative arthritis is suspected, the joint is aspirated to confirm the diagnosis and to identify the causative organism. Diagnosis must be made rapidly to prevent permanent joint damage.
Treatment includes antibiotics, proper hydration, pain control, and motion restriction. Suppurative infections are aspirated or incised and drained. Once the infection is controlled, passive jaw-opening exercises help prevent scarring and limitation of motion.
Rarely, acute injury may lead to arthritis of the TMJ. Pain, tenderness, and limitation of mandibular motion occur. Diagnosis is based primarily on history. X-ray results are negative except when intra-articular edema or hemorrhage widens the joint space. Treatment includes oral corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), application of heat, a soft diet, and restriction of jaw movement.
The TMJ may be affected by osteoarthritis (degenerative joint disease), usually in people > 50 years. Occasionally, patients complain of stiffness, a grating sound on jaw movement, or mild pain. Crepitus may result from disk degeneration or perforation, causing bone to grate on bone. Joint involvement is generally bilateral. X-rays or cone beam CT may show flattening (eg, subchondral cysts, erosions and lipping of the condyle, suggestive of dysfunctional change, most likely due to excessive loading of the joint). Treatment is symptomatic. An oral appliance (mouth guard) worn during sleep (and possibly while awake) may help alleviate pain and reduce grating sounds.
This arthritis usually develops in people (usually women) aged 20 to 40 years with a history of trauma or persistent myofascial pain syndrome. It is characterized by limited opening of the mouth, unilateral pain during jaw movement, joint tenderness, and crepitus. When it is associated with myofascial pain syndrome, symptoms wax and wane.
Unilateral joint involvement helps distinguish secondary degenerative arthritis from osteoarthritis. Diagnosis is based on x-rays, which, as in osteoarthritis, generally show condylar flattening, lipping, spurring, or erosion.
Treatment is conservative, as it is for myofascial pain syndrome, although arthroplasty or high condylectomy may be necessary. An oral appliance (occlusal splint [mouth guard]) usually relieves symptoms. The appliance is worn constantly, except during meals, oral hygiene, and appliance cleaning. When symptoms resolve, the length of time that the appliance is worn each day is gradually reduced. Intra-articular injection of corticosteroids may relieve symptoms but may harm the joint if repeated often.
The TMJ is affected in > 17% of adults and children with rheumatoid arthritis, but it is usually among the last joints involved. Pain, swelling, and limited movement are the most common findings. In children, destruction of the condyle results in mandibular growth disturbance and facial deformity. Ankylosis may follow. X-rays of the TMJ are usually negative in early stages but often show late-stage bone destruction, which may result in an anterior open-bite malocclusion. The diagnosis is suggested by TMJ inflammation associated with polyarthritis and is confirmed by other findings typical of the disease.
Treatment is similar to that of rheumatoid arthritis in other joints. In the acute stage, nonsteroidal anti-inflammatory (NSAID) drugs may be given, and jaw function should be restricted. An oral appliance worn during sleep is often helpful. When symptoms subside, mild jaw exercises help prevent excessive loss of mandibular motion. Surgery is necessary if ankylosis develops but should not be done until the condition is quiescent.
Slowly progressive unilateral enlargement of the head and neck of the condyle causes crossbite malocclusion, facial asymmetry, and shifting of the midpoint of the chin toward the unaffected side. The patient may appear prognathic. The lower border of the mandible is often convex on the affected side. Chondroma and osteochondroma may cause similar symptoms and signs, but they grow more rapidly and may cause even greater asymmetric condylar enlargement.
This condition usually results from trauma, infection, or irradiation occurring during the growth period but may be idiopathic. The deformity involves fullness of the face, deviation of the chin toward the affected side, an elongated mandible, and flatness of the face on the unaffected side. (The side on which the ramus is short causes muscles to appear fuller; the muscles on the unaffected side are stretched so that side appears flatter.) Mandibular deviation causes malocclusion.
Diagnosis is based on a history of progressive facial asymmetry during the growth period and x-ray evidence of condylar deformity and antegonial notching (a depression in the inferior border of the mandible just anterior to the angle of the mandible). There is frequently a causative history.
Treatment consists of surgical shortening of the unaffected side of the mandible or lengthening of the affected side. Presurgical orthodontic therapy helps optimize results.
Temporomandibular joint cyst and tumors are very uncommon but show symptoms similar to intra-articular disorders that make up most of these disorders. The complaints are mostly pain, malocclusion and swelling. The most common TMJ-specific benign tumors are osteoma, synovial cyst, ganglion cyst etc. The treatment of these cyst and tumors may be conservative or radical surgery depending on nature of pathology.
A primary care provider, such as a family practitioner, dentist or ENT specialist, may first diagnose your TMJ. Your doctor may refer you to an oral and maxillofacial specialist for further treatment. You may also see a pain-management specialist if your TMJ pain is severe. Dr. Parit Ladani is an eminent Oral and Maxillofacial Surgeon with experience of more than 15 year in the field and he is well trained to treat any Temporomandibular Joint Problems. Nuface Cleft and Maxillofacial Surgery Clinic is well equipped to treat any Temporomandibular Joint Problems.
If you experience common TMD symptoms such as jaw pain, difficulty opening your mouth or clicking and popping of the jaw, schedule a visit with your Oral and Maxillofacial Surgeon right away. You should also schedule an appointment if you grind or clench your teeth, as this can lead to TMJ dysfunction.
What treatments are available for TMJ disorders?
Primary goals in treatment of TMD are to alleviate pain and to improve mandibular biomechanical function. The importance of initial conservative approaches in the management of TMD cannot be overstated for reasons that are not yet fully understood. These treatment modalities, when adhered to for two to three months (either alone or in combination), often provide the majority of patients with relief and/or resolution of signs and symptoms.
Contemporary conservative TMD management may include any or all of the following:
There are things you can do on your own to help relieve TMD symptoms. Your doctor may suggest you try some of these remedies together.
Talk to your TMJ Specialist about these tried-and-true treatments for TMD:
Medications
A splint or night guard
Dental work
Counselling
If conservative treatments are unsuccessful, your healthcare provider may suggest one or more of the following:
TMJ surgery should only be considered after all other treatment options have been tried and severe pain remains. While TMJ surgery is the best option for many people, it’s important to weigh your options and make an informed decision.
Surgical intervention is appropriate only when:
In some people, corticosteroid, hyaluronic acid, PRF injections into the joint may be helpful. Infrequently, injecting botulinum toxin type A (Botox, others) into the jaw muscles used for chewing may relieve pain associated with TMJ disorders.
Indications for arthroscopic surgery include:
TMJ arthroscopy is contraindicated in patients
Depending on the cause of your TMJ pain, it also allows your healthcare provider a lot of freedom to do complex procedures on the joint, such as:
Open-joint surgeries may be necessary if:
Following are common procedure performed with Open Joint Surgery
Surgical procedures for the treatment of chronic or recurrent TMJ dislocation can be divided into two subgroups;
EMINECTOMY
SURGICAL PROCEDURES THAT LIMIT THE TRANSLATORY PATH OF THE MANDIBULAR CONDYLE
The indications for alloplastic TMJ reconstruction include:
Recovery from a TMJ surgery depends on the person and the type of surgery performed.
Your surgeon can give you information about when you can expect to go back to work after your procedure. For minor procedures, this might be the next day. Open-joint procedures, on the other hand, may require several weeks off, depending on your job and the type of surgery.
Depending on the procedure you had, you may have bandages to wear for several days afterward. Your stitches may dissolve on their own or they may need to be removed at a follow-up appointment. Your surgeon will let you know when you can remove the bandage and when you can clean the area with soap and water.
With most TMJ surgeries, you’ll experience swelling, bruising, jaw pain, and tenderness. Apply ice packs to the face for no more than 20 minutes at a time for the first day after surgery. Keep your head elevated using two or three pillows when resting to help with swelling. After 48 hours, you can apply warm heat from a heating pad or a microwaved wet washcloth to help with any discomfort. Your jaw will probably be swollen for a week or more after surgery.
For discomfort, your healthcare provider may prescribe pain medication or suggest taking over-the-counter medicines. They may prescribe muscle relaxants if you’re experiencing any spasms.
You may notice a change in your bite or clicking in your jaw. Let your healthcare provider know if this doesn’t resolve on its own as your joint heals over the days and weeks after your procedure.
Physical therapy or jaw exercises can help to restore your jaw’s function and range of motion. Your surgeon may suggest that you see a physical therapist to start jaw exercises in the first week after your surgery.
Wear a splint or other device on your jaw at all times until your doctor tells you it’s OK to remove it.
With all TMJ surgeries, you’ll need to eat a soft diet during the healing process. This may start with liquid-based foods, like smoothies and soups. After several days, you may be able to add soft foods like yogurt, applesauce, oatmeal, soup, mashed potatoes, and eggs. Avoid hard, chewy, and crunchy food.
Your healthcare provider will let you know when you can start adding other foods to your diet. For total joint replacement surgery, this process may take up to eight weeks.
It may be easier to eat small amounts every few hours rather than large amounts at mealtimes.
Your healthcare provider will probably suggest you schedule a follow-up appointment about two to three weeks after surgery to make sure everything’s healing correctly and discuss how you’re feeling.
Your recovery will depend on the procedure that you had done.
TMJ Surgery Anticipated Recovery Time
Arthrocentesis, arthroscopy A few days to a week
Arthrotomy, arthroplasty Two weeks
Joint replacement Three to eight weeks
