TMJ

TMJ (temporomandibular joint) disorders are a family of problems related to your jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

Trouble with your jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth, or trouble opening your mouth wide.

Do You Have a TMJ Disorder?

  • Are you aware of grinding or clenching your teeth?
  • Do you wake up with sore, stiff muscles around your jaws?
  • Do you have frequent headaches or neck aches?
  • Does the pain get worse when you clench your teeth?
  • Does stress make your clenching and pain worse?
  • Does your jaw click, pop, grate, catch, or lock when you open your mouth?
  • Is it difficult or painful to open your mouth, eat, or yawn?
  • Have you ever injured your neck, head, or jaws?
  • Have you had problems (such as arthritis) with other joints?
  • Do you have teeth that no longer touch when you bite?
  • Do your teeth meet differently from time to time?
  • Is it hard to use your front teeth to bite or tear food?
  • Are your teeth sensitive, loose, broken or worn?

The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

TMJ Treatment

There are various treatment options for TMJ that Dr. Diaz can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Diaz will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care combined with professional care.

The initial goals are to relieve the muscle spasms and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

  • Resting your jaw
  • Keeping your teeth apart when you are not swallowing or eating
  • Eating soft foods
  • Applying ice and heat
  • Exercising your jaw
  • Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night. It also helps to protect the cartilage and joint surfaces.  Appliances also help protect tooth wear.

What about therapeutic Botox injections for facial pain?

Therapeutic botox injections into the masseter and temporalis muscles can offer significant facial pain relief. If you suffer from clenching or grinding, you likely have muscle stiffness contributing to your symptoms. Botox injections to the masseter and temporalis muscles can lessen the stiffness, allow your mouth opening to improve and prevent further damage to your TMJs and teeth.

What is TMJ Arthrocentesis and how can it help TMJ pain?

Arthrocentesis is a minimally invasive TMJ procedure which reduces inflammation and helps restore the normal environment of your TMJs. 

TMJ Arthrocentesis is commonly defined as the lavage or wash out of the TMJ using small sterile needles and lactated Ringer’s solution.  This procedure if performed by a trained Oral and Maxillofacial Surgeon is predictable, non-invasive and effective in pain relief by reducing joint inflammation and to increase jaw mobility by removing joint adhesions (scar tissue) and small bone spurs.


HOW IS TMJ ARTHROCENTESIS PERFORMED?

TMJ arthrocentesis is an in-office procedure performed under IV sedation or general anesthesia. Dr. Diaz will discuss in detail the mode of anesthesia that best fits your condition and situation. Under sterile conditions, local anesthetic (numbing medicine) is delivered to the affected temporomandibular joint (TMJ). Two small, TMJ specific needles are then inserted into the TMJ. A sterile solution (Lactated Ringers) is then delivered to wash out the joint and remove and dilute inflammation within the joint. Adhesions which are formed in response to inflammation will also be removed through this non-invasive procedure. Depending on your condition, Dr. Diaz may offer an autogenous platelet rich plasma (your blood products) or a steroid injection into the joints. Recent studies have shown patient’s own plasma help release growth factors which helps promote bone healing and bone quality in the joint. Blood plasma has also shown to significantly reduce pain within the TMJ in long terms. The steroid injections can help to locally reduce inflammation and pain

ARE YOU A CANDIDATE FOR TMJ ARTHROCENTESIS?

Typically patients with chronic TMJ pain associated with osteoarthritis, acute closed lock or inability to open their mouth and TMJ click associated with pain are good candidates for TMJ arthrocentesis. After obtaining a thorough history and physical examination, and appropriate imaging of the TMJ, Dr. Diaz may recommend TMJ arthrocentesis. In some cases, an MRI may be necessary and if so, Dr. Diaz will further discuss this with the patient. The main objective of arthrocentesis is to wash out inflammatory mediators, release the disc, break adhesions, eliminate pain and improve joint mobility. The decision to perform arthrocentesis depends on the chronicity, type of disease condition within the joint and other factors which will be discussed with you at your consultation with Dr. Diaz.

HOW IS YOUR RECOVERY AFTER TMJ ARTHROCENTESIS?

Arthrocentesis of the temporomandibular joint is a minimally invasive treatment. It is usually performed on an outpatient basis under IV sedation.  It is a low risk and a low complication method. You should expect to get back to normal activities 24 hours after the procedure without significant downtime and recovery.

WHEN SHOULD YOU EXPECT IMPROVEMENTS AFTER TMJ ARTHROCENTESIS?

Depending on the problem associated with your TMJ, improvement after arthrocentesis procedure should be expected within few days. During recovery and rehabilitation, anti-inflammatories will help relieve the symptoms.

WILL YOU BE ABLE TO CHEW NORMAL FOOD AFTER TMJ ARTHROCENTESIS?

Dr. Diaz strongly recommends a soft diet after arthrocentesis. Maintaining a soft diet regimen is very crucial in healing injured temporomandibular joint. At your consultation we will give you nutritional guidance about the types of food s you should consume while healing.

DO I NEED ADDITIONAL TREATMENTS AFTER TMJ ARTHROCENTESIS?

Depending on your TMJ condition, arthrocentesis can be a one time and successful treatment for many patients. There are specific conditions which arthrocentesis may not produce adequate response. Advanced degenerative joint diseases and few other conditions may require further surgical interventions, such and open joint surgery.