The Problem with TMJ Surgery

I’ve been successfully treating TMJ disorders with conservative splint therapy, orthodontics, and reconstructive crown and bridge work for more than 25 years. During that time, I’ve encountered less than a handful of patients who could only be helped with joint surgery. I have, however, consulted with and treated dozens of patients who have been plagued with continuing pain and the inability to chew correctly following TMJ surgery on one or both joints.

Unlike splint therapy, orthodontics, and reconstructive crown work which all focus on gently encouraging the joints to find a better position on their own through repositioning the way the teeth fit together, joint surgery often physically forces the TMJs into a completely new anatomical position. There is no ability for the joint to ease back and forth between positions or make the minute adjustments so often required to adapt to the constantly changing landscape of the mouth. The joint is simply moved or shaved, and there is no way for it to move back if the new position is not ideal.

Forcibly moving the joint with surgery may help create more room for the disc to move freely and correctly, resolving pain and functional issues associated with locking and popping, but surgery almost never takes into consideration the most important function of the jaw: making the teeth fit together for chewing. Too often, I have heard clients recount stories of being told to simply stop chewing and stay on a soft diet for the rest of their lives when their teeth no longer fit together after TMJ surgery. A long-term soft or liquid diet is not ideal for anyone, nutritionally or otherwise. And for a person in their 30s, 40s, or 50s? Never chewing again is simply not a good enough answer.

Unfortunately, the inability to chew is not the only potential negative outcome of TMJ surgery. Some patients experience recurrence of pain symptoms, locking, and popping within a few years after the surgery. The most unfortunate cases I see are in patients who undergo surgery and then end up in the same pattern of symptom management that they were in before the treatment. These individuals find themselves back in an orthotic to control pain and locking, experience severe pain flare-ups several times per year, and require regular physical therapy, chiropractic adjustments, or massage therapy in just to maintain the most basic levels of function.

There are certainly circumstances where TMJ surgery may be the only answer, but those cases are extremely rare and usually involve some sort of trauma. The most successful case of TMJ surgery I have ever seen was a surgical unlocking of the discs done on a patient whose discs were displaced through a blow to the chin sustained during a bicycle accident. Again, these cases are the exception rather than the rule. I caution all my patients not to put themselves into the surgery category until all other treatment options have been ruled out or exhausted.

TMJ disorders exist on a broad spectrum of severity, with most cases being transient or easily managed with non-permanent changes to the the teeth or joints. In order to help you better understand this spectrum and the variety of non-surgical treatments available that may be of help, I’ve created a new resource entitled The Benefits of a Non-Surgical Approach to TMJ Dysfunction. I hope you will share this information with anyone you know who suffers with TMJ-related pain and dysfunction. As always, current or prospective patients are always encouraged to call or bring questions about their specific circumstances to their next regularly scheduled appointment.

Martha (Signature)

Jaw Injuries on the Athletic Field

Now that school is back in session and many of our kids are returning to organized athletic activities, it’s time to talk a little bit about jaw injuries on the athletic field. Certainly there is a great deal of information in the news media about concussion and sports-related injuries – especially for heavy contact sports like football and rugby or combat-related athletics like boxing and martial arts. But anytime your child sustains a body hit or blow to the head during a sporting event or physical activity, a tooth or jaw injury may also occur secondary to any other potential injuries to the head and neck.

The most common secondary effect of physical impact on the athletic field is the tendency for the teeth to slam together in reaction to the hit. Even an indirect blow to the body can sometimes force the lower jaw to slam hard enough into the upper jaw that fractured teeth or even a fractured jaw bone may result. A properly-fitted sportsguard is specifically designed to protect your child from these types of injuries. A sportsguard provides a cushion that not only keeps the teeth from slamming into one another, but also holds the joint space a little more open in order to provide some additional protection against a possible fracture in the base of the skull or jaw.

Sportsguards are commonly available in most drugstores and online. It is important that the guard fits your child correctly, and that it is not too big or too small to offer adequate protection. Custom-fabricated sportsguards are also available in our office, and I am always happy to look at an over-the-counter guard to make sure it fits your child properly. But remember, even with a sportsgaurd in place, sometimes injury to your child’s jaw or teeth can still occur.

Whiplash to the jaw is an especially common injury associated with sports-related impact. When your child’s head is thrown off the center of the neck as a result of a direct hit to the head or body, the lower jaw tends to be thrown with equal force in the opposite direction. Just as the muscles and ligaments in the neck can be overstretched into a whiplash injury when this happens, so can the muscles and ligaments of the jaw. A sportsgaurd can be of some protection against a jaw whiplash, particularly if your child’s teeth happen to be resting against it at the moment of impact, reducing the free-swing action of the lower jaw, but not always.

Sometimes a jaw whiplash is fairly minor, resulting in a little soreness in the cheek muscles that resolves within a week or so. Frequently, however, the symptoms of jaw whiplash do not show up until 7 to 10 days after the injuring incident. These symptoms can include jaw pain, headaches, ear pain, and even tooth pain. Your child may not make the connection that these symptoms are possibly related to the fall or hit they took on the athletic field a week or more ago, but you should be on the lookout for them.

A short time in a nightguard or splint to help support the jaw during healing, combined with some massage or physical therapy, may be all your child might need to mitigate the sometimes debilitating pain of a whiplash injury to the jaw. For even more information and some ideas on home care for an injured jaw, please take a look at the newest installment in my ongoing series on headaches entitled Jaw Injuries and Muscle Strain.

As always, I encourage you to call the office with questions or to schedule an appointment to have your child evaluated if you suspect he or she may have a jaw or tooth injury.

Martha (Signature)