The Benefits of a Non-Surgical Approach to TMJ

A brunette woman in pain massaging her sore jaw

TMJ disorder is not a one-size-fits-all diagnosis. In fact, there is a wide spectrum of severity in the disorder itself, and the treatment and recovery options are equally varied in length and invasiveness. Many, many cases of TMJ are transient and can be stabilized with a few simple changes in your self-care routine. Often, something as simple as wearing a nightguard during sleep will alleviate and prevent the headaches and jaw pain most associated with TMJ disorders.

Proper, pain-free functional use of the TMJ requires a three-dimensional balance between the position of the joints, the position of the teeth, and the ability of the muscles to fire correctly. In the more unusual cases where this balance is permanently destroyed through accident, injury, or improper bite or joint development, more extensive treatments like orthodontics or crown and bridge work to restore the proper balance may be appropriate. Only in the rarest of cases do we find situations where joint surgery is the only option to restore function and alleviate pain.

For all patients experiencing TMJ symptoms, it is extremely important that all non-invasive treatment options are exhausted before any permanent changes to the bite or the joints themselves are considered.

How the TMJ Works

The function of the TMJ is actually far more complex than that of most other joints in the body. Unlike a knee or an elbow, the TMJ is able to move up-and-down, side-to-side, and front-to-back. Hips, ankles, and wrists can also move in multiple directions to varying degrees, but none of those joints have the added functional requirement of making the teeth meet together properly for chewing, swallowing, and speaking. Luckily, the TMJ is not only functionally extremely complex, it is also highly adaptive.

Our bodies know that one of the most important physical functions we need to protect is our ability to chew and swallow food. Even if the position of the teeth is not ideal for proper joint and muscle function, the joints and muscles will adapt to the best chewing position possible – even if that means long-term degeneration of the joint and muscle strain. This remarkable adaptation goes both ways, however. When the bite is repositioned properly with the use of orthodontics or crown and bridge work, the joint will automatically adjust its hinge pattern to bring the teeth together in this new position. Over time, degenerated discs within the joint may even begin to remodel in a healthier manner now that the joint bones can function in a more open, healthier position. The joint can even form a new "pseudo-disc" given the proper environment and joint space.

The Drawbacks of TMJ Surgery

There are several types of joint surgeries. Often, the damaged cartilage disc is removed and the bony edges of the joint are shaved. This leaves no residual cartilage to repair itself. Discs may also be replaced with artificial materials that usually get damaged themselves. Sometimes these foreign materials can break away and migrate to other parts of the body like the brain cavity. One type of surgery tries to suture the popping disc back into place, but over time the disc will often displace again. Arthroscopic surgery "washes the joint space and removes pieces of debris". Depending on how and why that "debris" developed, however, it may turn up again and the surgery will have to be repeated.

In general, TMJ surgery does not allow the joint to find its own position naturally. Further, if the bite is not taken into consideration when the joint position is surgically changed, a patient may end up with teeth that cannot meet together at all for proper chewing. The TMJ pain may be alleviated, but the primary function of the system has been broken. Surgery of any kind always results in the formation of scar tissue which can cause a reduced range of motion, and may necessitate further surgery to remove the scar tissue. In rarer cases, the bone may also be damaged to the point that it starts resorbing or eating itself away.

A More Conservative Approach to TMJ Treatment

Certainly, making any kind of permanent changes to the bite requires an extensive understanding of the complex interplay between the teeth, joints, and facial muscles. But more importantly, a practitioner must understand and respect the body's potential ability to heal itself. Before any orthodontia, crown and bridgework, or joint surgery is commenced, several months should be spent in a removable splint or orthotic device to not only help determine the best new position for the teeth and joints, but also to allow for optimal healing. After this healing time, many patients are often able to wean off this device during the day, and wear it only at night, effectively controlling their pain while still maintaining function for chewing, swallowing, and talking.

The body is an amazingly adaptive instrument. When given the proper support, its abilities to adapt and heal itself are often surprising. Before you consider any permanent changes to your body to address your TMJ disorder, make sure that you have fully exhausted every opportunity to help your body help itself to heal.

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