equently Asked Questions about TMJ

What is TMJ?

“TMJ” is often used to describe the numerous conditions of the Temporomandibular Joint (TMJ) and its surrounding structures.  TMD (Temporomandibular Joint Disorders) is the more appropriate term for diseases or conditions of the TMJ.

What makes understanding TMJ/TMD difficult is that a number of conditions are lumped into the category.  In an ideal situation, TMJ/TMD would be a term descriptive of only conditions involving the Temporomandibular Joint itself and not muscle disorders and other pain conditions.  As it currently stands, “TMJ/TMD” encompasses muscle disorders, actual joint disorders of the TMJ, tumors and other pathology, disk issues, inflammatory conditions, and others.

How to cure TMJ permanently?

“Cure” is often possible for patients but difficult to define. Many ailments of the joint itself can be cured permanently with appropriate treatment-usually surgery.  Others, such as persistent muscle pain and headaches caused by grinding or clenching of the teeth can be more difficult to treat unless the clenching and grinding stops.

One newer finding in the world of TMJ joint disorders (not muscle disorders) is that minimally invasive surgical options such as arthroscopy result in the best and longest-lasting outcomes (often a cure). This contrasts with traditional thought where non-surgical treatment must be tried and exhausted prior to surgical treatment.

What causes TMJ?

There are numerous causes to TMJ/TMD.  Some are easily understood and others more complex.  Cysts, tumors, and other abnormal growths are similar to pathologies anywhere else on your body and are often treated with surgical removal.

Other conditions root cause are more difficult to understand.  There are many thoughts on what causes “TMJ/TMD”.  These include parafunction (gum chewing, clenching/grinding of teeth, and others), hormones (predominantly female condition), abnormal growth, genetic tendency, trauma, malocclusion (bad bites), and general wear and tear associated with advancing age (osteoarthritis). Treatment depends on the exact diagnosis and your preference for a surgical or non-surgical solution.

Who treats TMJ?

Many providers treat “TMJ” including dentists, oral & maxillofacial surgeons, orofacial pain specialists, physical therapists, and others.  Oral & Maxillofacial Surgeons are the only profession who can treat your TMJ surgically.

Unfortunately, there are a number of bogus treatments offered in the world of TMJ, some of which even involve class action lawsuits.  Seeing a provider or providers who are reputable and offer evidence-based treatment options is crucial to avoid long-lasting pain, excessive costs, and irreversible damage.

How is TMJ/TMD diagnosed?

TMJ/TMD is diagnosed by a qualified provider after a detailed examination and imaging analysis (CT scans being the gold standard first line imaging).  There are a number of conditions that can mimic TMJ/TMD and a number of variants of TMJ/TMD, which makes seeing a provider experienced in TMJ/TMD important.

Will TMJ get worse without treatment? & Can TMJ go away on its own?

It depends.  Many TMJ/TMD conditions are self-limiting, meaning if the cause is removed the body can heal and return to normal or near normal.  Frequently, if there is clenching/grinding of the teeth leading to muscle pain. Decreasing or stopping the clenching/grinding will lead to improvement.  More involved conditions like intra-articular (within the joint) conditions tend to be long-lasting without surgical intervention. Non-surgical treatment can often improve these conditions but without treating the actual problem within the joint, patients are prone to relapse or return of their condition throughout their lives. They are also more prone to progressive degeneration of the joint (osteoarthritis) when compared to minimally invasive TMJ surgery.

What are the symptoms of TMJ?

Generally, limited mouth opening, pain in the jaws, face, and around the ear with that increases with biting/chewing.  Other symptoms can include headaches, neck/shoulder pain, tinnitus (ringing in the ears), changes to the occlusion (bite), sounds in the joint such as clicking/popping, grinding, and others.

The important difference in TMJ/TMD symptoms is whether they are from your muscles or your joint.  Joint conditions are best treated by minimally invasive surgery, whereas there is no surgery for muscle disorders.  Symptoms such as sudden or continued loss of full mouth opening, pain immediately in front of the ear(s), painful mouth movements and chewing, and others indicate a joint problem best treated with surgery.

TMD vs TMJ

TMJ is simply the joint of the jaw located in front of both your ears.  “TMJ” however, is often used to describe the numerous conditions of the Temporomandibular Joint (TMJ) and its surrounding structures.  TMD (Temporomandibular Joint Disorders) is the more appropriate term for diseases or conditions affecting TMJ.

Who should have TMJ Surgery?

Any person with an intra-articular TMJ condition is a candidate for minimally invasive TMJ Surgery.  This means, anyone with a condition affecting the actual joint and not just the muscles around it.  There is no surgery for a muscle disorder but often patients have both a muscle and an intra-articular condition making diagnosis challenging.  Anyone whose jaw is locked closed, has changes to their occlusion/bite, or has pain and limited opening coming from their jaw joints themselves are ideally suited for TMJ surgery.  Additionally, patients who are not improving with non-surgical treatment are recommended for surgical evaluation and possible treatment.

Does TMJ Surgery Work?

Yes. Research in the past 10+ years has definitively and repeatedly shown that the best outcomes (pain, mouth movement, diet) come from patients who have minimally invasive surgery (TMJ arthroscopy) as their first treatment or after not responding to non-surgical treatment within 6 months.  This is contrary to traditional thought which recommended non-surgical treatment first and avoiding surgery at all costs-which often leads to chronic pain and increased total costs. Another potential benefit of TMJ surgery is that the problem is often definitively solved instead of merely managed.  This means patients frequently have a single procedure and do not have to deal with the condition for the rest of their lives.

How long do TMJ Joint Replacement devices last?

30+ years possibly.  The short answer is that well-placed devices by qualified and experienced surgeons may last you 30+ years or the rest of your life.

The long answer is more complex as we have yet to find a “fall off” date for TMJ replacement devices.  Joint replacements in other joints such as hips, knees, etc. have a generalized lifespan that once the joints reach a certain age, there is a steep increase in their failure rate.  Despite placing TMJ replacement devices for nearly 35 years, we have yet to find that “fall off” date-meaning we don’t really know how long they will last.  However, we currently believe that TMJ prosthetics will last longer than prosthetics in other joints.

Because of these findings, we are placing TMJ prosthetics much earlier (we previously only placed them as a last resort) and in younger patients (some children and adolescents when applicable).  We no longer recommend total joint replacement only after multiple failed surgeries, but often as an early option since patients typically thrive with the prosthetics which will likely last them several decades if not the rest of their lives.

How much does TMJ Surgery Cost?

This can vary wildly from a few hundred dollars to multiple thousands depending on the procedure and where it is performed. Additionally, variations in insurance coverage can make this difficult to determine.  TMJ arthrocentesis is often an in-office procedure making it relatively inexpensive. TMJ arthroscopy, arthroplasty, and removal of the TMJ disk often run from $3500-10,000 depending on if one or both sides requires treatment.  TMJ total joint replacement is a more involved procedure often costing close to $10-20,000 per side.