TMJ Disorders Orange County

TMJ (temporomandibular joint) disorders are a family of problems related to your complex 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 (muscles of mastication) 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. No one treatment can resolve TMJ disorders completely and treatment takes time to become effective.

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

Our philosophy about TMJ treatment is focused on a team approach and it starts with you; “The TMJ Patient”. Stress management and taking care of yourself and your overall health should be the initial and primary focus.

Home-care treatments can often be very effective and they 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

In addition your general dentist can focus on your overall dental health as poor dentition can be an indirect source of TMJ pain.

Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Bolourian will determine the proper course of treatment.There are various treatment options that Dr. Bolourian can utilize to improve the harmony and function of your jaw.

The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Splint therapy is the foundation and one of the most important steps in a comprehensive TMJ treatment modalities. Unfortunately many people are told that they need a “night guard”. So they go to a pharmacy and buy one. That approach only will worsen the condition. There are different types of appliances used for different purposes. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw (Not your teeth) forward, relives pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal.

If the above treatments and are found to be ineffective or with limited effectiveness, Dr. Bolourian may suggest a minimally invasive and very effective treatment called arthrocenthesis. This procedure is particularly beneficial when cause of restricted mouth opening and pain is secondary to upper joint space pathology, particularly adhesions and inflammation within the joint space.

What is Jaw Joint Arthrocentesis?

TMJ/Jaw Joint Arthrocentesis is basically washing out of the jaw joint space during which the jaw joint is washed out with sterile saline. The surgeon may or may not use anti-inflammatory steroids, long-acting local anesthetics, recently researched hyaluronic acid ( a naturally occurring joint lubricant). TMJ/Jaw Joint Arthrocentesis reduces jaw joint pain, improves jaw joint function and reduces jaw joint clicking.

TMJ/Jaw Joint Arthrocentesis of the TMJ joint space reduces jaw joint pain by:

  • Increasing lower jaw movements by removing adhesions. (Adhesions are primarily scarring within the joint space).
  • Flushing out and eliminating the inflammatory chemicals from
    the jaw joint.
  • By removing adhesions and inflammatory toxins from the TMJ space, we are able to reduce the mechanical obstruction caused by the anterior (forward) position of the disk (AKA: articular disk) and the disk will regain its ability to freely move to its normal position within the joint.

When is Jaw Joint Arthrocentesis used?

  • Dislocation of the articular disk.
  • Limitations of mouth opening originating in the jaw joint.
  • Joint pain.

What does the treatment involve?

TMJ/Jaw Joint Arthrocentesis usually takes place under a General Ansthetic – this means you will be asleep for the entire procedure. While you are asleep, Dr. Bolourian introduces two specially designed small needles into the TMJ/Jaw Joint. One of these needles allows sterile saline to be pumped into the joint under pressure while the other needle allows the saline to drain out of the joint. After a thorough wash out of the joint, Dr. Bolourian will inject a small amount of a lubricating compound within the joint space which will also reduce the inflammation. While you are asleep, your lower jaw will often be manipulated in an attempt to encourage the TMJ/Jaw Joint disc back into its normal position and break down any adhesions within the jaw joint.

How will you feel after the operation?

The area in and around the TMJ/Jaw Joint is often uncomfortable for few days after the procedure. Dr. Bolourian will prescribe to you an anti-inflammatory and muscle relaxer for a specified period of time. There will be some swelling in front of your ear. You may also find it difficult to open your jaw for a few days or perhaps weeks.

Will I need another appointment?

You will need to return a few weeks after surgery to have your jaw joint checked by Dr. Bolourian and possibly adjust your splint. Also, you will need to continue with TMJ/Jaw Joint exercises and physical therapy as per Dr. Bolourians instructions.

What are the possible complications?

Complications after TMJ arthrocenthesis are rare and usually temporary.

Complications usually present in the immediate post-operative phase and are mostly associated with fluid collection and perhaps vascular injury.

  • Facial Muscle Weakness- This may cause inability to close the eye temporarily.
  • Temporary Numbness
  • Bleeding within the jaw joint.
  • Ear problems

What About TMJ surgery and bite Correction Surgery?

On fewer occasions there may be a need for surgical intervention. If you frequently go to an emergency room because you haven’t been able to close your mouth or if there is evidence of severe disk pathology you may be a candidate for TMJ surgery. Surgical options such as arthroscopy and open joint surgery are sometimes needed, but are reserved for severe cases. Dr. Bolourian does not consider TMJ surgery unless the jaw can’t open, is dislocated and non-reducible, has severe degeneration, or the patient has undergone other mentioned treatments unsuccessfully.