joint disorders / facial pain
The temporomandibular joint (TMJ) is a small hinge located in front of the ear where the skull and jaw meet, allowing movement of the jaw.
TMJ disorders are common. You can experience a wide variety of symptoms such as earache, headache, limited opening and closing of the mouth. When symptoms of TMJ problems appear, consult an oral and maxillofacial surgeon (OMS). Your OMS is in a good position to correctly diagnose the problem.
The diagnosis of TMJ disorders can be complex and may require different diagnostic procedures. Special imaging studies of the joints may be requested and may be referred to other dental or medical specialists or to a physical therapist.
Treatment can vary from dental and conservative medical care to complex surgery. Depending on the diagnosis, treatment may include short-term non-steroidal anti-inflammatory medications for pain and muscle relaxation, splint therapy, and even stress management advice. If the non-surgical treatment is unsuccessful or if there is obvious damage to the joints, surgery may be indicated. Surgery may include arthroscopy (the method identical to orthopedic procedures used to inspect and treat larger joints, such as the knee) or repair damaged tissue through a direct surgical approach.
Together with other non-surgical treatments, these medication options can help relieve the pain associated with TMJ disorders.
- Analgesics and anti-inflammatories. If over-the-counter pain medications are not enough to relieve TMJ pain, your doctor or dentist may prescribe stronger painkillers.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others), are a pillar of treatment.
- Tricyclic antidepressants These medications, such as amitriptyline, used to be used primarily for depression, but now they are sometimes used to relieve pain.
- Muscle relaxants These types of medications are sometimes used for a few days or weeks to help relieve the pain caused by TMJ disorders.
- When other methods do not help, your doctor may suggest procedures such as:
- Arthrocentesis: Arthrocentesis is a minimally invasive procedure that involves inserting small needles into the joint so that the fluid can be irrigated through the joint to eliminate waste and inflammatory by-products.
- Corticosteroid injections: In some people, injections of corticosteroids or botulinum toxin in the joint may be helpful. Frequently, the injection of botulinum toxin type A (Botox, others) into the jaw muscles used to chew can relieve the pain associated with TMJ disorders.
- TMJ arthroscopy: In some cases, arthroscopic surgery can be as effective in treating various types of TMJ disorders as open joint surgery. A small thin tube (cannula) is placed in the joint space, then an arthroscope is inserted and small surgical instruments are used for surgery. ATM arthroscopy has fewer risks and complications than open joint surgery, but it also has some limitations
- Modified condylotomy : Modified condylotomy (kon-dih-LOT-uh-mee) addresses TMJ indirectly, with surgery on the jaw, but not on the joint itself. It can be useful for the treatment of pain and if blockage occurs.
- Open joint surgery. If your jaw pain is not resolved with more conservative treatments and appears to be caused by a structural problem in the joint, your doctor or dentist may suggest open joint surgery (arthrotomy) to repair or replace the joint. However, open joint surgery involves more risks than other procedures and should be considered very carefully, discussing the pros and cons.
If your doctor recommends surgery, be sure to discuss the possible benefits and risks, and ask what your options are.
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