Dealing with TMJ Disorders
Your treatment options if you have Temporomandibular Disorders
Comparing Nonsurgical and Surgical Treatments continued...
In the past, too many people were sent to surgery right away, Ohrbach says. Since those days, he says, “we’ve learned that displaced discs and clicking joints and even locking joints can largely be managed...through nonsurgical treatments.”
Indeed, some research backs up that approach. In one 2007 study published in the Journal of Dental Research, scientists found that patients with jaw locking from a permanently displaced disc fared equally well with nonsurgical versus surgical treatment.
“We took patients with the worst joint condition, where the jaw was locked and they couldn’t open [it] and had very severe pain and limitations with eating,” says Eric L. Schiffman, DDS, MS, an associate professor and director of the division of TMD and orofacial pain at the University of Minnesota, who led that study.
In the study, 106 patients were randomly assigned to receive “medical management” (which included home-based self-care, short-term medications, splints, physical therapy, and visits with health psychologists to help them with relaxation and oral habits), or to receive medical management plus surgery.
“We found that only 5% of the people in the nonsurgical group ever needed surgery and that the surgical group really didn’t do any better than the nonsurgical group over a 5-year period,” Schiffman says. “We thought that surgery might make the joint more normal and in the vast majority of cases, it doesn’t.” Those findings have helped to guide how health professionals currently treat TMD, he says.
However, if a patient has exhausted nonsurgical treatments and still has significant pain, it might be time to bring an oral surgeon into the treatment plan, experts say.
If surgery is being considered, it should be reserved for those with true jaw joint disorders, not jaw muscle disorders, according to Daniel M. Laskin, DDS, MS, a professor in the Virginia Commonwealth University department of oral and maxillofacial surgery and a spokesman for the American Association of Oral and Maxillofacial Surgeons. “The patients who have muscle problems should never have surgery,” he says.
Even then, only some patients with a joint disorder need surgery -- not all of them, Laskin says.
Two joint disorders are the most common, Laskin says: internal derangement, in which the disc within the jaw joint slips from its normal position, and degenerative joint disease.
“Even those, you start out trying to treat them nonsurgically,” Laskin says. Schiffman agrees and usually recommends at least three months of nonsurgical treatment for disc displacement or degenerative joint disease before considering surgery.
Many experts urge patients to get a second independent opinion before having any surgery on the jaw joint.
If a patient decides on surgery, Schiffman offers this rule of thumb: “Keep it as simple as possible.”