Dealing with TMJ Disorders
Your treatment options if you have Temporomandibular Disorders
Surgical Treatments continued...
That might mean opting for arthroscopic surgery to remove scar tissue and flush out the joint area, or athrocentesis, a procedure in which a needle is inserted into the joint to irrigate it and flush out debris.
“I would say that these are minimally invasive, and typically, the patients are either better or at least they’re not worse off,” Schiffman says. “Those typically are more than adequate. The more invasive treatments only increase the risk without a demonstrative improvement.”
One example of a more invasive surgery involves reshaping the disc or sewing it back into place. “In general, the surgery doesn’t seem to be highly successful at keeping the disc in place,” Schiffman says. “I want to point out, however, that oftentimes, patients do improve in [symptoms] such as pain. But if you want to try to make a joint normal surgically or nonsurgically -- frankly, there is no way.”
Despite drawbacks, Schiffman emphasizes that some patients can benefit from temporomandibular joint surgery, so it shouldn’t be ruled out if it’s genuinely worth a try. For example, he has seen patients whose jaws lock 20 to 30 times a day, he says. “In those cases, to not do surgery -- or at least not offer it to them as a viable option -- is not appropriate.”
Total jaw joint replacement may also be done on people with systemic joint diseases, such as rheumatoid arthritis, or if they have cancer or failed jaw joint surgeries. However, the National Institute of Dental and Craniofacial Research warns that surgery to replace or repair a jaw joint is controversial, irreversible, and should be avoided, if possible.
Finding Good Care
There’s no certified specialty in TMD either in medicine or dentistry, so how does one to find a good dentist or oral surgeon?
Some dentists are more skilled than their peers at treating TMD, Messina says. Ohrbach recommends looking for a dentist who has done residency training in TMD or facial pain problems at a dental school. A university-affiliated dental clinic that treats TMD may be another good source of care, he says.
If needed, ask a good dentist for a referral to an oral and maxillofacial surgeon, Messina says. Be aware that not all of these surgeons do temporomandibular joint surgeries, he adds. Laskin suggests that patients be sure to look for a surgeon who is board-certified.
Universities are also a good place to find an oral surgeon. “Typically, the university centers are the ones that are the most up to date on the latest procedures or are aware of whom they’ve trained,” Schiffman says.