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The Problem With TMJ Surgery

Posted on 9/22/2014 by Dr. Martha E. Rich
A dental expert holding a model of the human skull and indicating where the temporomandibular joint is located I've been successfully treating TMJ disorders with conservative splint therapy, orthodontics, and reconstructive crown and bridge work for more than 25 years. During that time, I've encountered less than a handful of patients who could only be helped with joint surgery. I have, however, consulted with and treated dozens of patients who have been plagued with continuing pain and the inability to chew correctly following TMJ surgery on one or both joints.

Unlike splint therapy, orthodontics, and reconstructive crown work which all focus on gently encouraging the joints to find a better position on their own through repositioning the way the teeth fit together, joint surgery often physically forces the TMJs into a completely new anatomical position. There is no ability for the joint to ease back and forth between positions or make the minute adjustments so often required to adapt to the constantly changing landscape of the mouth. The joint is simply moved or shaved, and there is no way for it to move back if the new position is not ideal.

Forcibly moving the joint with surgery may help create more room for the disc to move freely and correctly, resolving pain and functional issues associated with locking and popping, but surgery almost never takes into consideration the most important function of the jaw: making the teeth fit together for chewing. Too often, I have heard clients recount stories of being told to simply stop chewing and stay on a soft diet for the rest of their lives when their teeth no longer fit together after TMJ surgery. A long-term soft or liquid diet is not ideal for anyone, nutritionally or otherwise. And for a person in their 30s, 40s, or 50s? Never chewing again is simply not a good enough answer.

Unfortunately, the inability to chew is not the only potential negative outcome of TMJ surgery. Some patients experience recurrence of pain symptoms, locking, and popping within a few years after the surgery. The most unfortunate cases I see are in patients who undergo surgery and then end up in the same pattern of symptom management that they were in before the treatment. These individuals find themselves back in an orthotic to control pain and locking, experience severe pain flare-ups several times per year, and require regular physical therapy, chiropractic adjustments, or massage therapy in just to maintain the most basic levels of function.

There are certainly circumstances where TMJ surgery may be the only answer, but those cases are extremely rare and usually involve some sort of trauma. The most successful case of TMJ surgery I have ever seen was a surgical unlocking of the discs done on a patient whose discs were displaced through a blow to the chin sustained during a bicycle accident. Again, these cases are the exception rather than the rule. I caution all my patients not to put themselves into the surgery category until all other treatment options have been ruled out or exhausted.

TMJ disorders exist on a broad spectrum of severity, with most cases being transient or easily managed with non-permanent changes to the the teeth or joints. In order to help you better understand this spectrum and the variety of non-surgical treatments available that may be of help, I've created a new resource entitled The Benefits of a Non-Surgical Approach to TMJ Dysfunction. I hope you will share this information with anyone you know who suffers with TMJ-related pain and dysfunction. As always, current or prospective patients are always encouraged to call or bring questions about their specific circumstances to their next regularly scheduled appointment.

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