TM disorder: Should I have surgery for jaw pain?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

TM disorder: Should I have surgery for jaw pain?

Get the facts

Your options

  • Have surgery to correct temporomandibular disorder.
  • Continue to use other treatments.

Key points to remember

  • Surgery for temporomandibular (TM) disorder doesn't guarantee a cure, and it can make a jaw joint problem worse. It is considered a last resort. Whenever possible, it's best to preserve the normal joint structure, rather than cutting, removing, or replacing any part of it.
  • Most people with TM disorders get better with simple nonsurgical treatment.
  • If home treatments such as resting the jaw and jaw exercises don't work, you can try several months of wearing a bite guard or mouth guard at night and trying other nonsurgical measures to relax your jaw muscles.
  • Flushing out the joint using arthrocentesis—injecting fluid into the joint with a needle—offers a good chance of improving how well the joint works, without surgery.
  • Arthroscopic surgery —which uses a few small cuts or incisions instead of one large one—may work better than arthrocentesis if the problem is caused by scar tissue blocking the TM joint.
  • If you have a disabling structural problem, bone surgery that creates more space within the TM joint may help, but it is risky.
FAQs

What are TM disorders?

The jaw joint, or TM joint, connects the lower jawbone to the skull. Common symptoms of TM disorders include:

  • Pain in your jaw when you move it.
  • Pain or tenderness in the muscles of your face, ear, head, neck, or shoulders.
  • Headaches.
  • Clicking, popping, or cracking sounds when you move your jaw.
  • Inability to open your mouth all the way.
  • A jaw that locks in an open or closed position.

Most cases of TM disorder are mild. Out of 100 people who have it, 85 to 90 get better without surgery.1 This means that 10 to 15 of those people don't get better without surgery.

What types of surgery are used to treat TM disorders?

In arthroscopic surgery, the doctor inserts tiny surgical tools and a camera into a few small cuts in your jaw. It is the type of surgery most often used for TM disorders. It is used to:

  • Remove scar tissue and cartilage that is too thick.
  • Reshape parts of the jawbone.
  • Reposition the articular disc, which cushions the ball and socket of the jaw joint.
  • Tighten the joint to limit movement.
  • Flush out the joint.
  • Insert an anti-inflammatory medicine.

In open-joint surgery, the doctor makes a large cut or incision that exposes the joint. It is used when:

  • There are bony growths in the jaw joint, which are hard to reach with arthroscopic surgery.
  • There are complications from a previous surgery.
  • The joint is fused together by bony growth.
  • The joint can't be reached with arthroscopic surgery.

Why might your doctor recommend surgery?

Surgery is rarely used to treat TM disorders. Your doctor may recommend surgery if both of the following are true:

  • Other treatments have not worked, and your jaw pain has become so bad that you can't live your life normally.
  • There are specific, severe structural problems in your jaw joint.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have surgery Have surgery
  • Depending on the type of surgery, you may or may not be asleep during the surgery.
  • Depending on the type of surgery, you may or may not stay in the hospital for a day or two.
  • After surgery, you may start physical therapy within 48 hours.
  • Your jaw movement may be limited for at least a month, and you may need to eat only liquid and soft foods for a while.
  • Arthroscopic surgery can work well for those who don't get better without surgery.2
  • Bone surgery that creates more space within the TM joint may help if you have a disabling structural problem.
  • Surgery does not guarantee a cure.
  • Surgery could make your TM disorder worse.
  • After surgery, you may not be able to open your mouth as wide as you could before.
Don't have surgery Don't have surgery
  • You keep trying nonsurgical treatment like stress reduction, joint rest, jaw exercises, ice, use of a dental splint, or medicine.
  • You may choose to have arthrocentesis, where the doctor uses a needle to inject fluid into your jaw joint.
  • Out of 100 people who have TM disorder, 85 to 90 get better without surgery.1 This means that 10 to 15 of those people don't get better without surgery.
  • Arthrocentesis successfully treats a painfully locked jaw in 94 out of 100 people who have it done.3
  • There are no risks or side effects with home treatments.
  • With arthrocentesis, more fluid may form in the joint, or you may have infection or bleeding. But these problems are rare.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about surgery for temporomandibular disorder

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Although I have severe symptoms, they are new. I am treating this TM disorder by eating pureed foods, using medicine for muscle spasm and pain, and wearing a dental splint, and soon I'll be starting jaw exercises.

Ann, age 35

My doctor and I have decided to use arthroscopy to clean out my joint area, because there's stuff in there that's in the way and I can't open my mouth very far. She says that I have a good chance of that working as long as I do some physical therapy afterwards. I'm going to give it a try.

Bill, age 27

I considered surgery years ago when my TM symptoms got severe a couple of times, but I've learned how to manage the condition. I have managed my TM disorder for over 10 years now by not overtaxing my jaw, doing jaw stretches, wearing a dental splint when I'm under stress and grind my teeth at night, and using medicine when muscle spasm becomes a problem. It'll never be "right" again, but I'm afraid that surgery would make it worse!

Karen, age 40

Apparently, my rheumatoid arthritis has broken down my jawbone enough that only reconstructive surgery can fix it. I hate the idea of surgery, but I'm in such pain that I can barely use my jaw anymore.

Terry, age 55

If you need more information, see the topic Temporomandibular (TM) Disorders.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

I am desperate to find something that will give me use of my jaw.

I don't like the idea of having surgery on such an important joint.

More important
Equally important
More important

I'm ready to try surgery even if there's no guarantee it will help.

I don't want surgery if I can't be sure it will help.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is surgery a good treatment choice for most people with TM disorder?

  • Yes No, surgery is rarely used to treat TM disorders. It does not guarantee a cure, and it can further damage the joint.
  • No You're right. Surgery is rarely used to treat TM disorders. It does not guarantee a cure, and it can further damage the joint.
  • I'm not sure You may want to go back and read "Key points to remember." Surgery is rarely used to treat TM disorders. It does not guarantee a cure, and it can further damage the joint.
2.

In most cases, is it best to leave the joint as it is, rather than cutting, removing, or replacing any part of it?

  • Yes That's right. It's best to leave the joint as it is. Surgery should be considered a last resort for TM disorders.
  • No Sorry, but this is the wrong answer. It's best to leave the joint as it is. Surgery should be considered a last resort for TM disorders.
  • I'm not sure It may help to go back and read "Key points to remember." It's best to leave the joint as it is. Surgery should be considered a last resort for TM disorders.
3.

Is arthrocentesis (flushing out the joint) a better choice than arthroscopic surgery when scar tissue is blocking the TM joint?

  • Yes No, that's the wrong answer. Arthroscopic surgery may work better than arthrocentesis if the problem is caused by scar tissue blocking the TM joint.
  • No You're right. If the problem is caused by scar tissue blocking the TM joint, arthroscopic surgery may work better than arthrocentesis.
  • I'm not sure It may help to go back and read "Key points to remember." Arthroscopic surgery may work better than arthrocentesis if the problem is caused by scar tissue blocking the TM joint.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Jeannette Curtis
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Steven K. Patterson - Dentistry

References
Citations
  1. Scrivani SJ, et al. (2008). Temporomandibular disorders. New England Journal of Medicine, 359(25): 2693–2705.
  2. Reston JT, Turkelson CM (2003). Mega-analysis of surgical treatments for temporomandibular articular disorders. Journal of Oral and Maxillofacial Surgeons, 61(1): 10–12.
  3. Barkin S, Weinberg S (2000). Internal derangements of the temporomandibular joint: The role of arthroscopic surgery and arthrocentesis. Journal of the Canadian Dental Association, 66: 199–203.

TM disorder: Should I have surgery for jaw pain?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have surgery to correct temporomandibular disorder.
  • Continue to use other treatments.

Key points to remember

  • Surgery for temporomandibular (TM) disorder doesn't guarantee a cure, and it can make a jaw joint problem worse. It is considered a last resort. Whenever possible, it's best to preserve the normal joint structure, rather than cutting, removing, or replacing any part of it.
  • Most people with TM disorders get better with simple nonsurgical treatment.
  • If home treatments such as resting the jaw and jaw exercises don't work, you can try several months of wearing a bite guard or mouth guard at night and trying other nonsurgical measures to relax your jaw muscles.
  • Flushing out the joint using arthrocentesis—injecting fluid into the joint with a needle—offers a good chance of improving how well the joint works, without surgery.
  • Arthroscopic surgery —which uses a few small cuts or incisions instead of one large one—may work better than arthrocentesis if the problem is caused by scar tissue blocking the TM joint.
  • If you have a disabling structural problem, bone surgery that creates more space within the TM joint may help, but it is risky.
FAQs

What are TM disorders?

The jaw joint, or TM joint , connects the lower jawbone to the skull. Common symptoms of TM disorders include:

  • Pain in your jaw when you move it.
  • Pain or tenderness in the muscles of your face, ear, head, neck, or shoulders.
  • Headaches.
  • Clicking, popping, or cracking sounds when you move your jaw.
  • Inability to open your mouth all the way.
  • A jaw that locks in an open or closed position.

Most cases of TM disorder are mild. Out of 100 people who have it, 85 to 90 get better without surgery.1 This means that 10 to 15 of those people don't get better without surgery.

What types of surgery are used to treat TM disorders?

In arthroscopic surgery, the doctor inserts tiny surgical tools and a camera into a few small cuts in your jaw. It is the type of surgery most often used for TM disorders. It is used to:

  • Remove scar tissue and cartilage that is too thick.
  • Reshape parts of the jawbone.
  • Reposition the articular disc, which cushions the ball and socket of the jaw joint.
  • Tighten the joint to limit movement.
  • Flush out the joint.
  • Insert an anti-inflammatory medicine.

In open-joint surgery, the doctor makes a large cut or incision that exposes the joint. It is used when:

  • There are bony growths in the jaw joint, which are hard to reach with arthroscopic surgery.
  • There are complications from a previous surgery.
  • The joint is fused together by bony growth.
  • The joint can't be reached with arthroscopic surgery.

Why might your doctor recommend surgery?

Surgery is rarely used to treat TM disorders. Your doctor may recommend surgery if both of the following are true:

  • Other treatments have not worked, and your jaw pain has become so bad that you can't live your life normally.
  • There are specific, severe structural problems in your jaw joint.

2. Compare your options

  Have surgery Don't have surgery
What is usually involved?
  • Depending on the type of surgery, you may or may not be asleep during the surgery.
  • Depending on the type of surgery, you may or may not stay in the hospital for a day or two.
  • After surgery, you may start physical therapy within 48 hours.
  • Your jaw movement may be limited for at least a month, and you may need to eat only liquid and soft foods for a while.
  • You keep trying nonsurgical treatment like stress reduction, joint rest, jaw exercises, ice, use of a dental splint, or medicine.
  • You may choose to have arthrocentesis, where the doctor uses a needle to inject fluid into your jaw joint.
What are the benefits?
  • Arthroscopic surgery can work well for those who don't get better without surgery.2
  • Bone surgery that creates more space within the TM joint may help if you have a disabling structural problem.
  • Out of 100 people who have TM disorder, 85 to 90 get better without surgery.1 This means that 10 to 15 of those people don't get better without surgery.
  • Arthrocentesis successfully treats a painfully locked jaw in 94 out of 100 people who have it done.3
What are the risks and side effects?
  • Surgery does not guarantee a cure.
  • Surgery could make your TM disorder worse.
  • After surgery, you may not be able to open your mouth as wide as you could before.
  • There are no risks or side effects with home treatments.
  • With arthrocentesis, more fluid may form in the joint, or you may have infection or bleeding. But these problems are rare.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Temporomandibular (TM) Disorders.

Personal stories about surgery for temporomandibular disorder

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Although I have severe symptoms, they are new. I am treating this TM disorder by eating pureed foods, using medicine for muscle spasm and pain, and wearing a dental splint, and soon I'll be starting jaw exercises."

— Ann, age 35

"My doctor and I have decided to use arthroscopy to clean out my joint area, because there's stuff in there that's in the way and I can't open my mouth very far. She says that I have a good chance of that working as long as I do some physical therapy afterwards. I'm going to give it a try."

— Bill, age 27

"I considered surgery years ago when my TM symptoms got severe a couple of times, but I've learned how to manage the condition. I have managed my TM disorder for over 10 years now by not overtaxing my jaw, doing jaw stretches, wearing a dental splint when I'm under stress and grind my teeth at night, and using medicine when muscle spasm becomes a problem. It'll never be "right" again, but I'm afraid that surgery would make it worse!"

— Karen, age 40

"Apparently, my rheumatoid arthritis has broken down my jawbone enough that only reconstructive surgery can fix it. I hate the idea of surgery, but I'm in such pain that I can barely use my jaw anymore."

— Terry, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

I am desperate to find something that will give me use of my jaw.

I don't like the idea of having surgery on such an important joint.

More important
Equally important
More important

I'm ready to try surgery even if there's no guarantee it will help.

I don't want surgery if I can't be sure it will help.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is surgery a good treatment choice for most people with TM disorder?

  • Yes
  • No
  • I'm not sure
You're right. Surgery is rarely used to treat TM disorders. It does not guarantee a cure, and it can further damage the joint.

2. In most cases, is it best to leave the joint as it is, rather than cutting, removing, or replacing any part of it?

  • Yes
  • No
  • I'm not sure
That's right. It's best to leave the joint as it is. Surgery should be considered a last resort for TM disorders.

3. Is arthrocentesis (flushing out the joint) a better choice than arthroscopic surgery when scar tissue is blocking the TM joint?

  • Yes
  • No
  • I'm not sure
You're right. If the problem is caused by scar tissue blocking the TM joint, arthroscopic surgery may work better than arthrocentesis.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Jeannette Curtis
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Steven K. Patterson - Dentistry

References
Citations
  1. Scrivani SJ, et al. (2008). Temporomandibular disorders. New England Journal of Medicine, 359(25): 2693–2705.
  2. Reston JT, Turkelson CM (2003). Mega-analysis of surgical treatments for temporomandibular articular disorders. Journal of Oral and Maxillofacial Surgeons, 61(1): 10–12.
  3. Barkin S, Weinberg S (2000). Internal derangements of the temporomandibular joint: The role of arthroscopic surgery and arthrocentesis. Journal of the Canadian Dental Association, 66: 199–203.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Updated: January 13, 2010

Author: Jeannette Curtis

Medical Review: Kathleen Romito, MD - Family Medicine & Steven K. Patterson - Dentistry

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