TMJ/Facial Pain | Louisiana OIS

What can I expect during my TMJ/facial pain consult at Louisiana Oral & Implant Surgery?

The primary purpose of your TMJ/facial pain consultation at Louisiana Oral & Implant Surgery is to determine if you could benefit from one of the treatments we offer in an attempt to decrease your pain and increase your mouth opening. Treatments offered by Louisiana OIS are listed and explained below. It is important to know that we are not a comprehensive TMD/facial pain center and the treatments we offer are limited to surgical management only. Not every patient is a good candidate for treatments we offer. There are many other available non-surgical treatments we do not offer. As an oral and maxillofacial surgeon, I do not provide the more conservative non-invasive methods of treatment such as night guards or long-term medication prescriptions. In most cases, it is prudent to exhaust all conservative measures prior to seeking surgical management.

What is the TMJ (temporomandibular joint)?

The TMJ is the joint which connects the lower jaw bone to the skull and allows for mouth opening and food chewing. The TMJ can be thought of as a ball and socket joint with the ball portion of the joint being your jaw bone (condyle) and the socket portion of the joint in your skull (fossa). As with many other joints in the body such as the knee, the TMJ contains a meniscus-like structure (known as a disk) between the ball and the socket to allow for smooth movement and to prevent bone on bone contact.

What is temporomandibular joint dysfunction (TMD)?

TMD is a non-specific term referring to pain and/or compromised function of the TMJ(s) or chewing muscles. One very important distinction to understand is that there are 2 different ways TMD/facial pain can arise: muscle pain and joint pain. Determining if your pain is caused by your muscles, your joint (TMJ) or both is important for developing an effective treatment plan.

What are the symptoms of TMD?

TMD can manifest itself in a variety of ways. If your problem is primarily a problem with the joint (TMJ) itself, your pain will be localized only to the area just in front of your ear(s). The most common symptoms of primary joint dysfunction include pain with opening, pain with chewing, and limited mouth opening.

If your problem is primarily a muscle problem (muscle overuse/inflammation), your symptoms will likely manifest with pain in other areas of your face, over your jaw muscles, and into your temple areas or neck.

If your problem involves the joints and muscles together, your symptoms may be a combination of the above.

Why do my TMJs click and/or pop when I open?

TMJ clicking/popping is caused by a condition called internal derangement. The TMJ can be thought of as a ball and socket joint with the ball portion of the joint being your jaw bone (condyle) and the socket portion of the joint in your skull (fossa). As with many other joints in the body such as the knee, the TMJ contains a meniscus-like structure (known as a disk) between the ball and the socket to allow for smooth movement and to prevent bone on bone contact. With joint overloading, age, or sometimes for reasons that are not known, the ligaments that hold this disk in its proper place (between the ball and socket) are stretched or damaged. When these ligaments are damaged the disk can become displaced from its normal position because it is no longer properly held in place. Usually this results in displacement of the disc forward in front of the condyle such that the disc is no longer situated between the ball and socket. In patients with disk displacement, the disk may slip back into its normal position between the ball and socket (disk reduction) during mouth opening. If you hear clicking and/or popping when you open and close your mouth, this is the sound of the disk slipping in and out of its proper position every time you open and close your mouth.

How does a displaced disk (internal derangement) cause TMJ pain?

When a TMJ disk is displaced forward (anteriorly) outside of its normal position (described above), this results in the tissue behind the disk being pulled into the space between the ball and socket (normally occupied by the disk). This tissue is not meant to be in this location and is not meant to bear the forces of chewing which are normally borne by the TMJ disk. This tissue becomes traumatized with chewing, which can result in pain in the joint.

What other problems can disk displacement (internal derangement) cause?

Other than pain, the main problem a displaced disk can cause for patients is limited mouth opening due to mechanical interference from the malpositioned disk.

What if my TMJs click and/or pop but I don't have any pain?

Many people have non-painful clicking or popping when they open their mouth. If the patient is pain-free and has no serious limitation of mouth opening, no treatment is necessary.

How does clenching and/or grinding your teeth relate to TMJ problems?

Frequent clenching/grinding/chewing muscle tightness is a common cause for TMJ problems due to muscle overuse. Muscle overuse can cause muscle problems and joint (TMJ) problems. First, clenching and grinding will cause muscle soreness. Just as any muscle in the body will become sore and inflamed when overused, the chewing muscles will become painful when used beyond their intended function.

Second, clenching and grinding will overload the Joint (TMJ), leading to joint damage, degeneration, and eventually disk displacement (internal derangement) as described above.

What treatment options for a primary joint (TMJ) problem are offered at Louisiana Oral & Implant Surgery?

If your evaluation reveals that a significant portion of your symptoms are due to problems in your joint(s) itself, several different treatment options are available (outlined below); however, the mainstay of treatment offered by Louisiana OIS is known as arthrocentesis

Arthrocentesis is a low-risk minor procedure which can provide significant relief of symptoms in about 80% of people with TMJ problems. Please see the arthrocentesis section of the website for additional information.

Arthrocentesis Link

What other treatment options are there for a primary joint (TMJ) problem (not offered at Louisiana Oral & Implant Surgery)?

Medications- Medications such as ibuprofen (Advil) and naproxen (Aleve) can be very effective in controlling your pain and symptoms when taken properly. These medications decrease inflammation.
Night/occlusal guard (splint)- Since many TMJ problems are caused by excessive clenching, grinding, or muscle tightness at night, a night/occlusal guard (splint) can be very effective in management of the condition. Wearing a night guard has been shown to decrease pressure (damage) on the TMJs during periods of clenching. A night guard will help protect your teeth from wear during periods clenching and grinding. It is important to note that it may take up to 6 weeks of wearing a night guard in order to begin to have relief.
Soft diet- Since TMJ pain can be caused by excess pressure on the joint, your diet may be contributing to the problem. In order to decrease loading on the TMJ, you may benefit from a soft diet which does not require vigorous chewing. It is also important to avoid gum chewing and habits such as nail or toothpick biting

What are the treatment options for a primarily muscle problem offered at Louisiana Oral & Implant Surgery?

The main treatment of muscle pain offered at Louisiana OIS is Botox. Botox is a medication commonly used for cosmetic purposes in order to decrease facial wrinkles. It does this by partially paralyzing muscles in the areas it is injected. Botox can also be very effective in treating muscular pain caused by clenching and grinding. Botox can lessen muscle activity, decrease muscle tightness, decrease clenching and decrease muscle pain very effectively. Approximately 80-90% of patients see significant relief from botox injections.

What other treatment options are there for a primary muscle problem (not offered at Louisiana Oral & Implant Surgery)?

Medications- Medications such as ibuprofen (Advil) and naproxen (Aleve) can be very effective at controlling your pain and symptoms when taken properly. These medications decrease inflammation.
Night/occlusal guard (splint)- Since many muscle problems are caused by excessive clenching, grinding, or muscle tightness at night, a night/occlusal guard (splint) can be very effective in management of the condition. A night guard is a custom plastic appliance created by your dentist that fits over your teeth at night. Wearing a night guard has been shown to decrease muscle activity which will decrease muscle inflammation. A night guard will help protect your teeth from wear during periods clenching and grinding. It is important to note that it may take up to 6 weeks of wearing a night guard in order to begin to have relief.
Soft diet- Since muscle pain is caused from overuse, your diet may be contributing to the problem. In order to decrease muscle use and pain, you may benefit from a soft diet which does not require vigorous chewing. It is also important to avoid gum chewing and habits such as nail or toothpick biting
Massage with warm moist heat- Lightly warming a moist towel in the microwave and then massaging your jaw muscles with the warm moist towel can help alleviate symptoms.

Will everyone who seeks treatment for their TMD find significant improvement?

While the vast majority of patients will benefit when performed in the correct setting, a promise of complete relief would be misleading. Unfortunately, no guarantee can be made that performing arthrocentesis or botox will significantly reduce a patient’s pain or other symptoms.

Will TMD ever get better on its own with no treatment?

Yes! Studies have shown that even with no treatment, many TMJ and muscle problems will resolve on their own within about 5 years.

Nickolas S. Maskas DDS, MD

337-888-4771