If you need further treatment, your dentist or GP may send you to an oral surgeon (also called an oral and maxillofacial surgeon), who specialises in surgical procedures in and around the entire face, mouth and jaw area.

What treatments are available for TMJ disorders?

Treatments for TMJ disorders range from simple self-help advice and conservative treatments to injections and surgery. Most experts agree that treatment should begin with conservative, non-surgical therapies first, with surgery left as the last resort. Many of the treatments listed below often work best when used in combination.

Basic treatments for TMJ disorders

Some basic, conservative treatments for TMJ disorders include:

• Apply moist heat or cold packs. Apply an ice pack to the side of your face and temple area for about 10 minutes. Do a few simple stretching exercises for your jaw (as instructed by your dentist or specialist). After exercising, apply a warm towel or flannel to the side of your face for about 5 minutes. Perform this routine a few times each day.
• Eat soft foods. Eat soft foods such as yoghurt, mashed potatoes, cottage cheese, soup, scrambled eggs, fish, cooked fruits and vegetables, beans and grains. In addition, cut foods into small pieces to decrease the amount of chewing required. Avoid hard and crunchy foods, like hard rolls, pretzels, raw carrots, and chewy foods, like caramels, and thick and large foods that require your mouth to open wide to fit.
• Take medications. To relieve muscle pain and swelling, try non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen which can be bought over-the-counter. Your dentist or GP can prescribe higher doses of these or other NSAIDs or other prescription medications for pain such as opioid analgesics. Muscle relaxants, especially for people who grind or clench their teeth, can help relax tight jaw muscles. Anti- anxiety medications can help relieve stress that is sometimes thought to aggravate TMJ disorders. Antidepressants, when used in low doses, can also help to reduce or control pain. Muscle relaxants, anti-anxiety drugs and antidepressants are available by prescription only.
• Low-level laser therapy. This is used to reduce the pain and inflammation as well as increase range of motion to the neck and in opening the mouth.
• Wear a splint or night guard. Splints and night guards are plastic mouthpieces that fit over the upper and lower teeth. They prevent the upper and lower teeth from coming together, reducing the effects of clenching or grinding the teeth. They also correct the bite by positioning the teeth in their most correct and least traumatic position. The main difference between splints and night guards is that night guards are only worn at night and splints are worn all the time. Your dentist or GP will discuss with you what type of mouth guard appliance you may need.
• Undergo corrective dental treatments. Replace missing teeth; use crowns, bridges or braces to balance the biting surfaces of your teeth or to correct a bite problem.
• Avoid extreme jaw movements. Keep yawning and chewing (especially gum or ice) to a minimum and avoid extreme jaw movements such as yelling or singing.
• Don't rest your chin on your hand or hold the telephone between your shoulder and ear. Practice good posture to reduce neck and facial pain.
• Keep your teeth slightly apart as often as you can to relieve pressure on the jaw. To control clenching or grinding during the day, place your tongue between your teeth.
• Learning relaxation techniques to help control muscle tension in the jaw. Ask your dentist about the need for physiotherapy or massage. Consider stress reduction therapy, including biofeedback

• Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles.
• Ultrasound. Ultrasound treatment is deep heat that is applied to the TMJ to relieve soreness or improve mobility.
• Trigger-point injections. Pain medication or anaesthesia is injected into tender facial muscles called "trigger points" to relieve pain.
• Radio wave therapy. Radio waves create a low level electrical stimulation to the joint, which increases blood flow. The patient experiences relief of pain in the joint.

Surgery for TMJ disorders

Surgery should only be considered after all other treatment options have been tried and you are still experiencing severe, persistent pain. Because surgery is irreversible, it is wise to discuss this thoroughly with your specialist to ensure you are happy with the proposed procedure.

There are three types of surgery for TMJ disorders: arthrocentesis, arthroscopy and open-joint surgery. The type of surgery needed depends on the precise problem.

• Arthrocentesis. This procedure is performed in the dental surgery under a general anaesthetic. It is undertaken for sudden-onset, closed-lock cases (restricted jaw opening) in patients with no significant prior history of TMJ problems. The surgery involves inserting needles inside the affected joint and washing out the joint with sterile fluids. Occasionally, the procedure may involve inserting a blunt instrument inside of the joint. The instrument is used in a sweeping motion to remove tissue adhesion bands and to dislodge a disc that is stuck in front of the condyle (the part of your TMJ consisting of the "ball" portion of the "ball and socket").
• Arthroscopy. Patients undergoing arthroscopic surgery for TMJ disorders are first given a general anaesthetic. The surgeon then makes a small incision in front of the ear and inserts a small, thin instrument that contains a lens and light. This instrument is linked up to a video screen, allowing the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMJ disorders, the surgeon may remove inflamed tissue or realign the disc or condyle.

Compared with open surgery, this surgery is less invasive, leaves less scarring and is associated with minimal complications and a shorter recovery time. Depending on the cause of the TMJ disorders, arthroscopy may not be possible, and open-joint surgery may be necessary.

• Open-joint surgery. Patients undergoing open-joint surgery are first given a general anaesthetic. Unlike arthroscopy, the entire area around the TMJ is opened so that the surgeon can get a full view and better access. There are many types of open-joint surgeries. This treatment may be necessary if:
• The bony structures that comprise the jaw joint are deteriorating
• There are tumours in or around your TMJ
• There is severe scarring or chips of bone in the joint

Compared with arthroscopy, open-joint surgery for TMJ disorders results in a longer healing time and there is a greater chance of scarring and nerve injury.