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Oral Surgery/Bone spurs in TMJ

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QUESTION: I have had constant crepitus when chewing the past 6 weeks. As the day progresses, I get increasing pain and throbbing in my joint. At times it pops and temporarily locks. I have had to modify the texture of my food due to pain. Sometimes, when I eat, I have to put pressure on the TMJ with my hand. I had an X-ray that showed flattening of part of the joint and bone spurs. The allignment of my teeth are fine.  I am going to have an MRI to see the condition of the disc.  What are the pros and cons of surgery?

ANSWER: Amy - Amy, if you have bone spurs, the spurs will gradually destroy the cartilage in the joint and that puts excess forces of the jaw striking the tissues in the joint.  These forces will start breaking down the tissues further.  

The main pros of the surgery is to smooth out the spurs and allow for a smooth working joint and hopefully not wearing out the surfaces in the joint.  The main cons are minimal if the surgeon is a skilled board certified oral and maxillofacial surgeon.  One of the main factors in accentuating joint problems is muscle tightness and spasming of the jaw muscles.  It is very important, before any surgery is performed, that the jaw muscles are as relaxed as they can be.  The surgeon needs to work at it with a bite appliance to reduce pressure on the joint and at the same time relax the muscles.  

Often when muscle relaxation occurs, the joint feels less pressure and less discomfort.  The relaxation of the muscles will accentuate and promote better healing if surgery is performed.

I wish you well and hope you will be pain free soon.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response. The surgeon is a board certified Oral surgeon who was recommended by my dentist. Both my husband and I had used the Oral Surgeon about 4 years ago for implants which were successful.  The Oral Surgeon did discuss a splint to wear at night to reduce the pressure on the joint.   I have been reading literature which indicates that TMJ surgery should be the absolute last resort as your joint will eventually accommodate and the pain will improve.  The literature seems to indicate that surgery is controversial as there is a lack of evidence based research and a failed surgery can be disastrous.   This is making me quite nervous.  

http://www.tmj.org/site/page?pageId=269
http://portlandtmjclinic.com/treatments/managing-the-arthritic-tmj

Answer
Amy -  Let me just tell you that I don't disagree that some TM joints recontour and heal or at least feel better with time.  Some however do not, in fact, some joints progress going down hill and the joint freezes and the patient will not be able to open and close at all or able to open slightly.  

I think it is understandable that you want to avoid surgery.  I would suggest that you might feel better about trying to relax the jaw muscles first and see if that relieves some of the pressure and pain.  If, the pain continues and or gets worse, then surgery might be your only option.  

So I suggest that you ask the surgeon to fabricate an appropriate appliance that relaxes the muscles and gives you a balanced bite.  If he chooses not to, then speak with your dentist about either fabricating one himself or referring you to a dentist who is skilled in TMJ treatment.

I wish you well and hope you become comfortable no matter which method is used.  If you have any additional questions, feel free to contact me.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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