Oral Surgery/TMJ/TMD

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Question
QUESTION: Good day doctor, Is there an effective treatment or option that works in restoring correct movement and function of the Jaw joint..
I was formerly a singer by profession but can no longer sing because of this problem. Is there still hope for me or do I have to live this way forever?
most information researched online seems to be against TMJ surgery but still doesn't say if it can be cured


thank you, anxiously awaiting your prompt reply

ANSWER: Sonny - You are correct that many doctors state that they are against TMJ surgery.  That is not completely true.  There are a significant number of board certified oral and maxillofacial surgeons in the United States and in Europe who have done surgery with many regaining full functioning.   Where you live, I'm not sure if there are skilled surgeons, but if you are interested in being examined by a skilled surgeon, I will be happy to send you names of surgeons.

So you can be helped.

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QUESTION: Are most unsuccessful TMJ surgery cases for internal derangement high risk for degenerative joint disease?

ANSWER: Sonny - Internal derangement is a degenerative process.  Internal derangement of the joint produces inflammation within the TMJ and other joints, often initially by the production of inflammatory fluids.  A common and initial approach to TMJ and other joints with a build up of fluids is arthrocentesis.  This procedure removes the inflammatory fluids. Some doctors just irrigate the joint while others irrigate and then add lubricating and anti-inflammatory fluids.

With TMJ surgery, like any joint surgery in the body, entering into a joint space via surgery can produce an inflammatory reaction with a secondary degenerative joint problem or an accentuation of one present prior to the surgery.  Is that a reason not to do surgery?  It all depends on the cause.  If the internal derangement created a situation where normal joint functioning, such as, chewing, eating and talking are inhibited then TMJ surgery is necessary and yes any pre-existing degenerative joint problem can be accentuated or corrected.

Degenerative joint disease is actually osteoarthritis. People with osteoarthritis of any joint can produce pain and a limitation of function.  Osteoarthritis is a term used to describe the loss of articular cartilage at the end of the bone.  In the TMJ there is no articular cartilage attached to the bone, but there is a cartilage, called the meniscus, that sits as a sliding cushion between the jaw and the skull in the depth of the TMJ.  Damage to the meniscus from trauma or wear can produce changes to the condyle of the jaw bone or osteoarthritis.  It is important to know that when TMJ surgery is unsuccessful trauma to the internal aspects of the cartilage and bones can be accentuated.  For that reason, after surgery, especially if it is unsuccessful and yet the surgeon did not produce excessive damage to the joint during surgery, the patient needs to take steps backwards.  That means a very soft diet, use of a completely balanced occlusal guard and probably anti-inflammatory medications.  The joint needs to rest and it must completely heal, either good or bad to see the joint after complete healing.  At that time new radiological exams must be done and the surgeon needs to sit with other skilled surgeons to come up with a plan.  Although the surgeon who did the surgery might have been highly skilled, other surgeons might have seen similar situations and hopefully dealt with them successfully or, at least, cause healing to occur so some functioning is possible.

Sorry to write such a long answer, but the TMJ, as I am sure you know by now, is a joint that is used constantly and is fraught with situations that can arrive in an attempt to heal it.  I hope a doctor can help you, but if yours cannot help you, seek treatment elsewhere.


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

QUESTION: Can normal TMJ function be restored without disc repositioning?

Answer
Sonny -  Sorry for the delay, but I've been ill.  TMJ problems with disc position problems sometimes resolves on its own. A soft diet and an attempt to reduce any stress placed on the joint can sometimes resolve the entire situation.

Look it just happens with a little time for some people.  You can wait and see if it gets better, but stay on a soft diet and limit jaw function.  That alone, in some situations, reduces inflammation within the joint and the disc just repositions itself.  I hope it gets better on its own.

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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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