The temporomandibular joint (TMJ) is an anatomical structure that connects the lower jaw to the skull on either side of the head. It is composed of bone, muscle, ligaments and cartilage. There are disorders and parafunctional habits that can affect the joint specifically as well as the surrounding anatomy of the head and neck.

Patients may require TMJ treatment when the structures that make up the joint space start to deteriorate. This can cause pain, limit jaw movement, lead to popping and clicking, affect diet and speech, induce migraines and force the teeth out of alignment. To avoid some of the more serious symptoms, it is important to detect and treat TMJ problems early.

Dr. Pierse provides TMJ management and treatment in a highly conservative manner. Since TMJ disorders can present in many different ways, he uses a patient-specific approach in each case. The treatment options he offers can range from palliative care to full custom joint reconstruction. Dr. Pierse works closely with TMJ specialists, physical therapists and pain management professionals to help patients relieve discomfort, restore joint function and improve their quality of life.

Understanding TMJ Disorders

TMJ problems have several root causes. One of the most common problems is when patients develop a habit of clenching or grinding their teeth. This puts undue pressure on the TMJ and damages the structures of the joint space over time. Other potential causes of joint deterioration include pathology, disease, acute or chronic trauma and arthritis.

Patients may be suffering from a TMJ disorder if they are experiencing symptoms such as soreness or stiffness in their jaw and neck; headaches; clicking or popping as they move their lower jaw; difficulty opening their mouth (trismus); teeth that no longer align properly and increased wear of the dentition. Depending on the degree of damage to the joint, patients may benefit from pain management and physical therapy, or they may be candidates for surgical intervention.

Progression of TMJ Treatment

1. Palliative Therapy

Dr. Pierse’s initial approach to TMJ disorders is to help patients relieve muscle spasms and joint pain. This includes a combination of medical management, dietary restriction, warm compresses to the affected areas and physical therapy. Often, patients can improve their symptoms by taking steps such as resting their jaw or wearing a lab-processed mouth guard to reduce the effects of clenching and grinding. If symptoms persist, Dr. Pierse will recommend diagnostic imaging (a CT scan or MRI) to assess hard and soft tissue pathology.

2. Arthrocentesis

Chronic damage to the TMJ and its related structures can cause severe inflammation inside the joint space. This can limit the range of motion of the lower jaw. Dr. Pierse may perform an arthrocentesis to address these symptoms. This procedure flushes the joint space in an attempt to remove inflammation, thus reducing pain. It can be performed either under IV sedation at Precision Oral and Maxillofacial Surgery or in a hospital setting under general anesthesia.

3. TMJ Disc Plication

One of the structures that comprise the TMJ is a disc made of cartilage that cushions the joint as the lower jaw moves. If this disc shifts out of position, patients may experience severe pain, popping or clicking in the joint space and trismus. A plication procedure may solve this problem. During the surgery, Dr. Pierse sutures the cartilage in its appropriate position to alleviate pain, increase the patient’s range of motion and improve the overall function of the joint. This procedure is performed in a hospital setting under general anesthesia.

4. Custom Joint Reconstruction

Dr. Pierse has trained extensively and is certified in custom joint reconstruction. He recommends this procedure only when previous attempts at treating the joint space fail to provide improvement. The procedure may also benefit syndromic patients, patients with a history of trauma or patients with pathology. Prior to the surgery itself, the custom joint is fabricated specifically for the patient based on clinical information and 3D imaging. Dr. Pierse completes the surgery in a hospital setting with patients under general anesthesia. Typically, patients remain in the hospital for 24-72 hours after the procedure for observation and pain management.

With expert care and a collaborative approach, patients with TMJ disorders can get the treatment they need for improved comfort and function. Dr. Pierse invites patients to schedule an appointment with Precision Oral and Maxillofacial Surgery to learn more about both non-surgical and surgical solutions.

Contact Precision Oral and Maxillofacial Surgery online or by phone at Phoenix Office Phone Number (623) 518-2325.