Sometimes, the cause of a TMJ disorder is clear. For example, if you share a bed with someone, you probably know if you grind your teeth in your sleep, and if you do, it’s a safe bet that’s why your jaw hurts or feels stiff all the time. There are a couple of other usual suspects when it comes to TMJ disorders, but some cases can be more difficult to diagnose. Dental x-rays, CT scans, and MRIs can help pinpoint the root of the symptoms, identifying whether an issue is structural and determining which tissues it primarily affects. There is also a surgical procedure, sometimes used as a treatment for TMJ disorder, that can be used to help diagnose the root cause of the disorder as well. This procedure, called arthroscopy, uses a thin tube, called a cannula, that is inserted into the jaw juncture where an attached camera allows the oral surgeon to closely evaluate the area.

The temporomandibular joint, like any joint, consists of a ball and socket. The socket, called the fossa, is located in the skull, just in front of the ear; the ball, or condyle, is the tip of a bone in the lower jaw that fits into the fossa and allows this hinge to flexibly open and support the function of the jaw. The juncture of these bones is cushioned by a cartilaginous disc, and the whole mechanism is lubricated by synovial fluid. When arthroscopy is used as a treatment for TMJ disorder, its uses can vary slightly. The procedure may be used to release scar tissue that has adhered within the joint, to reshape bone and remove bone spurs, or to remove inflamed tissue or flush out infection, all with the end goal of helping the jaw move smoothly and painlessly and ending TMJ symptoms.

Arthrocentesis is another minimally invasive TMJ surgery, though it is also a diagnostic tool. Arthrocentesis is even less invasive than arthroscopy, relying on a pair of hypodermic needles to flush out the jaw joint with saline, rinsing out irritants and reducing pressure before relubricating the joint juncture with hyaluronic acid. Arthrocentesis treatments may also include hydrocortisone injections to manage the inflammation and pain of osteoarthritis. While both arthroscopy and arthrocentesis are outpatient procedures, arthroscopy uses general anesthesia and takes slightly longer, while arthrocentesis relies on local anesthesia and is usually completed in an hour or two.

Other TMJ surgeries, broadly known as open surgeries, are more involved and vary in their approach and their goals. Modified condylotomy is an outpatient procedure that addresses movement in the jaw with an intraoral incision that modifies the lower jawbone rather than the joint itself, with the goal of relieving pressure on the joint. Other open-joint surgeries approach the temporomandibular joint externally, with incisions directly in front of each ear that provide direct access to each joint. Arthroplastic procedures are used to treat severe conditions like excessive scarring or bone growth that inhibits motion, and fusion, or ankylosis of the bone, tissue, or cartilage in the joint; they’re also used in areas that can’t be reached arthroscopically. Impediments to the health and smooth function of the temporomandibular joints, like bone spurs and excess tissues, are surgically removed, and tissues are reshaped and smoothed; if needed, discs are repositioned or replaced. Some arthroplastic procedures require a brief stay in the hospital, while others allow the patient to go home the same day.

When the joint is severely degenerated, whether by injury, severe arthritis, tumors, or for another reason determined by you and your oral surgeon, it can be replaced with an artificial prosthetic joint in a total joint replacement procedure. While costly, total jaw replacement can drastically improve the quality of life for people with compromised or damaged jawbones. Any open-joint surgery comes with risks, and it’s important to discuss the risks and benefits with your dentist as you plan. Don’t be afraid to ask questions and follow instructions before and after your procedure to reduce your risks. You could be smiling a whole new smile in no time.

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