Conservative care is successful for the vast majority of TMD patients, however for a small number ( 5% of patients with disc displacements) surgical intervention maybe helpful. There are very few Oral Surgeons who routinely perform TMJ surgery. We have access to them on our team when needed.
TMJ surgery is most commonly recommended for patients with persistent limited opening or remaining pain from arthritis . Most of the time this surgery can be performed with minimally invasive techniques ( arthroscopy) without incision over the joint.
Bite therapy for TMJ
Decades ago, bad bites ( malocclusions) causing misalignment of the jaws, were thought to be the cause of TMD and most patients were treated with dental treatment to find some “ideal jaw position”.
This involved tooth grinding, orthodontics, crowns placed on most of the teeth in the mouth, or even corrective jaw surgery.
Unfortunately, some dentists still follow this philosophy of treatment.
It is known that in people who grind or clench a malocclusion or a change in bite can increase these forces to the TMJs. We also know that TMJ disorders such as joint inflammation, or arthritis can alter the bite. Most of the time these changes are temporary and resolve after conservative care, however in some patients the bite may need to corrected. It is important to note that the change in the bite was caused by the TMD not the other way around.
It is now the standard of care that no dentistry should be performed to treat TMD until the patient has completed conservative care and has minimal pain and normal jaw function!