Temporomandibular Joint Dysfunction


Facial and jaw pain is common and can be very debilitating but there are a wide range of ways we can help patients manage and overcome the issue.

The symptoms for temporomandibular joint dysfunction (TMD)- to give it the technical name – can include pain and tenderness in the jaw, pain in and around the ear, a difficulty chewing, the jaw locking and aching facial pain.

Your symptoms may mimic toothache, sinusitis, headache and neck pain, and therefore initial treatments may not have resolved the issue which can heap concern onto the discomfort.

Mr.Komath sees and treats a lot of patients with TMD and know they can suffer considerable pain which makes it so important to have the right guidance and management of the condition so that we can return you to a symptom-free life.

The problems are centred in the temporomandibular joint which acts like a sliding hinge connecting the jaw-bone to the skull on both sides of the face. Cartilage and a shock-absorbing disc act as buffers between both sets of bone but, if they wear out, the joint does not function cleanly and some patients often hear a clicking sound when they move their jaw around.

Pain can be generated by a combination of factors including jaw injury, arthritis, genetics or a propensity to grind your teeth.Mr.Komath has a depth of clinical experience in treating all facets of TMD and, in most cases, it can be cured with structured management and surgery is usually a last resort.


There are simple measures that can help many cases such as eating a soft diet and resting the jaw by avoiding activities such as gum chewing, teeth grinding, wide yawning and pencil chewing. In most cases, the TMD is not progressive although symptoms, and the pain, may fluctuate as it is brought under control.

Pain killers along with ice packs or a warm flannel, applied to area experiencing pain, and light massaging of the muscles can be very effective. We also advise and guide patients in improving their relaxation and sleep methods to encourage better self management to reduce the risk of TMD flaring up.

Each case is particular to an individual and we advise setting realistic targets to control the physical stress contributing to the pain while also understanding that it can take a huge emotional toll on a patient. We have the skills and experience to minimise its impact and provide a well-paced recovery.

Some patients may experience acute and severe symptoms which require a short course of sedatives or a neuropathic analgesic. There may also be a need for some cognitive behavioural therapy (CBT) to help with the anxiety the condition can cause.

We often work with the physiotherapy department to provide additional help with passive jaw stretching exercises, posture training and muscle relaxation protocols such as massage or acupuncture.

Chronic and worsening symptoms that have endured for more than three months along with unexplained persistent pain or trauma injury will obviously require more specialist therapies with X-rays and MRI scans needed. This could result in the need to consider injections to relieve the pain, minimally invasive procedures to irrigate and clean the joint or keyhole surgery.

But all of these methods are discussed in full detail with the patient and are only suggested after other routes have been explored.

Jaw pain can be very distressing and it is often difficult to appreciate how corrosive it can be both physically and psychologically.

An early diagnosis will always help us provide advice that can manage the symptoms and restore you to health.

Many patients may be reluctant to seek help, dismissing the pain as something like toothache or ear-ache, but it is vital that they see a doctor or dentist in the first instance and then consult a specialist.

We have the experience, the expertise, and facilities to treat jaw pain swiftly and effectively and, with that, we can attempt to alleviate the distress it causes.


Post-Operative Instructions following Jaw Joint Arthroscopy

 

What can I expect after surgery?

  • Following surgery, you will spend a brief period of time in the recovery room. Once you have recovered from the anaesthesia, you will be discharged with the appropriate prescriptions and home care instructions below. You must arrive with a responsible adult who will drive you home and care for you after the surgery.
  • Swelling is normal after surgery and may take 5-7 days to improve.
  • You may experience a temporary change in your bite. If so, this will
    usually resolve in 5-7 days.
  • You may notice clicking in your jaw joint that was not present before.
    This may be normal and is not a cause for concern.
  • You may have numbness and possible temporary paralysis of the face on
    the side of the surgery. This is usually caused by local anaesthetic (numbing medication) administered for your comfort and should only last for a few hours.

What are my post-operative instructions?

  • Apply ice packs to the affected side of the face for the first 12-24 hours.
  • While in bed, keep your head elevated with 2-3 pillows to minimise
  • Resorbable sutures (Stitches) are placed over your incisions. These
    stitches will dissolve so there is no need to remove any stitches.
  • You may shower anytime. To dry, lightly pat your face with a towel
    instead of rubbing it.
  • After the first 48 hours, you may apply warm heat (ie. heating pads or
    microwave a wet cloth) to the jaw muscles and temples as needed for comfort.

 

What should my activity level be?

  • Avoid any strenuous physical activity for 1 week.
  • You may return to school or light duty work (non-physical labor) within a
    week of the surgery or as tolerated per your symptoms.

What should my activity level be?

Begin jaw-stretching exercises as soon as possible after surgery:

  1. Pry bar: Pry the upper and lower teeth apart using your index finger on the lower teeth and your thumb on the upper teeth. Scissor or spread the teeth apart to stretch your jaw until you feel some tightness and hold it for 2-3 seconds. Repeat this manoeuvre 20 times in the morning, afternoon, and evening, for a total of 60 times daily.
  2. It may help to apply warm heat over your jaw muscles before and after these stretching exercises.
  3. Since these jaw-stretching exercises are likely to cause some discomfort, you may take analgesics (pain killers) one hour prior.

Are there diet restrictions after surgery?

  • A soft diet is recommended for 1-2 weeks after your surgery (e.g. yogurt, eggs, mashed potatoes, overcooked pasta, etc.).
  • Avoid hard, crunchy or chewy foods for 1-2 weeks.
  • Drink plenty of water and other liquids to stay well hydrated.

How do I manage pain after surgery?

Your doctors will prescribe analgesics (pain killers) based on your health history and current medications. Please take them as prescribed. The most common medications prescribed after

Patients having undergone TMJ arthroscopy are often prescribed:

Anti-inflammatory medications such as:

  • Ibuprofen
  • Paracetamol
  • Co Codamol
  • Diclofenac Gel application avoiding the external surgical scar. [Note: If two different anti-inflammatory medications are prescribed, complete the first prescription before starting the second one. Avoid taking two different types of anti-inflammatories at the same time.]
  • Muscle relaxants could be useful for a 2 week period
  • Diazepam 5-10 mg at night

Note: Our goal is to tailor the treatment to your specific needs. Your doctor may prescribe other medications as needed.

What follow-up care will I receive?

Your doctor’s office will call you to schedule a follow-up appointment. Usually this appointment will take place 2-3 weeks after surgery.

When should I call my doctor?

  • If you have difficulty breathing
  • If you have increased swelling 2-3 days after surgery
  • If you have difficulty closing your eyes after surgery
  • If you are unable to urinate
  • If you have severe pain that is not relieved by medications
  • If you experience a rash, nausea, vomiting, severe headache, severe
    constipation, or other unexpected reactions
  • If you have an oral temperature over 38 degrees Celsius.
  • If you have a question or concern that must be addressed prior to the
    follow-up visit.