TM disorder: Should I have surgery for jaw pain? - Quest Diagnostics Patient Health Library

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to correct temporomandibular disorder.
Continue to use other treatments.

Key points to remember

Surgery for temporomandibular (TM) disorder doesn't guarantee a cure, and it can make a jaw joint problem worse. It is considered a last resort. Whenever possible, it's best to preserve the normal joint structure, rather than cutting, removing, or replacing any part of it.
Most people with TM disorders get better with simple nonsurgical treatment.
If home treatments such as resting the jaw and jaw exercises don't work, you can try several months of wearing a bite guard or mouthguard at night and other nonsurgical measures to relax your jaw muscles.
Flushing out the joint using arthrocentesis—injecting fluid into the joint with a needle—offers a good chance of improving how well the joint works, without surgery.
Arthroscopic surgery—which uses a few small cuts or incisions instead of one large one—may work better than arthrocentesis if the problem is caused by scar tissue blocking the TM joint.
If you have a disabling structural problem, bone surgery that creates more space within the TM joint may help, but it is risky.

FAQs

What are TM disorders?

The jaw joint, or TM joint , connects the lower jawbone to the skull. Common symptoms of TM disorders include:

Pain in your jaw when you move it.
Pain or tenderness in the muscles of your face, ear, head, neck, or shoulders.
Headaches.
Clicking, popping, or cracking sounds when you move your jaw.
Inability to open your mouth all the way.
A jaw that locks in an open or closed position.

Most cases of TM disorder are mild. Out of every 100 people who have it, 65 to 95 get better without surgery.¹ This means that 5 to 35 of those people don't get better without surgery.

What types of surgery are used to treat TM disorders?

In arthroscopic surgery, the doctor inserts tiny surgical tools and a camera into a few small cuts in your jaw. It is the type of surgery most often used for TM disorders. It is used to:

Remove scar tissue and cartilage that has gotten too thick.
Reshape parts of the jawbone.
Reposition the articular disc, which cushions the ball and socket of the jaw joint.
Tighten the joint to limit movement.
Flush out the joint.
Insert an anti-inflammatory medicine.

In open-joint surgery, the doctor makes a large cut or incision that exposes the joint. It is used when:

There are bony growths in the jaw joint, which are hard to reach with arthroscopic surgery.
There are complications from a previous surgery.
The joint is fused together by bony growth.
The joint can't be reached with arthroscopic surgery.

Why might your doctor recommend surgery?

Surgery is rarely used to treat TM disorders. Your doctor may recommend surgery if both of the following apply:

Other treatments have not worked, and your jaw pain has become so bad that you can't live your life normally.
There are specific, severe structural problems in your jaw joint.

2. Compare Options

	Have surgery	Don't have surgery
What is usually involved?	Depending on the type of surgery, you may or may not be asleep during the surgery. Depending on the type of surgery, you may or may not stay in the hospital for a day or two. After surgery, you may start physical therapy within 48 hours. Your jaw movement may be limited for at least a month, and you may need to eat only liquid and soft foods for a while.	You keep trying nonsurgical treatment like stress reduction, joint rest, jaw exercises, ice, use of a dental splint, or medicine. You may choose to have arthrocentesis, where the doctor uses a needle to inject fluid into your jaw joint.
What are the benefits?	Arthroscopic surgery works for 80 out of 100 people who have it done.² Bone surgery that creates more space within the TM joint may help if you have a disabling structural problem.	Out of every 100 people who have a TM disorder, 65 to 95 get better without surgery. This means 5 to 35 of those people don't get better without surgery. Arthrocentesis successfully treats a painfully locked jaw in 94 out of 100 people who have it done.²
What are the risks and side effects?	Surgery does not guarantee a cure. Surgery could make your TM disorder worse. After surgery, you may not be able to open your mouth as wide as you could before.	There are no risks or side effects with home treatments. With arthrocentesis, more fluid may form in the joint, or you may have infection or bleeding. But these problems are rare.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Temporomandibular (TM) Disorders.

Personal stories about surgery for temporomandibular disorder

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"Although I have severe symptoms, they are new. I am treating this TM disorder by eating pureed foods, using medication for muscle spasm and pain, and wearing a dental splint, and soon I'll be starting jaw exercises. "

— Ann, age 35

"My doctor and I have decided to use arthroscopy to clean out my joint area, because there's stuff in there that's in the way and I can't open my mouth very far. She says that I have a good chance of that working as long as I do some physical therapy afterwards. I'm going to give it a try. "

— Bill, age 27

"I considered surgery years ago when my TM symptoms got severe a couple of times, but I've learned how to manage the condition. I have managed my TM disorder for over 10 years now by not overtaxing my jaw, doing jaw stretches, wearing a dental splint when I'm under stress and grind my teeth at night, and using medication when muscle spasm becomes a problem. It'll never be "right" again, but I'm afraid that surgery would make it worse! "

— Karen, age 40

"Apparently, my rheumatoid arthritis has broken down my jawbone enough that only reconstructive surgery can fix it. I hate the idea of surgery, but I'm in such pain that I can barely use my jaw anymore. "

— Terry, age 55

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons not to have surgery

I am desperate to find something that will give me use of my jaw.

I don't like the idea of having surgery on such an important joint.

More important

Equally important

More important

I'm ready to try surgery even if there's no guarantee it will help.

I don't want surgery if I can't be sure it will help.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Is surgery a good treatment choice for most people with TM disorder?

Yes
No
I'm not sure

You're right. Surgery is rarely used to treat TM disorders. It does not guarantee a cure, and it can further damage the joint.

2. In most cases, is it best to leave the joint as it is, rather than cutting, removing, or replacing any part of it?

Yes
No
I'm not sure

That's right. It's best to leave the joint as it is. Surgery should be considered a last resort for TM disorders.

3. Is arthrocentesis (flushing out the joint) a better choice than arthroscopic surgery when scar tissue is blocking the TM joint?

Yes
No
I'm not sure

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Eriksson PO, Zafar H (2007). Cervico-cranio-mandibular disorders. In RE Rakel, ET Bope, eds., Conn's Current Therapy 2007, pp. 1143–1148. Philadelphia: Saunders Elsevier.
Barkin S, Weinberg S (2000). Internal derangements of the temporomandibular joint: The role of arthroscopic surgery and arthrocentesis. Journal of the Canadian Dental Association, 66: 199–203.