More Controversial Treatments

When the basic treatments listed above prove unsuccessful, your dentist may suggest one or more of the following:

• Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing the jaw joint and facial muscles. This treatment can be done at the dentist's office or at home.
• Ultrasound. Ultrasound treatment is deep heat that is applied to the TMJ to relieve soreness or improve mobility.
• Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called "trigger points"" to relieve pain.
• Radio wave therapy. Radio waves create a low level electrical stimulation to the joint, which increases blood flow. The patient experiences relief of pain in the joint.

Surgery

Surgery should only be considered after all other treatment options have been tried and you are still experiencing severe, persistent pain. Because surgery is irreversible, it is wise to get a second or even third opinion from other dentists.

There are three types of surgery for TMD: arthrocentesis, arthroscopy and open-joint surgery. The type of surgery needed depends on the TMD problem.

• Arthrocentesis. This is a minor procedure performed in the office under general anesthesia. It is performed for sudden-onset, closed lock cases (restricted jaw opening) in patients with no significant prior history of TMJ problems. The surgery involves inserting needles inside the affected joint and washing out the joint with sterile fluids. Occasionally, the procedure may involve inserting a blunt instrument inside of the joint. The instrument is used in a sweeping motion to remove tissue adhesion bands and to dislodge a disc that is stuck in front of the condyle (the part of your TMJ consisting of the "ball" portion of the "ball and socket")
• Arthroscopy. Patients undergoing arthroscopic surgery first are given general anesthesia. The surgeon then makes a small incision in front of the ear and inserts a small, thin instrument that contains a lens and light. This instrument is hooked up to a video screen, allowing the surgeon to examine the TMJ and surrounding area. Depending on the cause of the TMD, the surgeon may remove inflamed tissue or realign the disc or condyle.

Compared with open surgery, this surgery is less invasive, leaves less scarring, and is associated with minimal complications and a shorter recovery time. Depending on the cause of the TMD, arthroscopy may not be possible, and open-joint surgery will need to be considered.

• Open-joint surgery. Patients undergoing open-joint surgery also are first given a general anesthesia. Unlike arthroscopy, the entire area around the TMJ is opened so that the surgeon can get a full view and better access. There are many types of open-joint surgeries. Among the reasons this approach is taken include, if:
  • The bony structures that comprise the jaw joint are deteriorating
  • There are tumors in or around your TMJ
  • There is severe scarring or chips of bone in the joint

  Compared with arthroscopy, open-joint surgery results in a longer healing time and there is a greater chance of scarring and nerve injury.

  Reviewed by the doctors at The Cleveland Clinic Department of Dentistry.
  Edited by Charlotte E. Grayson, MD, February 2003.
  
  Portions of this page © The Cleveland Clinic 2000-2003

  
  Last Editorial Review: 1/31/2005 6:19:12 AM
  
  
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