Treatments / Oral & maxillofacial surgery
TMJ & Jaw Pain
The temporomandibular joint is the hinge in front of your ear, and problems with it cause pain, clicking, restricted opening or locking. Most cases respond to conservative treatment. Assessment comes first, because TMJ symptoms have several different causes and they are not treated the same way. TMJ pain and jaw pain are assessed by Dr Bhargav Kuchu, whose MDS speciality is oral and maxillofacial surgery.
Who this is for
- Jaw pain, or pain in front of the ear
- Clicking, grating or a jaw that locks open or shut
- Difficulty opening the mouth fully, or trismus
- A jaw that has dislocated, or that dislocates repeatedly
- Headaches and jaw ache linked to grinding
What actually happens
- Examination of the joint, the bite and the muscles
- Imaging where it will change the plan
- Conservative treatment first: splint therapy, physiotherapy, medication
- Arthrocentesis or surgical options only where conservative treatment has not worked
What a splint is, and how you use it
A splint is a thin, hard plastic guard made to fit your own teeth from a mould or scan. Most people wear it at night, which is when clenching and grinding tend to happen without you knowing. It stops the teeth grinding against each other, takes some load off the joint and gives the jaw muscles a chance to relax.
It is checked and adjusted at review visits so that your bite on it stays even. A splint is rarely the whole treatment on its own. It works alongside the steps below, and how long you wear it depends on how your symptoms respond.
Exercises, physiotherapy and medicines
Jaw exercises are gentle, controlled movements you are shown and then do at home, a few minutes at a time. They help a jaw that is stiff or does not open fully, and they retrain muscles that have got into the habit of tightening. Physiotherapy can add heat, massage of the chewing muscles and guided stretching.
Medicines are used for a limited period: pain relief that also calms inflammation, and sometimes a medicine to relax the muscles. They settle a flare-up while the other measures start working. They are not meant as a long-term answer.
Day-to-day habits make a real difference too. Soft food for a while, small bites, no chewing gum, a hand under your chin when you yawn, and your teeth apart during the day. A simple reminder: lips together, teeth apart.
Arthrocentesis, and why surgery comes last
Arthrocentesis is a washout of the jaw joint. The area in front of the ear is numbed, two fine needles are placed into the joint space, and sterile fluid is rinsed through it. This flushes out the fluid that keeps the joint inflamed and can free up a disc that has got stuck, which is why it is sometimes used for a jaw that locks or will not open fully. There are no cuts or stitches, though the jaw is usually sore for a few days afterwards.
Open surgery on the joint is rarely needed. It is kept for a small number of specific problems inside the joint, usually after simpler treatment has been tried and has not helped. Joint surgery that needs an operating theatre is done in hospital, not at the clinic.
Surgery comes last for a plain reason. A lot of jaw pain comes from the muscles rather than the joint, and an operation cannot fix muscle pain. Surgery also brings its own recovery and risks, so it is only worth considering when the problem is truly inside the joint.
A click on its own is often nothing to worry about. Jaw pain and clicking: when to get it checked sets out the signs that do need looking at, and the ones that are urgent.
Dr. Bhargav Kuchu examines you, and where the case calls for it he seeks the opinion of Dr. Swetha Basu, our consultant in oral medicine, radiology and orofacial pain.
Questions people ask
How long does TMJ treatment take?
It varies from person to person. Some people notice a change within a few weeks of starting conservative treatment, while others need a few months of splint wear, exercises and reviews. Progress is checked at each visit, and the plan is changed if it is not helping.
Will I have to wear a splint for the rest of my life?
Usually not. A splint is normally worn for a period while symptoms settle, and its use is reviewed along the way. Some people who grind their teeth at night choose to keep wearing one to protect their teeth.
Is arthrocentesis painful?
The joint area is numbed first, so most people feel pressure rather than sharp pain during it. The jaw is usually sore for a few days afterwards, and simple pain relief is generally enough.
Who treats jaw pain and TMJ problems at STHIRA?
Dr Bhargav Kuchu, whose MDS is in oral and maxillofacial surgery, a specialty that includes the jaw joint, examines and assesses them at the clinic in Rai Durg, Hyderabad. Where the case needs a second view, he seeks the opinion of Dr Swetha Basu, our consultant in oral medicine, radiology and orofacial pain.
Can I just take painkillers and wait?
For a short flare-up that settles within a few days, taking ordinary pain relief as directed on the pack is often reasonable. If you are pregnant, have a medical condition or take other medicines, ask a pharmacist which one is safe for you. If the pain keeps coming back, or your jaw locks or will not open fully, get it examined, because painkillers do not treat the cause. Jaw pain that comes with chest pain, breathlessness or sweating can be a heart problem. Call 108 for an ambulance straight away rather than travelling in yourself.
Related treatments
Corrective Jaw Surgery
Orthognathic surgery for jaw position, facial asymmetry and bite problems braces alone cannot fix.
Full Mouth Rehabilitation
Rebuilding a worn or collapsed bite as one plan rather than tooth by tooth.
Facial Trauma & Jaw Fractures
Assessment and fixation of facial and jaw fractures, and repair of facial lacerations.