TMJ Surgery: When It Is Considered, Types and Recovery

Surgeons generally look for several things to line up before an operation is on the table:

• Conservative care has been tried properly. Reversible treatments have been used for a reasonable period, under supervision, without enough improvement.
• The problem is in the joint itself. Examples include a disc that has slipped out of place and blocks movement, scar tissue inside the joint, arthritis that has damaged the joint surfaces, bone that has fused, damage from an injury, a growth, or a joint that dislocates repeatedly.
• Function is seriously affected. The jaw will not open far enough to eat normally, locks, or causes pain that has not responded to other care.
• Imaging supports it. An MRI shows the disc and soft tissue, and a CT scan shows the bone. Surgery is planned from what the images show together with the exam, not from symptoms alone.

A joint that clicks or pops without pain or limited movement is not, as a rule, a reason for surgery. Our page on jaw popping covers what dentists check for.

Because an operation cannot be undone and the jaw joint is used constantly, irreversible treatment for TMJ disorders is generally approached with caution. Many people find their symptoms ease over time with conservative care.

Conservative care means treatment that can be stopped or changed without lasting effects. It commonly includes:

• Rest for the jaw: soft food, smaller bites, avoiding wide opening and avoiding chewing gum
• Warmth or cold held against the area for comfort
• A splint or guard made and adjusted by a dentist. Our article on a TMJ splint compared with a night guard explains the difference.
• Physical therapy, including jaw movements taught by a therapist or dentist. See TMJ exercises for why these should be shown in person.
• Attention to clenching and grinding, which dentists call bruxism, and to sleep and stress
• Medicines chosen and supervised by a dentist or doctor
• Injections into the joint or the jaw muscles, in some cases, given by a clinician

Not everyone needs every item, and the order varies. If you are being offered surgery and little of this has been tried, it is reasonable to ask why.

There are four broad levels, from least to most invasive. A surgeon chooses based on the diagnosis, and typically considers the least invasive option that could work.

Every one of these procedures carries risk, and none comes with a promise of relief. In general terms, the risks surgeons discuss include:

• Pain or limited movement that does not improve, or becomes worse
• A change in how the teeth meet
• Weakness of some facial muscles if a nerve near the joint is affected, which is often temporary but can last
• Numbness near the ear or temple
• Infection, bleeding, scarring or problems affecting the ear
• Stiffness from scar tissue
• The risks of anesthesia
• The need for further surgery

How likely any of these is depends on the procedure and the person, and it is the surgeon's job to explain that for your case. Useful questions to ask:

• What exactly is wrong in my joint, and how does this operation address it?
• What happens if I continue with conservative care instead?
• How often do you perform this procedure?
• What result is realistic for me, and what are the chances I am no better?
• What will recovery involve, and for how long?

For an irreversible operation, asking for a second opinion from another surgeon is a reasonable step.

Jaw joint surgery is carried out by an oral and maxillofacial surgeon, a specialist trained in surgery of the mouth, jaws and face. Not every surgeon in that field performs every joint procedure, and joint replacement in particular tends to be concentrated among surgeons who do it regularly.

The usual route starts with a general dentist or a doctor, who examines the jaw, starts conservative care and refers on if needed. Some people see an orofacial pain specialist along the way. Physical therapists are often part of the team before and after an operation. Our guide to the types of dentists explains who does what.

Recovery depends heavily on which procedure was done, so the only timeline that applies to you is the one your surgeon gives you.

After arthrocentesis or arthroscopy, people commonly go home the same day. Soreness and some swelling in front of the ear, and a jaw that does not open fully at first, are typical. A soft diet is usual for a period the surgeon sets.

After open-joint surgery or joint replacement, there may be a hospital stay, more swelling, a longer stretch on soft or liquid food and a slower return to normal activity.

Two things are common to all of them:

• Guided jaw movement. Surgeons typically prescribe a program of jaw movements or physical therapy, started on their schedule, to keep the joint moving and limit stiffness. Do the program as taught, no more and no less.
• Written instructions come first. Your surgeon's instructions on eating, medicines, cleaning your teeth, wound care, activity and follow-up visits override anything general, including this page.

The soft food planner can help with meal ideas while chewing is limited, within whatever your surgeon allows.

Call the surgeon's office if pain or swelling increases instead of easing, if you have fever, discharge from the incision, a change in your bite, new weakness in the face, or a jaw that will not open or close.

Coverage for TMJ treatment is one of the more confusing areas of insurance, because the jaw joint sits between medicine and dentistry.

• Medical insurance is often the plan involved for joint surgery, hospital fees, anesthesia and imaging such as MRI. Dental plans more often come up for splints and office visits. This varies.
• Some plans limit or exclude TMJ treatment. The plan document is the only reliable source, and rules differ between plans and between states.
• Pre-authorization is typically required. Insurers commonly want records showing the diagnosis, the imaging and the conservative care already tried.
• Several separate bills are usual: the surgeon, the facility, the anesthesia provider, imaging and physical therapy. Check whether each is in your plan's network.

We do not give cost figures for TMJ surgery. Fees vary widely with the procedure, the hospital and the region, and no general range would be meaningful. Ask the surgeon's office for a written estimate and ask your insurer, in writing if possible, what it will cover before a date is set. Coverage is never certain until the plan confirms it.

Most jaw joint problems are not emergencies, but a few situations are.

• A jaw that locks open or locks shut. This is an emergency. Go to the emergency room, or to a dentist or oral surgeon who can see you immediately. Do not try to force the jaw back into place. Our page on lockjaw explains more.
• Jaw pain with chest pain or pressure, shortness of breath, pain spreading to the arm, sweating or nausea. Pain from the heart can be felt in the jaw. Call 911.
• A blow to the face or jaw followed by teeth that no longer meet properly, a jaw that will not close, or numbness.
• Signs of spreading infection: trouble breathing or swallowing, swelling spreading toward the eye or neck, fever with facial swelling, or bleeding that will not stop. Call 911 or go to the emergency room.

For anything less clear, the ER or dentist tool helps sort out how quickly to be seen, and our jaw pain page describes what dentists commonly check for.