Managing the Arthritic TMJ

When a TMJ disc has been displaced for a long period of time, the jaw joint begins to remodel. The surfaces of the bones change shape in response to the altered mechanics. On imaging, this remodeling may appear as bone spurs, flattening, or surface irregularities, which technically meets the definition of arthritis. This can sound alarming, but it is important to understand that these changes do not necessarily mean ongoing pain or permanent disability.

The jaw joint has a remarkable capacity to adapt. Over time, the tissue that was originally behind the disc—which had been pulled into the joint space when the disc displaced—can transform into a tough pad of scar-like tissue that functions similarly to the original disc. This is called a pseudodisc. Once this adaptation occurs, the joint can function comfortably again without the original disc in place.

Dr. Yolanda Cruz is a general dentist. Management of the arthritic TMJ is provided within the scope of general dentistry.

What this means for treatment:

The goal of treatment is to create the right conditions for this natural adaptation to occur and to support the process. This primarily involves:

• Wearing an appropriate oral appliance during sleep to protect the joint from the heavy grinding and clenching forces that would otherwise prevent healing
• Ensuring that the natural bite is stable, so the joint is not constantly being pushed into an uncomfortable position
• Managing jaw muscle tension, which often accompanies a sore joint

A word on surgery:

Surgery for the TMJ carries risks and should generally be considered a last resort. Open joint surgery in particular can interfere with the natural adaptation process described above. Closed procedures such as arthrocentesis (washing out the joint with fluid) and arthroscopy (visualizing and gently treating the joint through small instruments) are less invasive options that are sometimes used when conservative treatment alone is not providing enough relief. Dr. Cruz will refer to an oral and maxillofacial surgeon when a surgical evaluation is appropriate.

Many people have jaw joints that show arthritic changes on imaging but experience little or no symptoms, because the joint has successfully adapted. Having an arthritic-looking TMJ does not automatically mean a lifetime of pain or limitation.