Temporo mandibular joint dysfunction: treatment options

Dear Ask The Doctor: I have had a tmj problem for over 8 years and when i went to a tmj specialist 8 years ago the doctor said my jaw was not bad enough to have surgery, over the years my jaw has gotton worse, and i also have arthritis but the doctors are still not sure as to what kind because the test results are always positive negitive but the doctor did a ct scan and said i do have a type of athritis in my jaw, and my jaw causes me so much pain, and the doctor in emergency said i do need surgery on my jaw but my own docor wants me to see a tmj specialist again because she dose not know much about tmj so i was wondering if i should ask to see a different doctor? to find out if i do need usrgery or should i spend the 300 on going to see the tmj specialist to find out from them wheather they think i need surgery when a doctor already said i do need it?? im in constant pain and very tired of being on meds that dont really help with the pain.

Dear Tania: Temporomandibular disorder(s) (TMD), or temporomandibular joint syndrome, is the most common cause of facial pain after toothache. Temporomandibular disorder is a commonly seen condition in primary care and dentistry practice, as many as 75% of the people in the United States population will at some time have some of the signs and symptoms of TMD. Problems in this area can cause head and neck pain, a jaw that is locked in position or difficult to open, problems biting, and popping sounds when you bite. The causes are various: grinding the teeth (bruxism), clenching the jaw, punch to the jaw, osteoarthritis or degenerative joint diseases, and other joint diseases, it might be related to your type of arthritis, which does not change the treatment approach. Most temporomandibular disorders (TMDs) are self-limiting and do not get worse. Simple treatment, involving self-care practices, rehabilitation aimed at eliminating muscle spasms, and restoring correct coordination, is all that is required. No steroidal anti-inflammatory analgesics (NSAIDs) should be used on a short-term, regular basis and not on an as needed basis, eat soft food, apply warm compresses on the area of pain. Home therapy includes mandible (lower jaw) movements, such as opening and closing the jaw from side to side. Try this after a warm compress is applied for 20 minutes. The lower jaw movements should be repeated three to five times a day, five minutes continuously each time, for about two to four weeks. On the other hand, treatment of chronic TMD can be difficult and the condition is best managed by a team approach; a primary care physician, a dentist, a physiotherapist, a psychologist, a pharmacologist, and in small number of cases, a surgeon. The different modalities include patient education and self-care practices, medication, physical therapy, splints, psychological counseling, relaxation techniques, biofeedback, hypnotherapy, acupuncture, and arthrocentesis. Arthroscopic surgery is indicated in the following: internal derangements, adhesions, fibrosis, and degenerative joint diseases.