TMJ and Facial Pain

Living with TMJ and Facial Pain, can be socially isolating, physically painful and emotionally challenging. At Weill Cornell Medicine, we help patients achieve the high quality of life that you want and deserve.

Many dentists are trained in conservative therapies for TMJ, such as a night guards and bite plates. However, patients and/or their dentists should be referred to an oral and maxillofacial surgeon if their condition requires further attention. Specifically, if patients are experiencing a lack of improvement with physical therapy, bite plates, and/or medication.

At Weill Cornell Medicine, our oral and maxillofacial surgeons have vast experience with treating all stages and facets of TMJ. If you have tried non-surgical treatments for TMJ, consider learning about surgical options. You do not need to live with discomfort or the fear of embarrassment.

Why Choose Weill Cornell Medicine for TMJ Disorders?

Individualized treatment: The team of oral and maxillofacial surgeons at Weill Cornell Medicine is uniquely able to help patients with complex conditions and challenging cases. To treat TMJ disorders, first the cause must be identified. In less severe cases TMJ disorders can be treated with self-managed care (eating soft foods, using ice packs, avoiding extreme jaw movement) or nonsurgical treatments (anti-inflammatory medications, BOTOX® injections, stabilization splints). TMJ disorders are most often caused by muscle spasms but, in some cases, require very specialized treatment.

Multidisciplinary care from leading experts: When you choose Weill Cornell Medicine, you have access to a network of doctors and specialists. Your oral and maxillofacial surgeon may consult with experts in dentistry, otolaryngology, physical therapy and other medical specialties as needed. Weill Cornell Medicine partners with NewYork-Presbyterian, one of the top hospital systems in New York City and the U.S.

Note: We do not provide non-surgical care treatment. 

Signs and Symptoms of TMJ and Facial Pain

Due to the complex nature of the temporomandibular joint, the correct diagnosis can be challenging, thus leading to difficulty in treatment of TMJ/Facial Pain. Minor TMJ discomfort will usually go away without treatment. However, anyone with the following TMJ signs symptoms should consider an evaluation to prevent or avoid future issues:

·  Constant or repeated episodes of pain or tenderness at the TMJ or in and around the ear

·  Discomfort or pain while chewing

·  “Locking" of the joint in either the open or closed position

·  Chronic pain in other parts of the face lacking an obvious cause

·  A clicking or grinding noise when the jaw is opened or during chewing accompanied by discomfort or limitation of movement

Treatment Options for TMJ and Facial Pain

The treatment plan is directly related to the signs, symptoms and the diagnosis. The oral and maxillofacial surgeons at Weill Cornell Medicine will perform a complete work up to arrive at the correct diagnosis and develop an appropriate treatment plan for you. Treatment options therefore vary related to the diagnosis. The various treatments include:

Conservation Management: 

·  Warm Compresses

·  Nightguard Therapy

·  Physical Therapy/Jaw Exercises

·  Muscle Relaxants/Anti-Inflammatory Medications

· BOTOX® Injections into Surrounding Musculature

Minimally Invasive Solutions:

·  Arthrocentesis 

Minimally Invasive Surgery:

·  Arthroscopic Surgery - During arthroscopic surgery, the joint is accessed through a small incision with a camera and specialized instruments for the purpose of diagnosing and treating the patient’s condition

Open TMJ Surgery:

·  Open Arthroplasty - Open Arthroplasty accesses the temporomandibular joint surgically for the purpose of addressing more advanced degenerative changes.

Total Temporomandibular Joint Replacement:

·  Total Temporomandibular Joint Replacement is necessary when a joint is not otherwise salvageable due to severe degenerative changes.

Obstructive Sleep Apnea Treatment:

·  Sleep apnea is a disorder in which one experiences one or more pauses in breathing or shallow breaths while you sleep.

Sleep apnea is an ongoing condition that disrupts sleep. When breathing is paused or becomes shallow, one will often move out of deep sleep and into light sleep, making the quality of sleep poor. Sleep apnea can be treated with lifestyle changes, mouthpieces, breathing devices, and/or surgery.

For mild sleep apnea, a custom fitted mouthpiece or some lifestyle changes (weight loss, smoking cessation, clearing nasal passages) may be helpful.

For moderate to severe sleep apnea, a breathing device called CPAP (continuous positive airway pressure) or surgery to widen the breathing passages by shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw may be helpful.

A CPAP machine uses a mask that fits over your mouth and/or nose and gently blows air into your throat. This air pressure helps keep your airway open while you sleep.

Surgery to shrink the tissue involves a small shot into the breathing passages. Surgery to stiffen excess tissue requires a small incision in the tissue and inserting a piece of stiff plastic.

Oral Bone Grafting

An area of special interest to the OMFS team has been the area of reconstructive surgery.

Bone grafting is performed for two primary reasons:

·          Repair or correction of an oral defect

·          Preparation for dental implant placement

Techniques that we use to rebuild the jaw of patients undergoing cancer resection surgery, or to close the fistula of a child with a cleft lip and palate have all been modified to allow us to use the principles of bone grafting on the level of the implant patient. Typically, the patient that requires bone to build the jaw enough to support dental implants can be managed with the use of local grafts. These grafts can be taken from areas of the lower jaw. If more bone is necessary the area of the tibia, the lower leg. This work is done in an office setting.

If a larger area of the jaw needs to be built up, then we can go into the marrow spaces of the hip bone, an excellent site not only for marrow but for cortical bone that acts as a scaffold to shape these grafts. This work is done in a hospital setting.

If the jaw needs to be grafted to allow for implant placement, then the grafted bone will need to mature prior to placing these fixtures into it. Depending upon the bone source and site, healing can take anywhere from 4 months to 8 months to mature.

Patients that are candidates for implants and bone grafting can expect to have several surgical interventions during reconstruction. This is a time-consuming effort that will yield a spectacular return to function. A patient that has this type of work is usually in treatment at least 12 to 18 months. For those patients who are impatient, then dentures may be a more expedient solution.

Cost of Evaluation 

We do not participate with Commercial dental insurance but participate with many medical insurances for your Oral Surgery care.

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Meet Our Surgeons

The physicians at the Weill Cornell Medicine Dentistry, Oral and Maxillofacial Surgery Division offer patients the highest level of safety and care. As a top-ranked academic medical center, you have access to our extensive network of specialists who provide seamless care throughout your treatment — to promote long-term physical and mental health.