Oral Surgery

TMJ (Temporomandibular Joint) Disorders

The TMJ is the flexible joint which connects the lower jaw (mandible) with the temporal bone of the skull and allows the jaw to move freely in order to chew, talk and yawn.If you put your fingers in front of your ears and open your mouth, you can feel these joints move.

TMJ Disorders can be caused by degenerative joint diseases, such as osteoarthritis, or an internal disorder where there is a problem with the disc that is located between the lower jaw hinge and the temporal bone.The purpose of this disc is to act as a shock absorber to the TMJ when chewing, yawning or affected by trauma.Pain in the muscles that control the jaw function is called myofascial pain and is also a common form of TMJ disorder.

What causes Temporomandibular Joint Disorders?

Very often the cause of TMJ disorders can be attributed to involuntary clenching or grinding of the teeth. This is known as bruxism and many people are unaware that they are doing this, particularly since it usually happens during sleep.

Stress can cause clenching which tire the lower jaw and put pressure on the disc and ligament of the TMJ resulting in the displacement of the disc and subsequent pain and discomfort.

Trauma, acute injury to the jaw, is also a major factor for TMJ disorders.Broken bones within the jaw or damage to the disc will hinder the smooth motion of the jaw and result in pain and loss of function.

Symptoms of TMJ Disorders include:

  • Jaw locking (in open or closed position)
  • Popping or clicking sound in the TMJ
  • Inability to open the mouth fully
  • Pain in the joint and jaw muscles
  • Dizziness and Headaches
  • A shift in the bite position


If diagnosed early, most TMJ disorders will respond to simple, non-invasive therapy.

An important, first step approach is the fabrication of a customised clear plastic splint (called an occlusal splint) which fits over the upper or lower teeth and reduces the effects of grinding by providing a thin barrier between the upper and lower teeth and therefore reduces the stress placed on the TMJ. The splint is only worn at night and does not cause any damage to the teeth or to the bite and is not too intrusive to wear as it is only about 2mm thick.

Other options for non-invasive therapy include:

  • Painkillers and anti-inflammatory drugs
  • Exercises for relaxing and reducing stress
  • Heat packs on the jaw joint morning and night for about ten minutes
  • Resting the jaw
  • Ultrasound physiotherapy

If symptoms are not alleviated however, your oral surgeon may recommend surgery on the joint or an injection of a cortisone into the joint.An arthroscopic examination of the joint may also be necessary. He will monitor your progress, explain your options, show you any x-rays or scans and provide you with a treatment plan once you have agreed what the best option is.It is important to remember, however, that most patients will not require more invasive solutions if the problem is caught early enough.If in doubt, seek a consultation with your dentist/oral surgeon as soon as possible.

Oral Surgery


An apicectomy is a procedure where part of the root of a tooth is removed and should be considered only when conventional root canal therapy has failed.With root canal therapy, the rate of failure increases particularly on the posterior teeth as the procedure becomes technically more complicated.If your dentist advises you to have an apicectomy, it will be because they think that the tooth can only be saved in this manner.

Why may an apicectomy be recommended?

There are many reasons why root canal therapy may fail including:

  • The tooth root curves and the dental instruments cannot reach the root tip where the infected non vital dental pulp is located.This part of the root would be removed in an apicectomy.
  • Broken endodontic instrument – these instruments are extremely fine and can fracture in the canal of the tooth.They can be removed with an apicectomy.
  • Underfilling of the root canal where the non vital dental pulp remains and causes an infection at the tip of the root.
  • Root filling material is overextended through the end of the root of the tooth and causes a reaction at the root similar to an infection.
  • Tiny accessory root canals which may not be visible on an x-ray or treated conventionally by root canal treatment.An apicectomy will remove the part of the root where the extra canals exist and thus remove the non vital dental pulp within.
  • When infection keeps reappearing despite root canal therapy, the area of infection may have to be removed during an apicectomy.

Apicectomy Surgery

Most apicectomies are carried out with the use of local anaesthetic together with intravenous (‘twilight’) sedation though may be performed under general anaesthetic in hospital if you prefer this option or your dentist recommends it due to the level of difficulty of the procedure.

The surgery involves making an incision in the gum over the root of the particular tooth and exposing this area with a dental drill to ascertain the amount of tooth root that needs to be removed.This is removed with the dental drill and infection is also removed from around the end of the root and a medicated filling material may be placed into the canal.The gum is then closed with sutures by your dentist.

What to expect afterwards?

It can take a week to fully recover from an apicectomy. You can expect to experience some pain, swelling and bruising.This is quite normal.Your dental surgeon will probably prescribe a painkiller for you such as Panadeine Forte and you can expect to use them for the first couple of days following surgery.Some bruising may occur on the face at the surgical site for a few days also.The healing of the bone around the root of the tip can take six months and your dental surgeon may review this with an x-ray at that time.


Due to the tooth already being in a poor condition, it is possible that the apicectomy may not be successful.If this should prove to be the case then symptoms may return and it may be possible to redo the apicectomy in an attempt to preserve the tooth, however if it should fail again there may be no option but to remove the tooth. Your dental surgeon can usually give you a prognosis of the tooth at your consultation

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