Your jaw joint is actually called your temporomandibular joint, or TMJ for short. It’s in front of each ear linking your lower jaw – the mandible – to the temporal bone at the bottom of your skull. Its complex sliding and hinging action enables you to open and close your mouth, and move your jaw backwards, forwards and sideways. Between the two bones is a tough, rubbery disc called a meniscus and many TMJ problems are the result of damage or displacement of this disc. Not surprisingly, it gets a lot of use as you talk, eat and yawn – roughly one in ten people in the UK experience problems with it. They can develop at any age, but happen most often between 20 and 40, and are more common in women.
Our renowned medical team provides a range of treatments, from the traditional to the innovative:
This is an effective and well-researched procedure that’s a potential alternative to surgery. It takes advantage of the blood’s natural healing properties to reduce pain and improve joint function. It uses a specially concentrated dosage of platelets prepared from your own blood to repair damaged cartilage, tendons, ligaments, muscle and bone. Treatment is administered via an injection and depending on the injury two to six injections may be required, performed at weekly intervals. Patients usually see their symptoms improve within four to six weeks of having the injections. PRP is a safe treatment option which, because your own blood is used, carries no risk of allergic reaction. Read more clinical evidence supporting PRP here.
This day case treatment is exclusively offered to our patients. It combines the benefits of Platelet-Rich Plasma (PRP) therapy with Lipogems®, a pioneering procedure that uses your body’s own adipose (fat) cells to treat pain and inflammation. AMPP injections are minimally invasive and are carried out under ultrasound guidance. Altogether the procedure takes about an hour to perform with a minimal recovery time of around three hours. As well as being a potential alternative to surgery, AMPP can also aid post-surgery recovery.
For pain relief, injections can be more effective than an oral medication because they deliver medication directly to the exact anatomic location that is generating the pain. Typically, a steroid medication is injected to deliver a powerful anti-inflammatory solution directly to the area causing pain.
It can sometimes be difficult to tell that you’re suffering with a TMJ disorder because you often feel pain in your ear. Many people also don’t realise the TMJ joint can develop the same diseases as any other in your body, such as arthritis.
• pain and tenderness of your jaw joint
• pain spreading up the side of your head/face and into your neck
• clicking when you open and close your jaw
• locking of your jaw either open or closed
• pain when eating or yawning
• pain in and around your ear.
Clenching or grinding your teeth, or suffering an injury to your teeth or jaw, can cause the meniscus disc to be knocked out of place. If it gets displaced, you would feel pain in your jaw as well as clicking and locking when moving it. Over time the jaw can wear out prematurely leading to osteoarthritis. While the displacement of the meniscus is the most common problem, your TMJ can also be affected by any conditions that affect other joints, such as rheumatoid arthritis, osteoarthritis, gout and psoriatic arthritis.
Common causes include:
• Teeth grinding and jaw clenching
People who grind their teeth and clench their jaw might not even be aware they’re doing it. Also known as bruxism, it often happens while you are asleep or concentrating on something else. For around 70 per cent of sufferers, it’s due to stress or anxiety, and in some cases it can cause facial pain and headaches, and can wear down your teeth over time. Physiotherapy exercises and a bite guard worn at night can both help, as can Botox injected into the muscles around your jaw.
• Rheumatoid arthritis
This is caused by your immune system attacking parts of your own body by mistake. It affects the lining of your joints and leads to an uncomfortable swelling. Symptoms include joint tenderness, tiredness, fever and loss of appetite. When it affects the TMJ it can also change the size of your jaw and make it difficult and painful to eat or yawn.
Osteoarthritis affects millions of people across the world and happens when the cartilage, the rubbery padding that protects the ends of your bones, wears down over time as we get older. In the TMJ, osteoarthritis can cause jaw clicking and locking, pain and a grating sound when opening and closing your mouth.
• Hyper-mobility/Ehlers-Danlos Syndrome (EDS)
This is a hereditary condition that affects collagen, an important protein that helps keeps your body together as it’s in bones, muscles, tendons and your skin. EDS causes joints to be unusually loose and flexible, and in the jaw this can lead to TMJ issues. Common symptoms include difficulty chewing and opening your mouth, pain near your ear or in your teeth, headaches, a grinding or popping when you move your jaw and even dislocation.
• Ankylosing spondylitis
This is a type of arthritis affecting the neck and back. Symptoms develop gradually over months or even years, often first appearing between the ages of 20 to 30. It causes swelling and stiffness in different parts of the body, but in your jaw it can cause pain and restricted mobility. In the UK, around 200,000 people have been diagnosed with it.
Gout can be extremely painful and affects around two per cent of people in the UK. Caused by a build-up of small crystals around your joint, it leads to sudden pain and swelling and when it develops in the jaw it can make it difficult to open your mouth.
• Psoriatic arthritis
This can arise in some people who have psoriasis, a skin condition, and can affect any joint in the body causing pain, stiffness and swelling. In the TMJ, psoriatic arthritis can also lead to teeth grinding and other dental problems.
If the first-step approaches of rest, ice or heat and over-the-counter pain medication don’t help, or a specialist has advised your condition needs more in-depth treatment, there are several options that don’t involve surgery.
We offer a variety of biological therapies that harness your body’s natural ability to repair itself – Platelet Rich Plasma (PRP) treatment and Activated Mesenchymal Pericyte Plasma (AMPP) injections (make link to page).
They are minimally invasive, can decrease inflammation, stop the progression of arthritic damage and may repair joint cartilage. The recovery time is also much shorter than with surgery.
Following these treatments, you are encouraged to mobilise the jaw joint the same day and will be given instructions for simple exercises to help quickly return to normal activity without having to go through the risks associated with surgery.
Our consultant Mr. Luke Cascarini is the only UK surgeon who is trained to perform a technique to repair the position of the TMJ’s meniscus disc using an arthroscopic procedure, better known as keyhole surgery.
Sometimes open joint operations are needed to remove failed discs, for grafting and, very rarely, for joint replacement surgery, which is considered a last resort.
As with any operation, there procedures do carry risks, which you can discuss with your GP or specialist.
It involves a long recovery time – at least a month – and even after recovery, you may be permanently limited to the types of food you can eat. Following a TMJ replacement, alternative treatments are no longer possible, and should the artificial joint fail another replacement is the only option. In the UK, TMJ replacement is a rare operation and should it be necessary it’s important to make sure your surgeon is appropriately trained.
Our innovative range of treatments goes beyond what’s available on the NHS. As well as providing a full opinion on your condition that includes all the traditional non-surgical and surgical options, our experienced consultant Mr. Luke Cascarini will also assess your suitability for our alternative biological therapies, Platelet Rich Plasma (PRP) and Activated Mesenchymal Pericyte Plasma (AMPP).
You’ll see our expert maxillofacial and head and neck surgeon consultant, Mr. Luke Cascarini for around 30 minutes. During the consultation, he will:
– discuss your medical history to find out more about your symptoms
– examine the joint and identify the source of the pain and any mobility issues
– arrange for a diagnostic investigation, usually an MRI scan or occasionally a CT scan
– discuss all the treatment options with you, along with their potential benefits and any risks.
Our experienced team works as part of a collaborative partnership of surgeons, sports medicine doctors and physiotherapists to provide the perfect patient pathway to get you quickly on the road to recovery. Whether you need conventional treatment or if you are a candidate for our regenerative treatments, you can be sure that you will get the best advice.
Biological treatments are pioneering procedures and we’re continuously monitoring and recording its effectiveness. Patients undertaking these treatments are asked to complete pre-operative and post-operative questionnaires.
The information obtained from these questionnaires allows us to monitor your progress and it also contributes to our evidence-based database and other global studies on biological treatments. All information gathered is anonymised.