TMJ Disorders

Dr. Krueger has a passion for patients with TMJ disorders that range from mild to the most severe symptoms.  He trained with Dr. David Hoffman a national leader in TMJ surgery at Staten Island University Hospital while doing his residency at the University of Medicine and Dentistry of New Jersey.

Dr. Krueger has been treating TMJ disorders for over 20 years.  He is the only surgeon in Oregon outside of the Portland area who has been certified by the BioMet Corporation for placement of their total joint replacement system.  He placed the first TMJ total joint replacement at St. Charles Medical Center in Bend.

The American Society of TMJ Surgeons represents the nations leading authorities in TMJ disorders and treatment.  Membership requires sponsorship and nomination from existing members as well as submission of extensive operative reports and presenting at the national meeting before candidates are elected into membership.  Dr. Krueger is the only surgeon in Oregon that is a member of the American Society of TMJ Surgeons.

TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Dr. Krueger can help you have a healthier and more comfortable jaw.

Trouble With Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disc, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking, or grating noise when you open your mouth or trouble opening your mouth wide.

Do You Have a TMJ Disorder?

• Are you aware of grinding or clenching your teeth?
• Do you wake up with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth?
• Does stress make your clenching and pain worse?
• Does your jaw click, pop, grate, catch, or lock when you open your mouth?
• Is it difficult or painful to open your mouth, eat, or yawn?
• Have you ever injured your neck, head, or jaws?
• Have you had problems (such as arthritis) with other joints?
• Do you have teeth that no longer touch when you bite?
• Do your teeth meet differently from time to time?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken, or worn?

The more times you answered “yes”, the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

Treatment

To fully diagnose most TMJ disorders specific imaging is required.  During your initial consultation, Dr. Krueger will typically take digital panoramic and tomographic Xrays.  This allows Dr. Krueger to evaluate the boney structures of your jaw and skull base.  Frequently detailed imaging of the cartilage disc in your TMJ is required.  This is accomplished with an MRI performed at Cascade Medical Imaging.

There are various treatment options that Dr. Krueger can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Krueger will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.

The initial goals are to relieve the muscle spasms and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

• Resting your jaw
• Not clenching or grinding your teeth
• Eating soft foods
• Applying ice and heat
• Exercising your jaw
• Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended.  Dr. Krueger has physical therapy as a core component of management of TMJ disorders both with conservative treatments as well as following all of his surgical treatment.  This is typically performed at Southside Physical Therapy.  An acrylic appliance is known as a splint. A splint (or nightguard) fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. The splint can relieve pressure on parts of your jaw and aids in disc repositioning. It may be worn 24 hours a day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours/day or just at night to move your jaw into the proper position. Appliances also help to protect from tooth wear.

What About Bite Correction or Surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair are sometimes needed, but are reserved for severe cases. Dr. Krueger does not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.  He performs these surgeries at St. Charles Medical Center and Bend Surgery Center.

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