NWOS Two Faces Logo
Newton Wellesley Oral and Facial Surgery

Adam Orden DDS, MS

Pediatric and Adult Oral and Facial Surgery

Diplomate, American Board of Oral and Maxillofacial Surgery
1330 Beacon Street, Brookline, MA 02446

Temporomandibular Joint Disorders

Dr. Orden is a recognized expert in TMJ disorders. His work on degenerative joint disease earned him a Master of Science at the University of Illinois, where he trained at the U. of Illinois Facial Pain Center, the largest facial pain center in the country.

Among the problems we treat are:

  • Clicking and Locking of the TMJ
  • Arthritis
  • TMJ Full Joint Replacement
  • Painful Joint conditions

What is TMJ?

The temporomandibular joint connects the lower jaw with the base of your skull and is located directly in front of your ear.

Temporomandibular joint disorders can arise from two major causes

  • Muscle inflammation
  • Problems with the cartilage or connective tissue of the joint

There are many conditions that may case TMJ problems. Each condition requires an accurate diagnosis and specific treatment. Among the various problems that can lead to TMJ pain and dysfunction are:

  • Grinding of the teeth
  • Misaligned Jaw
  • Injury or Trauma to the Jaw or Joint
  • Infections
  • Arthritis of the Joint

Clicking and Locking

Clicking in the TMJ wihtout pain is present in the majority of the population. Clicking accompanied by limited range of motion, pain, or locking is referred to as an "internal disk derangement." Most commonly the disk is positioned in front of its normal position (see the video demonstration).

Dr. Orden specializes in treatment of these conditions by using a graduated approach. Initial treatment in early cases can often be accomplished with physiotherapy or plastic mouthguard.

Patients that do not respond to 'conservative' splints can be treated by outpatient arthroscopy and irrigation. Very few cases need corrective joint surgery.

Normal TMJ Disk

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

Anteriorly Displaced Disk

Click the play button on this video to demonstrate how clicking occurs with an anteriorly displaced disk.

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

Treatment of TMJ pain

Less is More !

Limited opening accomapnied by pain in the TMJ as well as muscle soreness is often referred to as TMJ. However, this condition is really MPD (myofascial pain dysfunction).

NIH (National Institute of Health) is the recognized medical authority in the United States. Click on this link to read what the NIH says about TMJ Disorders NIH Guidlines for Treatment of TMU Disorders

Prosthetic plastic splints or bite plates that fit over the upper and lower teeth can also help reduce masticatory muscle tension that comes from clenching and grinding. This treatment, accompanied by analgesics works to relieve this condition in the majority of patients.

Internal Joint Derangment