Welcome to Merrimack Valley Oral Surgeons Inc.

TMJ. Three simple letters that spell pain and jaw movement problems for millions of people who suffer from temporomandibular joint disorders. Tens of thousands of them live in New England. 90% of them are women, many of whom are reacting to increased stress in their lives.

The temporomandibular joints (TMJs) are the joints located just in front of each ear, and they are involved in the movements of the lower jaw. Basically, each joint is a ball-in-a-socket arrangement. The ball is part of the mandible (lower jawbone) and the socket is part of the temporal bone of the skull. The joint is named for the two bones (the temporal bone and the mandible) that make up this joint, hence the name, temporomandibular joint or the abbreviation, TMJ. Patients who have TMJ disorders with symptoms of pain and/or jaw dysfunction need proper diagnosis and treatment for these problems.

Do You Have TMJ Disorder?

Are you aware of clenching or grinding your teeth?
Do you wake up with sore, stiff muscles around your jaw?
Do you have pain on the sides of your face or in the temple areas?
Do you have pain in front of one or both of your ears?
Is the pain worse when you chew food?
Does stress make your clenching or 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?
Do your teeth meet differently from time to time?
Are your teeth sore, especially when you awake in the morning?

If you answered "yes" to any of these questions, you may have a TMJ disorder. If you answered "yes" to more than one of these questions, you should have a TMJ evaluation.

Correct diagnosis is essential because there are different types of TMJ problems with different methods of treatment. The most common types of TMJ disorders are those involving the muscles and ligaments around the joint (Myofascial Pain Dysfunction -joint sprain) and those involving derangement or breakdown of the structures inside of the joint (Internal Derangement and Degenerative Joint Disease). A combination of these types of TMJ disorders can frequently occur.

TMJ disorders occur from a variety of causes, including major trauma as in auto accidents, minor trauma as with teeth-clenching, and systemic joint disease as with rheumatoid arthritis.

Early diagnosis of TMJ disorders will usually result in less involved treatment. Unfortunately, diagnosis can be difficult because TMJ mimics so many other medical problems. The good news is that there have been dramatic recent advances in the diagnosis and treatment of TMJ disorders.

Most patients respond to properly performed nonsurgical treatments (including rest, soft diet, medications, physical therapy, night guards, TMJ splint therapy, and stress management). And for those patients who require surgery, minimally invasive procedures have proved highly successful.

TMJ cases are unique to each patient. Many have multiple causes requiring various treatment modalities.

At the TMJ Center we work closely with many excellent dentists. We can, if you wish, provide non-surgical as well as surgical treatment (95% of TMJ patients do not require surgical treatment). We would be pleased to schedule a comprehensive consultation. Please call Dr. Tarro at (978) 454-5637 in Lowell, MA or (781) 438-7206 in Stoneham, MA to schedule an appointment. If surgery is ultimately indicated, please note the following about our minimally invasive procedures:

TMJ Arthrocentesis: Office procedure. Indicated for treatment of sudden onset, closed lock internal derangement, with little to no previous TMJ symptoms. It can be accompanied by blunt sweeping of the superior joint space to relieve adhesions and adhesive capsulitis.
Performed under general anesthesia in the office for acute locked joints and TMJ adhesions. Minimal post-op discomfort.

TMJ Arthroscopy: Day - care hospital procedure. Indicated for treatment of internal derangements and intracapsular disorders that have not been resolved satisfactorily by properly performed nonsurgical treatment. The holmium: YAG laser is used to make a relaxing incision anterior to displaced discs and to treat inflamed synovial tissue. Displaced discs can be repositioned and sutured in a more posterior position.
A variety of internal joint disorders are treated with advanced laser technology. Post - op progress and physical therapy are carefully monitored.
Allen W, Tarro, D.M.D., is a pioneer in arthroscopic TMJ surgery.

Hundreds of TMJ sufferers are now finding relief at the new, state-of-the-art TMJ Center.

Nationally and internationally recognized Director and Surgeon (Dr. Allen W. Tarro)
Full-service capabilities at Saints Memorial Medial Center
Free parking / comfortable office enviroment
Prompt attention / fully trained caring staff
Nonsurgical Modalities - for 95% of patients
Minimally invasive surgery - when other means are not responsive

Compared to open joint surgery, minimally invasive techniques are associated with less pain, fewer complications, quicker recovery, and superior cosmetic results (tiny 1/4" incisions versus 2-2 1/2" to 3" incisions). Of great significance, minmally invasive surgery has had a very high success rate.

What Causes TMJ Problems?

You may clench or grind your teeth. This is usually stress related and results in tightening your jaw muscles and increasing pressure in your temporomandibular joint. Or, you may have damaged your jaw joint due to injury or disease. It is important to understand that more than one cause may be involved in TMJ problems. These causes must be identified and be resolved or, at least, be under control. If this is not the case, TMJ treatment may be initially successful, but then symptoms usually return, with ultimate treatment failure. This is especially true if jaw habits of clenching or grinding the teeth are not identified and controlled.

Initial Treatment

The initial treatment for TMJ disorders usually involves resting the jaw and eating a soft consistency diet. Along with this, there are a number of non-surgical treatments that may be indicated. These may include some or all of the following:

Medications (non-narcotic and not habit forming)
1. Non-steroidal, anti-inflammatory medications (e.g., Motrin, Advil, Naprosin)
2. Muscle relaxant medications (e.g., Parafon Forte DSC, Soma, Flexeril)
Physical therapy for treatment of the muscles around the joint. Note that physical therapy has not been successful in treating disorders inside of the joint (internal derangements).
Stress management
TMJ splint therapy. It is important to note that the splint must be properly designed and balanced.
Treatment of acquired jaw habits of clenching or grinding the teeth. These acquired habits are usually stress induced and may require stress management or hypnotherapy.

It is important to note that the great majority (more than 95%) of TMJ disorders are successfully treated with non-surgical treatment. However, there are a small number of cases that require surgical treatment to resolve TMJ symptoms.

Surgical Procedures

TMJ disorders that are not resolved by non-surgical treatment may require surgery. Surgery may be considered only for TMJ disorders that are intracapsular (inside of the joint) and symptomatic with pain and/or jaw dysfunction. There are three types of TMJ surgical procedures.

The first type is arthrocentesis. This is a minor procedure performed in the oral surgery office under general anesthesia. It is a treatment indicated for sudden-onset, closed lock cases (restricted jaw opening), when there has been no significant prior history of TMJ problems. It involves inserting needles inside of the affected joint and washing out the joint with sterile fluids. On some occasions, the procedure can also include inserting a blunt instrument inside of the joint. The instrument is used in a sweeping motion to remove tissue adhesion bands and to dislodge a disc that is stuck in front of the condyle (ball) inside of the joint.

The other two types of TMJ surgery are arthroscopy and open TMJ surgery. Arthroscopy is a surgical technique that is much less invasive than open TMJ surgery. The procedure requires very small skin incisions of about one-quarter of an inch instead of the 2 to 3-inch incisions that are used in open TMJ surgery. Arthroscopy also has been associated with fewer complications than with open TMJ surgery, and it requires a shorter time in the hospital (day-care surgery only). TMJ arthroscopy is performed with a smaller version of the sophisticated instruments that have revolutionized knee surgery during the past three decades. Furthermore, for the past nine years, your surgeon, Dr. Allen W. Tarro (click here for more information about Doctor Tarro), has been using laser instruments to perform advanced arthroscopic surgical procedures in the temporomandibular joint. The results of TMJ arthroscopy have been very rewarding, with a high success rate, minimal complications, and short recovery times.

The Director: Allen W. Tarro, D.M.D.

Nationally and internationally recognized authority on TMJ arthroscopy.
Director of the TMJ/Facial Pain Clinic, Department of Oral and Maxillofacial Surgery, Boston University School of Graduate Dentistry, Boston, Mass. 1990-1994.
Director of the TMJ/Facial Pain Clinic, Northeast Rehabilitation Hospital, Salem, NH. 1990-2000.
Merrimack Valley Oral Surgeons, Inc. Private practices in Lowell, Mass., and Stoneham, Mass., with Christos Bacos, D.M.D., Neil Hornung, D.M.D., and Hamid Esbah, D.M.D.
Author of textbook on TMJ Arthroscopy: "TMJ Arthroscopy: A Diagnostic and Surgical Atlas," J.B. Lippincott Publishing Co., 1993
Author of numerous papers on TMJ Arthroscopy. Published in leading professional journals. Contributing author in medical textbooks.
National and international lecturer on diagnosis and treatment of TMJ disorders and TMJ arthroscopy.
Board-certified oral and maxillofacial surgeon.

Dr. Tarro is one of a very small number of oral and maxillofacial surgeons who devotes the great majority (approximately 80%) of his practice to the diagnosis and treatment of TMJ disorders. He treats all phases of TMJ problems with both nonsurgical and surgical modalities, as indicated. More than 95% of his patients are treated non-surgically; less than 5% require any kind of surgery.