Bay Area Oral & Facial Surgery
Oral & Facial Surgery
San Francisco CA

TMJ Disorders


Contact Form

We monitor our contact requests several times a day and will usually reply within one business day during open hours.

TMJ (temporomandibular joint) disorders are a family of problems related to your complex jaw joint. If you have had symptoms like muscle pain or a "clicking" sound with opening, 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 diagnosis and treatment are important.

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

Trouble with your Jaw?

TMJ disorders develop for many reasons. You may have a damaged jaw joint due to injury or arthritis. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of tissue similar to 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, popping, clicking, or grating noise when you open your mouth or trouble opening your mouth wide.

Some patients have a problem with TMJ dislocation. In these cases, opening wide when yawning or eating a sandwich may actually cause the jaw joint to jump out of its natural socket. Although massaging the joint and surrounding jaw muscles may help relax you enough so that the joint pops back into position, occasionally anesthesia and muscle relaxants are needed so that the surgeon can re-seat the jaw joint.

Some patients clench or grind their teeth, tightening jaw muscles and stressing the TM joint. For many, this clenching or grinding occurs at night during sleep. Patients may experience jaw muscle fatigue or tenderness in their teeth upon awakening in the morning. In some cases, a severe clenching or grinding problem will wear down the teeth or even cause crowns and fillings to pop off. Dr. Silva will be able to advise your dentist on the best kind of bite splint and/or nightguard to make for you.

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 at your temples?
  • 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 worn excessively?

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.


There are various treatment options that Dr. Silva can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, Dr. Silva 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 spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory, or muscle relaxant. Dr. Silva may inject a steroid solution directly into the affected joint to reduce pain and inflammation. In other cases, a non-surgical procedure known as arthrocentesis can be done to flush out inflamed fluid from inside your jaw joint capsule. This can be easily accomplished in the office under local anesthesia.

Self-care treatments can often be effective as well and include:

  • Resting your jaw muscles and massaging sore areas
  • Keeping your teeth apart when you are not swallowing or eating
  • Eating soft, nonchewy foods
  • Applying ice and heat to sore jaw muscles
  • Replace missing teeth and missing dental restorations to stabilize your bite
  • Practicing good posture

Temporary, clear plastic appliances known as a splint, may be recommended. Dr. Silva will be able to clearly advise your dentist as to the best appliance for you. For example, a flat plane splint usually fits over your top teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. A nightguard will protect your existing fillings and crowns from wear caused by excessive clenching and grinding.


BOTOX® Therapeutic treatment is a revolutionary approach to achieving relaxation of the jaw muscles. BOTOX® is injected into the muscles around the jaw which are in spasm and causing pain. Many patients that have severe clenching and grinding habits feel groggy or tired on daily muscle relaxants and other drugs which are taken by mouth. With BOTOX®, the jaw muscle spasm can be reversed without the unpleasant side effects of prescription muscle relaxants.

The Botox® Therapeutic Procedure

BOTOX® Therapeutic injections are performed by first identifying the areas of jaw muscle spasm. Dr. Silva applies a very small amount of local anesthesia to the skin before injecting the proper amount of BOTOX®. The relaxation of jaw muscles develops over the first 1-2 weeks. Although the effect of BOTOX® is not permanent and may need to be repeated two to three times per year, many patients are actually able to re-train their jaw muscles not to spasm and they enjoy long-lasting comfort. Once muscle spasm is broken, muscle relaxation may last well past the normal effect of BOTOX®.

Postoperative Information

After your BOTOX® injection, you may experience slight bruising around the area that quickly fades. Normal activities can be performed immediately. Possible side effects are temporary weakness of nearby muscles. BOTOX® Therapeutic is completely reversible so any side effect is only a temporary condition. Dr. Silva will explain all risks associated at the time of your consultation.