Appliances

It is normal for your new appliance to feel tight around your teeth. However, this should not be at the expense of pain or swelling around your jaws, gums, or teeth. 

Your bite should also feel normal to you and without any strain in your TMJ region. If so, there may be areas/spots that need to be polished or adjusted in our office. Please inform us of this issue.

Do not soak these appliances in any liquid for a prolonged amount of time. To clean them, rinse and brush them with a toothbrush.

TMJ Surgery

MEDICATIONS:

You should have the following medications either prior to the arthroscopy or upon being discharged from the ambulatory unit. Take these medications as directed. Do not  drink or drive while taking any of these medications.

  1. Antibiotics: You should not need any antibiotics besides the bacitracin/neosporin for the surgical puncture sites. You may buy this over-the-counter from any pharmacy.

  2. Analgesics: A prescription for Acetaminophen-Hydrocodone (Norco, Vicodin, Percocet) will be given - do not drink or drive with this medication, it will cause sedation. It is also habit forming so use this as little as possible. Use this medication for severe pain only. Do not combine with other tylenol containing products. Please follow the prescription directions when taking these medications.

  3. Anti-Inflammatories:  A non-steroidal anti-inflammatory prescription Meloxicam (Mobic) will also be given. In addition to pain control, this medication will also diminish the amount of postoperative swelling. Please take this at lunch time daily.  

  4. Muscle relaxants: It is not unusual for some patients to have increased muscular spasm during the early postoperative period. For this, a muscle relaxant Cyclobenzarpine (Flexeril)  may have been given. Take this at bedtime for the first week

SWELLING: Swelling is normal and expected after your procedure, and this resolves differently for everyone.  You can expect severe swelling around your joints immediately after surgery; this is from the fluid used to irrigate your joints. You may notice increased swelling in the first 3-4 days after your procedure, but this is normal and should begin to decline after this time. To help minimize swelling, you should sleep/lay down with your head elevated using pillows; never lie flat. You should also apply the ice to your face on/off every 20 minutes at a time for the first day after surgery. Your medications should also help with the swelling. There should be a marked improvment after 1-2 weeks.

PAIN: Some soreness and pain around your joints is common and will go away over time. Please use the medications prescribed to you as indicated to help control your pain. Please call our office if the pain is not being controlled with these medications

SORE THROAT: For the first couple of days following surgery you may experience a sore throat and some nasal congestion. This is normal after anesthesia and should go away within a couple of days. Drinking plenty of liquids usually helps with the throat tenderness.

DIET: On the day of your surgery, you should limit yourself to clear liquids only to prevent any trauma to the newly operated joints and minimize risk of nausea. Afterwards, you should have a liquid or pureed diet until instructed by your surgeon.

PHYSIOTHERAPY: (Starting the day after surgery): It is important to exercise your jaws after your TMJ surgery.  On the day of your surgery, you are to rest your jaws completely. Starting the next day however, you are to do these exercises, 4 times a day, 20 repetitions each time, and each exercise held for 4 seconds.

  • Simple opening; place your thumb on your top front teeth and your index finger on your front bottom teeth. Gently separate these fingers to pry open your mouth  as much as you can without it being uncomfortable.
  • Move your lower jaw to the left and then to the right and then foward (like a bulldog's jaw, with your lower teeth in front of your upper teeth)
  • Swipe your tongue on the front and back surfaces of your teeth as if you were "painting" them.

 

OTHER PHYSICAL ACTIVITY: Although you just had surgery, we insist on regular, but light, out-of-bed activities (walking, shopping, sitting in a chair) to minimize the chances of serious blood and pulmonary complications.  Try to be as active as possible, but a slow gradual return to your normal activity level is the most sensible approach. Keep your head elevated with pillows, at least 60 degrees, to minimize swelling. 

BANDAGING & COMPRESSES: You will have a head wrap on to help reduce some of the swelling initially. You should keep this on for as long as possible on the first day of the surgery, and then you may take it off in order to shower normally.  You should apply ice packs over your face for the first 24-48 hours on 20 minutes and then off for 10 minutes at a time. You may use the ice compresses for 24-48 hours. Afterwards, there is little benefit from cold compresses, and we recommend switching to Hot compresses on/off every 30 minutes to help facilitate muscle laxity.

You will have some bandages over your TMJ's to cover the spot of entry. These adhesive   tapes should remain in place until your doctor removes them, but if they begin to wash off or fall off in the shower etc., this is ok;  they do not need to be replaced. Should this occur, simply clean wounds with with fresh water, and apply over-the-counter antibiotic ointment (neosporin or bacitracin) to these areas  twice a day for 5 days.

FOLLOW UP: You should expect to return to our office on the first through (sometimes) sixth weeks post-operatively. If there are any complications or problems that arise prior to the first visit, please call us immediately with your concerns.

WARNING SIGNS OF COMPLICATIONS: Please be aware of these possible complications and inform your doctor if you encounter them. In the event of a life-threatening emergency, or if you can not reach your doctor,  please call 911  and report to the nearest hospital emergency room.

  • Prolonged numbness or tingling sensation 8+ hours after your procedure (Call ASAP).
  • Excessive bleeding not controllable by constant pressure over the site (Call ASAP).
  • Rapidly progressing swelling or black/blue bruising. (Call ASAP)
  • Pus or foul odor from surgical sites.
  • Fevers/Chills (Although can be normal up to 2 days after general anesthesia).
  • Nausea/diarrhea
  • Difficulty breathing or swallowing liquids (Call ASAP)

Feel well, and if you have any questions or concerns please feel free to contact us at any time.