Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN
In this article we will explore some of the reasons TMJ treatments will fail. Many times treatments fail because there is a misdiagnosis or failure to diagnosis the true root cause. In some cases, this may be ligament laxity causing joint instability, joint swelling and eventual osteoarthritis. The ligaments are the strong connective tissue that hold skull to spine and jaw to skull.
It is the recommendation of The National Institute of Dental and Craniofacial Research, a branch of the US government’s National Institutes of Health, that less treatment is best in treating TMJ disorders. They recommend that patients avoid treatments that cause permanent changes in the bite or jaw. Such treatments include crown and bridge work to balance the bite, orthodontics to change the bite, grinding down teeth to bring the bite into balance (occlusal adjustment), and repositioning splints, which permanently change the bite. They also state that finding the right care can be difficult, and they recommend looking for a healthcare provider who understands musculoskeletal disorders (affecting muscle, bone, and joints) and is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice.
We often find that we are in agreement with the first part of this recommendation, the latter part we find ourselves frequently in disagreement with it. TMJ has always been and will continue to be like other chronic painful disorders: a joint instability issue. Until this is addressed, treatment regimes will continue to be pain management and not pain cure.
The findings of doctors : the problems TMJ sufferers were caused by their doctors
A September 2025 study Journal of oral rehabilitation (1) published results of a survey among TMJ sufferers and how they were treated. The researchers wrote: “Despite the availability of evidence-based guidelines on temporomandibular disorders (TMD), some past theories of TMD aetiology, diagnosis and treatment are still diffused among clinical practitioners.” In other words, inappropriate treatments are offered to many patients. How did they come to this conclusion?
In November 2023, the researchers collected comprehensive data on TMJ patients’ diagnostic journeys, treatment experiences, and outcomes by way of patient surveys.
- A total of 153 participants filled out the survey. Of them:
- 31.4% (48 patients) needed to consult two or three professionals, while some of them saw up to four or five (27 patients, 17.6%).
- Patients experienced a wide range of pain duration time before receiving a diagnosis. Almost one-third of patients were in pain for more than one year (43 patients, 28.1%), and
- a remarkable number never received appropriate care (30 patients, 19.6%).
- Those patients who saw one or more dentists who emphasized abnormalities of dental occlusion or jaw position ended up consulting significantly more health providers before receiving a diagnosis.
Regarding iatrogenesis (complication caused by medical treatment), misdiagnosis and undertreatment.
Researchers at the University of Illinois at Chicago College of Dentistry and the Department of Biomedical Technologies, School of Dentistry, University of Siena, Italy wrote in a 2021 paper in the Journal of Oral Rehabilitation (2) that some of the problems TMJ sufferers have were caused by their doctors. This is noted in the paper’s opening sentence: “Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been (now been understood). . . Regarding iatrogenesis (complication caused by medical treatment), sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment.
Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect (the patient does not think the treatment will work), and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification (worsening pain) of TMDs.” See below for their 2023 paper continuing on this topic.
Again, while getting a cortisone shot, taking an NSAID (nonsteroidal anti-inflammatory medication), or using an occlusal splint or other appliance might seem harmless, it truly isn’t because the underlying etiological diagnosis goes missing: TMJ instability. When the standard treatments such as those just mentioned don’t work, some doctors may be quick to recommend an innovative surgical option, because of all the internal derangement or other osteoarthritis seen on MRI.
The mutilation of jaws that I have seen by surgery is unconscionable. I have seen people who have had their condyles taken off and when they chew, the rest of their jaw just flaps in the wind. Surgical and medical treatments from the past have included meniscectomies, retracting the condyle with a steel headband or even wiring the jaws shut for months, psychotherapy, multidisciplinary teams, complete resection of the articular meniscus, amputation of the condylar heads leaving the discs intact, reconstructive surgeries to “recapture the articular disc,” disc replacements using plastic implants, and the list goes on and on.
Unfortunately, people with TMD end up with these surgeries and other invasive procedures because the imaging studies on their jaws show something “terrible.” Such diagnostic tests include radiographs of the TMJ with and without appliances, various x-ray views including panoramic, transcranial, and oblique views, laminographic studies, CT MRI of the TMJ, dynamic arthrography, mandibular kinesiography, EMG of mastication muscles, and thermography. This does not even include all the diagnostic criteria a dentist uses to show how “off” one’s bite is. There is a strong correlation between abnormal joints and a history of orthodontics. It is now recommended by many in the dental profession to eliminate the patient’s TMJ pain and dysfunction before initiating any type of orthodontic mechanics. It should be noted that throughout my career and even right now, there are still dentists and others who believe malocclusion is the cause of TMD. While I acknowledge it can be involved, it is rarely—and I mean rarely—the cause. It is actually the other way around! Instability in the TMJ causes malocclusion.
Quick note:
- temporomandibular disc displacement with reduction, the disc moves forward and is displaced, with reduction it returns. It is characterized by the popping, clicking noises common in TMJ.
- temporomandibular disc displacement without reduction, the disc moves forward and is displaced and stays there. This causes limited mouth opening and locking (referred to as a “closed lock”) pain and an alteration of the TMJ complex.
Successful, but unnecessary overtreatment?
In October 2023, the same research team as the 2021 paper continued this line of study in the Journal of Oral & Facial Pain and Headache. (3) They describe how “some management practices in the field of orofacial musculoskeletal disorders (also described as temporomandibular disorders [TMDs]) are based on concepts about occlusal relationships (the contact between teeth), condyle positions, or functional guidance; for some patients, these procedures may be producing successful outcomes in terms of symptom reduction, but in many cases, they can be examples of unnecessary overtreatment.” Briefly, the researchers suggest that many surgical procedures, while producing happy results for many patients, may have been the wrong choice because of the complications of the procedure. They suggest the same results could have been achieved with less medical intervention, (conservative care vs. surgery) and less risk of complication to the patient.
When treatment is not successful doctors may recommend a psychiatric examination.
Someone who has been suffering from long-term TMJ problems, at some point, starts to realize that their challenges are challenges far beyond a disc or a TMJ appliance problem. When this person then has a failed TMJ surgery, these challenges they face become that much greater, and their jaw problem that started out as an annoyance has turned into years of searching for anything that will help them with the new cascade of symptoms they suffer from beyond opening their mouths without pain.
TMJ surgery and appliances do help people. But these are not the patients we see in our clinic. We see the people TMJ surgery and appliances did not help. These are people, perhaps like yourself, whose TMJ has turned into a problem of headaches, neck pain, difficulty swallowing, and dizziness. For some of these people, their doctors may have found it inconceivable that they did not respond to the treatments they offered and may recommend a psychiatric examination. Generally speaking, if you are searching for a cure for your problem, your problem is not “all in your head.”
- Throughout this article, we are going to start making connections to a different approach to your treatment.
- Our connection is that perhaps your standard care treatments did not help you because the problems caused by degenerated and damaged TMJ ligaments were not addressed.
- In 30-plus years of experience helping patients with TMJ, we have found undiagnosed, damaged ligaments to cause jaw instability and excessive, unnatural mobility in the jaw joint. This causes grinding disc displacement and osteoarthritis.
Further reading
Ernest Syndrome | Is this the answer to unresolved TMJ, facial, ear and throat pain?
Prolotherapy for Temporomandibular Joint Pain and Dysfunction
Our published research
The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Lockerman LZ, Hauser R. The association between mandibular position to cervical spine and internal jugular vein diameters in upright position. Have we been ignoring critical generators of head and neck pathology? Cranio. 2023 Sep;41(5):403-406. [Google Scholar]
Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Hauser R., Hauser H, Blakemore KA. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction. (2007) [Google Scholar]
References
1 Manfredini A, Saracutu OI, Greene CS, Ferrari M, Manfredini D. Patient Experiences With Temporomandibular Disorders: A Survey on the Pathways in Diagnosis and Treatment. Journal of Oral Rehabilitation. 2025 May 14. [Google Scholar]
2 Greene CS, Manfredini D. Transitioning to Chronic TMD Pain: A Combination of Patient Vulnerabilities and Iatrogenesis. J Oral Rehabil. 2021 May 9. doi: 10.1111/joor.13180. Epub ahead of print. PMID: 33966303. [Google Scholar]
3 Greene CS, Manfredini D. Overtreatment” Successes”–What Are the Negative Consequences for Patients, Dentists, and the Profession?. Journal of Oral & Facial Pain & Headache. 2023 Apr 1;37(2). [Google Scholar]