TREATING THE LOCKED TMJ
TMJs typically undergo locking when a forwardly dislocated disk, which has been clicking into place during each opening and then out again with each closing, suddenly stops clicking back into place. Subsequently, the mouth can only open to the place where it used to click or pop. If you try to open wider, the midline of your lower jawbone will veer off to the side of the lock, because the condyle of that side stops moving, (the dislocated disk is blocking its path) while the condyle of the other side keeps moving. If you use your fingers to try and push your mouth open further, you'll feel immediate pain just in front of your ear on the side of the lock, because you’re stretching the ligaments that once held the TMJ disk in place and now hold it in the opening path of the condyle.
IF YOUR TMJ STAYS LOCKED, the degenerative process will run its natural course, which may not be so bad. ¥our jaw will gradually and progressively open wider until normal or near-normal opening is achieved, and the pain will subside. The process may require days or decades, but it almost always occurs by middle age. Orthopedic treatment can facilitate the adaptation, as explained in MANAGING THE ARTHRITIC TMJ.
UNLOCKING can usually be accomplished by biting forcefully on a small stick, such as a tongue blade or coffee stirrer, placed between the last two molars on the side of the lock, especially if the lock is recent. The stick, located behind the center of the mass of the jaw closing muscles, pries the condyle down slightly, which can allow it to get over the posterior band of the disk and onto its center, where it belongs. However, simply unlocking the TMJ without making any changes to the situation that produced the locking rarely solves the problem, because the joint is very likely to lock up again. If you want your TMJ to stay unlocked, you need to plan on disk recapturing, as detailed in the paper on that subject.
JAW MUSCLE RELAXATION facilitates unlocking, because the jaw closing muscles are aligned vertically. When they are tight, they prevent the condyle from lowering far enough to allowing the disk to go back into place. Also, jaw muscles tighten up automatically in response to pain. Various medications or even Intravenous (IV) sedation may be needed to calm them before trying to unlock the locked TMJ.
SURGERY may be used to unlock the jaw. Arthrocentesis is a closed surgery that inserts little tubes into the locked TMJ and pumps fluid in to unlock it. Even if it fails to unlock the disk, it often relieves pain, at least temporarily, by flushing out the inflammatory by-products. Arthroscopy is another closed surgery that can be used to pump fluid into a locked TMJ. It uses slightly larger tubes, which allow visualization and even some manipulation of the joint tissues. More aggressive open surgeries can create long term problems by preventing natural adaptation from occurring.
CONCLUSION - In choosing how far to go in attempting to unlock your TMJ, it’s important to keep the treatment proportional to the symptoms and the prognosis. Locking is the most symptomatic stage in the natural course of a TMJ disorder, but it is just a stage. If your symptoms are minor at this stage, the locking will never become a serious problem in your life, especially if you are willing to wear an orthopedic appliance during sleep on a long-term basis.