TMJ surgery is necessary only in a small number of cases: when the joint is badly damaged, when the jaw is locked or fused, or when severe symptoms continue after conservative care has already been tried. Clicking, morning soreness, and pain from clenching are not reasons for surgery.
That is a narrower answer than most surgery pages give, and it comes from the research rather than from a surgical practice. An NIH brochure quoted by The TMJ Association puts it directly: surgical treatments are controversial, often irreversible, and should be avoided where possible. Dental Line does not perform TMJ surgery. Dr. Irena Starchenko treats the jaw conservatively and refers the few patients who genuinely need a surgeon.
What counts as a real reason for TMJ surgery?
A real reason is a structural problem that no reversible treatment can fix. The National Institute of Dental and Craniofacial Research limits surgery to severe symptoms that persist despite other treatment, or to joint destruction that cannot be repaired another way.
The situations that meet that bar include:
- A jaw that stays locked open or closed and does not release with conservative care.
- Ankylosis, where the joint has fused so the jaw barely moves.
- Severe degenerative damage to the joint, such as advanced arthritis that has destroyed the bone.
- A growth or tumor in or near the joint.
- Injury from trauma, a fracture, or a birth defect affecting the joint.
- Pain and lost function that remain after a full course of simpler treatment.
Failing one treatment does not put you on this list. A night guard that did nothing tells you the guard was the wrong tool, not that you need an operation. Not improving with conservative care does not automatically mean surgery is the next step.
Which TMJ problems do not need surgery?
Most TMJ problems do not need surgery. Muscle pain, clenching, and a noisy joint are managed without opening the joint, and many of them ease on their own once the strain is reduced.
| What you have | Does it need surgery? |
|---|---|
| Clicking or popping without pain | No. Joint sounds alone are normal and need no treatment. |
| Morning tightness and sore muscles | No. This responds to rest, exercises, and often a night guard. |
| Pain from clenching or grinding | No. An appliance and habit changes come first. |
| Painful clicking from a displaced disc | Usually no. Less invasive care is tried long before surgery is discussed. |
| Jaw locked and not releasing | Possibly. This needs a prompt exam and may need a specialist. |
| Joint fused, fractured, or severely destroyed | Yes. These are structural problems, and a surgeon should evaluate them. |
Painless clicking is the clearest example. NIDCR notes that joint sounds without pain are common and usually fade, so treating them at all is hard to justify, let alone operating.
What are the types of TMJ surgery?
TMJ surgery comes in three levels, and each one is more invasive than the last. A surgeon chooses among them. A general dentist does not, and neither does this page pretend to describe how they are performed.
| Procedure | What it involves | Where it fits |
|---|---|---|
| Arthrocentesis | Fluid is flushed through the joint to release adhesions and wash out inflammation. | The least invasive option, for a locked or displaced disc. Results vary. |
| Arthroscopy | A small camera goes into the joint so the surgeon can see it and treat what is found. | NIDCR says it works moderately well for pain and movement. |
| Open-joint surgery | An incision beside the ear opens the joint so it can be repaired or rebuilt. | Reserved for severe damage. No long-term studies confirm its safety. |
Joint replacement is a separate and bigger decision. Only two TMJ implants are FDA-approved, and they are meant for injury, a birth defect, a frozen joint, severe damage, or pain that has already failed simpler care. Older implants caused serious harm and were withdrawn, and NIDCR notes that the current devices still need long-term study. Any mention of an implant should slow the conversation down, not speed it up.
Recovery differs sharply between these levels, which is another reason to know which one is being proposed. A flush of the joint is done as an outpatient procedure and most people return to normal eating within days. Open-joint surgery is a longer recovery, often several weeks, with swelling, bruising, and muscle spasm, and there is a risk of nerve irritation near the incision. Ask which level applies to you before comparing anyone’s experience to your own.
What should happen before surgery is even discussed?
Conservative care should happen first, and it should be given long enough to work. That means self-care, jaw exercises, anti-inflammatory medicine when it is safe for you, and a custom appliance when clenching is part of the cause. The night guard used for TMJ pain is one piece of that, not a hurdle to clear on the way to an operating room.
Before agreeing to anything irreversible, ask the surgeon four things: why this procedure and not a simpler one, what else exists, how it is expected to help, and what the risks are. Then get a second opinion, ideally from an orofacial pain specialist who does not perform the surgery. The person recommending an irreversible procedure should not be the only person you hear from.
How does Dental Line handle this in Encino?
Dr. Starchenko starts with the exam and stays with reversible care. She looks at the joint, the muscles, and the bite, then matches the plan to the cause. For the large majority of patients, that plan is TMJ treatment in Encino built on conservative steps, and it never involves a surgeon.
When a case does meet the bar, she refers to an oral and maxillofacial surgeon or an orofacial pain specialist and sends the exam findings with you. Dental Line does not perform TMJ surgery, does not place TMJ implants, and does not bill for either. Her AAFE Frontline TMJ and Facial Pain Therapy training, completed in July 2026, is continuing education rather than a surgical credential, which is exactly why the referral exists.
She is a USC graduate with more than 30 years in practice and a member of the American Dental Association and the Academy of General Dentistry. The office is at 18024 Ventura Blvd, Encino, and she sees patients from Sherman Oaks, Tarzana, and Studio City.
Frequently asked questions
Do I need surgery for a clicking jaw?
Almost never. Clicking without pain is common and needs no treatment. Clicking with pain is evaluated and usually managed with conservative care.
What if my night guard did not help?
Then the guard was not the right tool for your problem. The next step is to reconsider the diagnosis, not to schedule surgery. A guard only helps when clenching is the cause.
How long should I try conservative care first?
Long enough to know whether it is working. Many people improve over several weeks of rest, exercises, and an appliance. Pain that keeps worsening, or a jaw that stays locked, should be rechecked sooner.
Is TMJ surgery permanent?
Open-joint surgery permanently changes the joint, and it cannot be undone. That is the reason it comes last and the reason a second opinion matters.
Who decides whether I need surgery?
An oral and maxillofacial surgeon or an orofacial pain specialist, after reviewing your history and imaging. Your dentist’s role is to exhaust conservative care and to refer with records when the findings call for it.
Does insurance cover TMJ surgery?
Surgical care is billed by the specialist who performs it, and it usually goes through medical insurance rather than dental insurance. A custom night guard made by a dentist is the opposite: it most often runs through the dental plan. The two should never be quoted as one price.
Coverage for surgery varies widely and often needs preauthorization, so the surgeon’s office is the right place to confirm it. What goes into the dental side of TMJ care, and how PPO plans treat it, is a separate question from the operation itself.
Start with an exam, not an operation
If your jaw locks, clicks, or aches, find out what is actually wrong before anyone talks about surgery. Dr. Starchenko will tell you whether conservative care fits and, if it does not, refer you with a clear reason. Request an appointment or call (747) 265-6179.
