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Maxillofacial · UK

TMJ management - the whole jaw, properly.

The full pathway for temporomandibular joint disorders - custom splints, jaw physiotherapy, botox, arthrocentesis, arthroscopy, open surgery and total joint replacement. Consultant maxillofacial surgeons, conservative care first, surgery only when the joint has earned it.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private TMJ management costs in the UK.

Indicative ranges across our partner maxillofacial units.

In short

£800–£1,800, most people better in 8–12 weeks.

Procedure Indicative range
Maxillofacial / TMJ consultation £200–£400
Custom bite splint (occlusal / stabilisation) £400–£900
Jaw physiotherapy course (6 sessions) £400–£900
Botox to masseter / temporalis for TMJ £450–£900
Arthrocentesis (joint washout ± steroid) £2,500–£4,500
TMJ arthroscopy £5,500–£9,000
Open TMJ surgery / discectomy £9,000–£18,000
Total TMJ replacement (custom prosthesis) £25,000–£45,000

Prices vary by hospital, the consultant, and how much of the pathway you need. NHS TMJ care is available through oral and maxillofacial services, but waits for splints, imaging and surgery are typically long.

The problem

The right diagnosis, the right splint, and only the surgery you actually need.

TMJ care is where private practice quietly under- and over-treats - off-the-shelf guards that do nothing, irreversible bite work that should never have started, and surgery offered without a proper conservative trial. We fix all three before you commit.

  • Is it actually the joint?

    Most TMJ pain is muscular - clenching, posture, sleep. Getting the diagnosis right is what stops people ending up in an operating theatre they never needed.

  • Reversible options first

    A custom splint, physiotherapy and botox are reversible and settle around 80 percent of cases. Bite-adjustment and full-mouth reconstruction are not reversible - they come last, if at all.

  • Surgery only when the joint has earned it

    Arthrocentesis, arthroscopy, open surgery and total joint replacement all have their place - but only after conservative care has been tried, or where the imaging leaves no doubt.

When it helps

When TMJ management is the right step.

The pictures we see most, plus the one red flag that means urgent maxillofacial review rather than a routine splint appointment.

  • Jaw pain around the joint or muscles

    Pain in front of the ear, over the cheek and temple, worse chewing or on waking - the commonest reason people come to us.

  • Clicking, popping or grating

    Noises from the joint on opening or chewing, often with a sense of catching. Not everyone needs treatment - but painful clicking does.

  • Locking - closed or open

    A jaw that will not open more than a couple of centimetres (closed lock) or will not close (open lock). Closed lock often responds well to arthrocentesis.

  • Bruxism and clenching

    Night grinding, worn teeth, headaches on waking, a stiff jaw. Splints and botox to the masseter usually settle it.

  • Chronic tension-type headache from the jaw

    Temple and side-of-head pain traced to the jaw muscles rather than a migraine. Physio and botox often help.

  • Post-dental or post-orthodontic pain

    Symptoms after long dental appointments, third-molar surgery, orthodontics or a change in bite. Usually settles with a splint and physio.

  • TMJ arthritis or degenerative disease

    Osteoarthritis, rheumatoid or psoriatic arthritis affecting the joint - sometimes needing arthroscopy, open surgery or, ultimately, a joint replacement.

  • Red flag: sudden bite change or facial swelling

    A new open bite, facial asymmetry, numbness or a rapidly enlarging swelling is not routine TMJ - it needs urgent maxillofacial review, not a splint appointment.

Procedure options

A stepped pathway - conservative to complex.

Every option, in order - from a splint at one end to a total joint replacement at the other. Most people never need to leave the top of the ladder.

  • Occlusal / stabilisation splint

    A custom hard acrylic splint worn at night - the workhorse of conservative TMJ care. Protects the teeth, unloads the joint and settles most muscular pain within 8–12 weeks.

  • Jaw physiotherapy

    A structured programme of jaw exercises, posture work, manual therapy and self-management. Delivered by a physiotherapist with a specific TMJ interest, not a general musculoskeletal list.

  • Botulinum toxin (botox) to masseter and temporalis

    Injections into the chewing muscles to reduce clenching force. Useful for bruxism, muscular pain and refractory headaches. Effect lasts 3–6 months and can be repeated.

  • Arthrocentesis

    A keyhole washout of the upper joint space under sedation or GA - two fine needles, saline flush and often a steroid or hyaluronic acid injection. Often the first surgical step for closed lock.

  • TMJ arthroscopy

    A 1.9 mm arthroscope inserted into the joint through a small incision in front of the ear, allowing direct inspection, adhesion release and targeted washout. Day-case with fast recovery.

  • Open TMJ surgery / discectomy

    A pre-auricular open approach for disc repositioning, discectomy or repair of a damaged joint. Reserved for arthroscopy failures and clear structural disease.

  • Total TMJ replacement

    A custom-made titanium fossa and condyle prosthesis, planned from CT - for end-stage joint destruction, failed prior surgery or severe arthritis. Life-changing when it is the right operation.

  • Adjuncts - hyaluronic acid, PRP, medical therapy

    Intra-articular hyaluronic acid, platelet-rich plasma and short courses of amitriptyline or gabapentin sit alongside the mechanical treatments where the picture is mixed.

Safety and recovery

What to expect afterwards - honestly.

Conservative TMJ care is low-risk. The surgical steps get progressively bigger - worth planning carefully and staging in order.

  • Conservative treatment carries very little risk

    A splint may feel odd for a fortnight. Physio can transiently increase soreness. Botox rarely gives temporary chewing weakness or a slightly altered smile - all reversible.

  • Arthrocentesis and arthroscopy - the small-risk end

    Under GA or sedation, day-case, minor bleeding, transient facial nerve weakness and infection all under 1–2 percent. Most people are back to a soft diet the same day.

  • Open TMJ surgery - real but manageable risks

    Temporary facial nerve weakness in around 5–10 percent, permanent in under 1 percent, altered bite, scarring in front of the ear, and a small chance of persisting pain.

  • Total joint replacement - the big operation

    A 3–5 hour procedure with a 2–3 night stay. Nerve injury, infection, prosthesis loosening, revision surgery and a 6–12 week rehabilitation. Life-changing when indicated, not to be entered lightly.

  • A soft diet, protected jaw, jaw physio

    After any surgical step, 2–6 weeks on a soft or blenderised diet, no wide yawning, no gum. Structured physio from day one is what protects the result.

  • Bruxism and clenching return without a plan

    The joint improves - the habit does not. A long-term splint, stress management, sleep review and repeat botox where needed are what keep the pain away.

  • Not every click needs treating

    Painless clicking is common and often benign. We do not operate on noises alone. Treatment is for pain, locking or genuine dysfunction - never for a scan finding.

  • Beware the “bite-adjustment” route

    Irreversible dental work - grinding teeth down, full-mouth reconstruction, orthodontics - to “cure” TMJ is rarely the right first step. Reversible options come first, every time.

  • Red flags after surgery

    Fever, spreading facial swelling, uncontrolled bleeding, sudden numbness, drooping face or severe worsening pain need the same-day team or A&E, not a routine call.

Reading your TMJ notes

Your TMJ notes in four parts. Read the last one first.

Whether the visit was a splint fit, an injection, a keyhole washout or a joint replacement, the note the maxillofacial surgeon sends you keeps to the same shape.

A UK consultant maxillofacial surgeon reviewing a patient’s TMJ imaging

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note or the MRI report before your review, just ask.

  1. 01 Header

    Diagnosis, joint side and mechanism

    Which joint, which structures are affected - muscle, disc, bone - and whether the problem is myofascial, internal derangement, arthritis or a mix.

  2. 02 Technique

    Procedure and findings

    What was done - splint fit, arthrocentesis, arthroscopy or open surgery - and what was seen inside the joint if it was entered.

  3. 03 Findings

    Imaging and intraoperative detail

    The MRI, cone-beam CT and any arthroscopic findings - disc position, effusion, adhesions, cartilage state - in plain terms.

  4. 04 Impression

    Plan, physio and follow-up

    Read this first: the splint and physio plan, medication, when to return, and the criteria for stepping up (or down) treatment.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

TMJ surgery is usually covered where medically indicated.

Frequently asked

Everything we get asked about TMJ care.

Quick answers on splints, arthrocentesis, joint replacement, cost and recovery.

  • What is TMJ dysfunction, exactly?

    TMJ dysfunction is an umbrella term for pain and mechanical problems affecting the temporomandibular joint and the muscles that move it. It ranges from muscular clenching and headaches through disc problems that click or lock, to full arthritis of the joint. Most cases are muscular and settle with a splint, physiotherapy and lifestyle changes - only a minority ever need surgery.

  • Conservative treatment or straight to surgery - how do you decide?

    Almost always conservative first. A custom occlusal splint, a course of jaw physiotherapy and, where indicated, botox to the masseter and temporalis settle around 80 percent of TMJ pain within three months. Surgery is reserved for genuine intra-articular disease - a locked joint that will not open, painful clicking with imaging changes, arthritis or a joint that has failed conservative treatment.

  • Are bite splints actually effective?

    Yes, when they are custom-made hard acrylic stabilisation splints - not the soft over-the-counter guards. Evidence and everyday practice both show most people with muscular TMJ pain and bruxism improve significantly at 8–12 weeks. A splint does not cure grinding, but it protects the teeth and unloads the joint while the muscles calm down.

  • What is arthrocentesis and when is it used?

    Arthrocentesis is a keyhole washout of the upper joint space under sedation or general anaesthetic. Two fine needles are placed into the joint, sterile fluid is flushed through, and often a steroid or hyaluronic acid is injected at the end. It is the standard first surgical step for a joint that has locked closed or for painful internal derangement that has not responded to conservative care. Recovery is a day and most people are back to office work in 2–3 days.

  • When is a total TMJ replacement needed?

    Total joint replacement is reserved for end-stage disease - severe osteoarthritis, rheumatoid destruction, ankylosis, failed multiple prior TMJ surgeries or a joint destroyed by tumour surgery. It is a custom-made titanium prosthesis planned from CT. It is a big operation with real risks, but for the right patient it transforms function and pain. It is never a first-line option and never appropriate for muscular TMJ dysfunction.

  • How much does private TMJ treatment cost in the UK?

    Roughly £200–£400 for a consultation, £400–£900 for a custom splint, £400–£900 for a physiotherapy course, £450–£900 for botox, £2,500–£4,500 for arthrocentesis, £5,500–£9,000 for arthroscopy, £9,000–£18,000 for open TMJ surgery and £25,000–£45,000 for a total joint replacement. NHS pathways exist through oral and maxillofacial services, but waits for splints, imaging and surgery are usually long.

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