The TMJ or “Jaw Joint” is a hinge joint allowing jaw opening and side to side movement when chewing, speaking, swallowing or yawning.  Jaw joint pain is quite common and may come from the jaw joint itself, or from the surrounding muscles, or both. Causes of jaw joint disorders are numerous and are often difficult to determine. The most common cause of temporomandibular joint disorders is trauma (eg a heavy blow to the face/jaw), they may have an obvious cause such as arthritis or other pathology, or be due to a less obvious cause such as clenching or grinding of the teeth at night, which most patients are not aware they are doing.

Symptoms of Temporomandibular Dysfunction (TMD) can include: Pain, Clicking, Grating noises, Popping, Locking and Reduced mouth opening, and can also be associated with: Ear pain, Headache, Facial pain and swelling or Jaw locking.

Symptoms are often worsened when eating tough foods, yawning, in cold weather and in the morning on awakening. For most patients the condition will usually progress from a painless click in the joint, through joint pain to joint locking, although the time frame will vary enormously from patient to patient. Diagnosis of these problems involve a thorough history and clinical examination, plus review of X-rays and sometimes a CT and/or MRI scan

Conservative treatment  It is most important to remember that most TMJ disorders may respond well to simple conservative (non-invasive) treatment if a patient presents in the early phases of the condition. Such treatments may include dietary modifications and avoidance of extreme jaw movements (such as yawning, loud singing and gum chewing) prescribed jaw exercises and the use of pain relieving anti-inflammatory drugs.

Another conservative measure is the construction of an occlusal (bite) splint. The splint is removable and is made of clear plastic and fits over the upper (usually) or lower teeth. The splint is usually worn only during sleep and can help reduce the effects of clenching and grinding by keeping the teeth apart.

Surgical treatment For TMJ disorders that do not respond fully to conservative management, Dr Curtis may recommend an ‘arthrocentesis’, or  injection of cortisone into the jaw joint. This is a relatively simple ‘day only’ procedure performed under a general anaesthetic in a private hospital facility . Much more rarely, the more invasive procedure of an open surgical operation on the joint can be considered.

Exposure of impacted teeth is sometimes needed to assist an Orthodontist who is correcting dental crowding. The most common tooth that is impacted (apart from the third molar teeth), is a maxillary canine tooth.

In order to move these teeth into the correct position in the oral cavity, it is often necessary for a surgical procedure to be performed. This usually involves removal of a small amount of overlying tissue to expose the crown of the impacted tooth, and then an orthodontic bracket with a chain attached is glued to the surface of the impacted tooth.

Your Orthodontist is then able to exert gentle force on the impacted tooth via the chain allowing movement of the impacted tooth into its correct position in the oral cavity.

Apical surgery is used as an adjunct to root canal treatment. Root canal treatment is usually undertaken by a Dentist or Endodontist if the pulp (nerve) in the tooth is infected. This infection may spread to cause an abscess beneath the tooth root. Untreated, an abscess will slowly enlarge and ultimately result in a more serious infection.

Surgery to remove the infection in the bone below the tooth is called apical surgery. Apical surgery may involve removal of the abscess, part of the infected tooth root and a filling placed in the apex of the tooth root to seal the root in an effort to prevent the infection recurring.

  • Wisdom teeth, or third molar teeth, develop and generally erupt in the late teenage years or early twenties. They may be either, protruding through the gum (erupted) or covered by the gum tissue and bone (unerupted), to different degrees.
  • Third molar teeth are commonly removed because they are impacted. An impacted third molar tooth is a tooth that cannot erupt properly into the mouth because of insufficient space. They may be either causing pain and problems (symptomatic) or you may be unaware of them (asymptomatic) but may show signs of a disease process and therefore need to be removed.
  • The most common reason they are removed is because of infection or tooth decay. This occurs more often around impacted third molar teeth which are difficult or impossible to clean adequately
  • Less common reasons for their removal include jaw cysts, damage to the tooth immediately in front or rare pathology.

At the time of consultation the doctor will take a comprehensive history, examine the area and Xray and discuss with you the indications for recommending the removal of, or monitoring of, your impacted third molar teeth. Most impacted third molar teeth will be removed under a general anesthetic as a day surgery procedure. As with any surgery, there are risks associated with removing teeth, which may vary with your age and general health or with the tooth or teeth being removed. Teeth removal from bone and gum tissue do require a healing phase and so you will be given information about your proposed surgery and advised on what to expect in relation to post-operative pain and recovery time. You will also be given information item numbers and fees for your financial considerations. You are then in a position to make informed consent.


We are a referral based surgical practice specialising in Oral & Maxillofacial Surgery (OMS), and have been serving the Central Coast community for over 20 years. An initial consultation is required prior to any surgical treatment.

Then, according to your needs, our doctors can provide procedures under local anaesthetics in our rooms (Gosford or Macquarie Street, Sydney), or can also provide treatment under general anaesthesia in a number of fully accredited Private Hospitals across the Central Coast, Northern Beaches and Sydney regions.

About Us

Our Central Coast rooms are located in the heart of Gosford, close to public transport and with our own onsite parking and level wheel chair access. Our practice is led by three highly experienced and dedicated practitioners, Dr Nigel Curtis, Dr Stephen Cox and Dr Ying Shi Chang who are supported by a friendly, professional and empathetic reception and clinical team.

Our practice is committed to  providing the  highest quality patient care whilst at all times respecting your individual needs and privacy.

Our Services

  • Wisdom Teeth removal
  • Dentoalveolar Surgery
  • Temporomandibular Joint (TMJ) Disorders
  • Facial fractures
  • Oral Pathology
  • Dental Implants
  • Orthognathic (corrective jaw) Surgery