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Diane Nesenbrink was goofing around, as teenagers are wont to do, when she opened her mouth wide to chomp on a chicken leg.

She heard a loud crack and her jaw locked open. Panicked and in pain, the 13-year-old pushed with all her might to get her mouth shut, but with little success.

"I looked like a Pac-Man with his mouth open ready to gobble things up ... except I couldn't move my mouth," Ms. Nesenbrink recalled.

That incident, 27 years ago, marked the beginning of the Stratford, Ont., woman's lifelong ordeal with jaw joint problems.

"My doctor told me it was all in my head," she said. "But I couldn't chew, I couldn't smile and I was in pain."

It was Ms. Nesenbrink's dentist who finally diagnosed her condition: temporomandibular joint syndrome.

The TM joint connects the lower jaw to the skull just under the ear; it is composed of muscles, nerves and bones, and when they are damaged - by trauma, teeth grinding, arthritis or other conditions - it can lead to serious problems.

About one in seven people suffer from TMJ disorder, but most problems are minor or temporary, and can be easily managed. But in rare cases - about 1 per cent - like that of Ms. Nesenbrink, the jaw joint needs to be surgically replaced.

"It's the same idea as a hip or a knee - the joint gets damaged and needs to be replaced," Gerald Baker, head of the division of oral and maxillofacial surgery at Mount Sinai Hospital in Toronto, said in an interview.

But patients who need a new hip or knee have been deemed a political priority and are guaranteed joint replacements within nine months - with the "medically acceptable" wait for consultation pegged at no more than three months and the subsequent wait for surgery no more than six months.

"The jaw joint is an important joint as well, but we've been forgotten," Dr. Baker said.

In fact, his patients wait an average of more than two years for surgery. Even critical cases - where patients suffer excruciating pain and are unable to move their mouths - wait at least three months.

"We see patients who are in dire straits: Talking, eating, chewing, smiling are all difficult, if not impossible," Dr. Baker said. "The condition can be debilitating."

Compared with those who need new hips or knees, patients requiring jaw joint replacement tend to be younger, principally women aged 30 to 50. The treatment population is about 90 per cent women because the underlying cause of severe jaw joint problems is often autoimmune disorders such as rheumatoid arthritis, lupus or psoriasis, which principally affect women.

There are about 50 Ontario patients on the waiting list for TMJ replacement, and as many from the rest of the country.

Mount Sinai is the only centre that offers total jaw joint replacement for Ontario patients. The program has a budget of only $210,000 annually, which has not risen in more than a decade. Considering that each jaw prosthesis costs $15,000 to $20,000, that budget doesn't go far.

Jaw joint replacement cases from the rest of Canada are done principally at Credit Valley Hospital in Mississauga, and there are small programs in Montreal and Edmonton. (A number of patients are also shipped to the United States, where the surgery costs about $100,000 U.S.)

It is not unusual for patients with severe TMJ syndrome to have undergone a dozen operations before getting an artificial joint.

Ms. Nesenbrink said she underwent a number of operations, including having her jaw joint rebuilt with cartilage and bone from a rib, before getting a plastic and metal jaw joint in 1999. She received a new prosthesis last October.

"An artificial joint has a lifespan of seven to 10 years, so we have to do revisions, and that makes our wait list even longer," Dr. Baker said.

Ideally, he said, patients with severe TMJ syndrome should be getting joint replacement earlier as this would avert many other costly operations.

"Doing it sooner is a good investment and it helps patients avoid the vicious cycle of chronic pain," Dr. Baker said.

But the starting point is simply having the jaw joint recognized as just as important as hips and knees.

"We want to be included in the wait time strategy for artificial joints," Dr. Baker said. "That's all."