This is an overview from an internationally recognised TMJ surgeon. It is a comprehensive article highlighting the incidence is likely to be underestimated and prevention the main objective. Eradication is very difficult. Not surprisingly, a lot of the conclusions are based on current orthopaedic surgical literature. Caution in patient expectations with those who are immunocompromised, prophylactic antibiotics and establishing an appropriate operative environment, are important factors that can be controlled. Joint aspiration, if possible, is the most effective guide to joint infection. There is little evidence that imaging is of any benefit in infection. Rather controversially, it raises that TMJ surgeons should consider that any patient getting an inferior alveolar nerve block should receive antibiotics for fear of contamination!