Do you always have to open it up and clean it out?

Not sure. They did with mine because the cavitat machine which I was told is similar to sonar bounces a sonar signal off the jaw bone which tells if a certain area is as dense as the surounding area of bone. If it isn't this indicates that the bone is infected to the point of bone loss.

My symptoms were my jaw at the hinge point on the right side started clicking when I chewed which gradually got worse and painful.  

I guess the infection could be at a deeper level and might be able to be treated without surgery.

You shouldn't put off dealing with either as the bacteria can travel through the blood and cause you a lot of grief, including heart problems.

If you haven't seen this tooth meridian chart before maybe you can match up any problems you are already having with the teeth  area that are connected. This may allow you if you don't have dental insurance, and money is an issue to pick the areas that need priority care. 

http://www.meridiantoothchart.com/tooth_charts.html