From the Guidelines
The best treatment for temporomandibular joint (TMJ) disorders typically begins with conservative, non-surgical approaches, prioritizing cognitive behavioral therapy (CBT) with or without biofeedback or relaxation therapy, as strongly recommended by recent guidelines 1. The initial management should focus on reducing inflammation and pain, using over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or naproxen (220-500mg twice daily), as well as applying moist heat or ice packs to the affected area for 10-15 minutes several times daily. Some key points to consider in the management of TMJ disorders include:
- Practicing gentle jaw stretching exercises and maintaining a soft diet while avoiding extreme jaw movements like wide yawning or gum chewing
- Using a custom-fitted night guard or splint from a dentist to prevent teeth grinding and reduce joint stress
- Stress management techniques such as meditation or physical therapy, as stress often worsens TMJ symptoms
- For persistent cases, prescription muscle relaxants like cyclobenzaprine (5-10mg before bed) or targeted corticosteroid injections might be recommended, as suggested by various guidelines 1 These conservative treatments work by reducing inflammation, relaxing tense muscles, and preventing further joint damage. Most TMJ disorders improve with these approaches, though severe cases may eventually require more advanced interventions like arthrocentesis or surgery if conservative treatments fail after several months, as outlined in recent clinical practice guidelines 1. It's also important to note that some treatments, such as irreversible oral splints, discectomy, and NSAIDs with opioids, are strongly recommended against due to their potential harms and lack of benefits 1. Overall, the management of TMJ disorders should prioritize a multidisciplinary approach, incorporating the expertise of dentists, physicians, and other healthcare professionals to provide comprehensive care and improve patient outcomes, as emphasized in recent studies 1.
From the Research
Treatment Options for TMJ
- Noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, can be used to manage mild to moderate temporomandibular joint disorder 2
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be effective in reducing pain and improving function 2
- A combination of noninvasive therapies, such as patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices, can improve symptoms of temporomandibular disorders 3
Comparative Studies of Treatment Modalities
- A comparative randomized study found that intra-articular injections of substances with anti-inflammatory properties, such as betamethasone, sodium hyaluronate, or platelet-rich plasma, in addition to a bite splint, can reduce pain and improve maximum pain-free mouth opening in patients with temporomandibular joint disorders 4
- The study also found that the group injected with platelet-rich plasma yielded the best results after six months, while patients treated with sodium hyaluronate or betamethasone obtained the best results at the end of the first week 4
Multidisciplinary Approach to Management
- A multidisciplinary team approach to management is essential in the fundamental care of all temporomandibular disorder patients, as treatment can be specifically tailored to individual patient needs 5
- Physiotherapy treatment techniques, including therapeutic exercise protocols and manual therapy techniques, can be effective in controlling primary symptoms of temporomandibular disorders, such as pain, functionality, and quality of life 6
- The combination of different therapies within physiotherapy achieves the best results in treatment, according to analyzed studies 6