From the Guidelines
Treatment for temporomandibular joint (TMJ) disorders should begin with conservative approaches, prioritizing non-invasive and reversible methods to minimize morbidity and mortality, and improve quality of life. The most recent and highest quality study 1 recommends cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care.
Key Recommendations
- Start with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) to reduce inflammation and pain, as suggested by various guidelines 1.
- Apply moist heat or ice packs to the jaw for 10-15 minutes several times daily.
- Practice gentle jaw stretching exercises and maintain a soft diet, avoiding chewy foods, wide yawning, and gum chewing.
- A nighttime mouth guard or splint can help prevent teeth grinding and reduce jaw tension; these can be purchased over-the-counter or custom-made by a dentist.
- Stress management techniques like deep breathing or meditation may help, as stress often worsens TMJ pain through increased muscle tension.
Important Considerations
- If these measures don't provide relief within 2-3 weeks, consult a healthcare provider who might recommend physical therapy, prescription muscle relaxants like cyclobenzaprine (5-10mg at bedtime), or in severe cases, corticosteroid injections, as per the guidelines 1.
- Most TMJ disorders improve with these conservative treatments as they allow inflamed tissues to heal and reduce muscle tension that contributes to pain and limited jaw movement.
- It is essential to avoid irreversible oral splints, discectomy, and NSAIDS with opioids, as strongly recommended against by the guidelines 1.
From the Research
Treatment Options for Temporomandibular Joint (TMJ) Disorders
- Noninvasive pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants, can be used to manage mild to moderate TMJ disorders 2.
- Minimally invasive injections, including botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose, can also be effective in managing TMJ disorders 2.
- Conservative therapies, such as self-care, physical therapy, and appliance therapy, are commonly used to treat TMJ disorders 3.
- Pharmacological agents, including analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, anxiolytics, muscle relaxants, antidepressants, anticonvulsants, and benzodiazepines, can be used to reduce pain and improve function in patients with TMJ disorders 3.
Surgical Treatment Options
- Surgery may be necessary for severe arthrogenous TMJ disorders that are insufficiently managed by conservative measures 4.
- Arthrocentesis or arthroscopy can be used to treat arthrogenous TMJ disorders, while open joint surgery may be necessary for severe cases 4.
Multidisciplinary Approach
- A multidisciplinary team approach to management is essential in the fundamental care of all TMJ disorder patients, as treatment can be specifically tailored to individual patient needs 5.
- A management pathway showing escalation of treatment from conservative to invasive can be proposed, based on the severity of the disorder and the patient's response to treatment 4.