From the Guidelines
Temporomandibular joint (TMJ) crepitus should be managed with conservative treatments, including rest, soft diet, avoiding extreme jaw movements, and applying warm compresses to relax the muscles, as recommended by the most recent guidelines 1. The goal of treatment is to reduce inflammation, relax tense muscles, and improve joint mechanics.
- Conservative approaches should be pursued first, including reassurance and education, avoidance of wide mouth opening or aggravating activities, soft diet, jaw exercises, massage, non-steroidal anti-inflammatory drugs (NSAIDs), heat and/or cold, bite plate in the presence of bruxism, physiotherapy, mindfulness, yoga, meditation, acupuncture, splint therapy, cognitive behavioural therapy, paracetamol, and neuromodulatory medications (eg, amitriptyline, gabapentin) 1.
- Over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage pain and inflammation.
- Physical therapy exercises focusing on gentle jaw stretching and strengthening can improve function.
- A custom-fitted night guard or splint from a dentist may help reduce teeth grinding and joint stress. If crepitus is accompanied by severe pain, limited jaw movement, or difficulty eating, professional evaluation by a dentist or oral surgeon is necessary as more advanced treatments like corticosteroid injections or surgery might be required in persistent cases 1. It is essential to note that surgery should be considered only after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint 1.
From the Research
Definition and Causes of Crepitus
- Crepitus is defined as a grinding, popping, or thumping sound or sensation secondary to abnormal motion in a joint 2
- It can be a source of persistent pain and dysfunction, especially in athletes or individuals with repetitive motion injuries
- The causes of crepitus include direct or indirect trauma, overuse syndromes, joint dysfunction, osseous abnormalities, muscle atrophy or fibrosis, and idiopathic causes 2
Relationship between Crepitus and Osteoarthritis
- Subjective crepitus is a risk factor for incident symptomatic knee osteoarthritis, with a higher frequency of crepitus associated with a higher odds of developing symptomatic osteoarthritis 3
- Crepitus can be a feature of osteoarthritis, and individuals with osteoarthritis may experience crepitus as a symptom 4
- However, crepitus does not appear to be a major cause of concern for people who experience it, and it is often less concerning than symptoms such as pain 4
Treatment and Management of Crepitus
- The initial treatment of crepitus should be nonoperative, with a focus on strengthening the surrounding muscles, improving joint mobility, and reducing inflammation 2
- Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and inflammation associated with crepitus, but their use should be carefully considered due to potential side effects 5, 6
- Surgical treatment options may be considered in cases where nonoperative management is unsuccessful, but the best approach will depend on the individual case and the underlying cause of the crepitus 2