From the Guidelines
A TMJ workup should begin with conservative approaches, including reassurance, education, avoidance of aggravating activities, soft diet, jaw exercises, massage, NSAIDs, heat and/or cold, and physiotherapy, as these methods have been shown to be effective in managing temporomandibular disorders (TMD) 1.
Initial Management
The initial management of TMJ disorders typically involves a combination of the following:
- Reassurance and education on the condition and its management
- Avoidance of wide mouth opening or aggravating activities
- Soft diet to reduce jaw loading
- Jaw exercises to improve range of motion and reduce muscle tension
- Massage and physiotherapy to reduce pain and improve function
- NSAIDs, such as ibuprofen or naproxen, for pain and inflammation
- Heat and/or cold application to reduce pain and inflammation
Additional Therapies
Additional therapies that may be considered include:
- Custom occlusal splint worn at night to reduce teeth grinding and joint loading
- Cognitive behavioral therapy and mindfulness techniques to address psychological factors contributing to TMJ disorders
- Acupuncture, although the evidence for its effectiveness is moderate 1
Advanced Imaging and Interventional Procedures
If conservative measures fail after 4-6 weeks, referral to a specialist for advanced imaging (MRI or CT) and consideration of interventional procedures like corticosteroid injections may be warranted 1.
Key Considerations
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. Additionally, routine irreversible alteration of temporomandibular joints, jaws, occlusion, or dentition is not recommended 1.
From the Research
TMJ Workup
- Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures 2
- A variety of methods for evaluating and managing temporomandibular disorders (TMD) have been proposed, including noninvasive pharmacologic therapies, minimally invasive muscular and articular injections, and surgery 2, 3
- Diagnosis of TMD is most often based on history and physical examination, with diagnostic imaging beneficial when malocclusion or intra-articular abnormalities are suspected 4
Treatment Options
- Conservative therapies for TMD include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2, 4
- Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
- Pharmacological agents commonly used for the treatment of TMDs include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, muscle relaxants, antidepressants, anticonvulsants and benzodiazepines 5
Patient Management
- Patient education and self-care are important components of TMD management, with or without pharmacologic treatment 6
- A combination of noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices, can improve symptoms of pain and function of the temporomandibular joint 4