From the Guidelines
Temporomandibular joint dysfunction (TMJ or TMD) should be initially managed with conservative approaches, including rest, soft diet, and avoiding extreme jaw movements, as well as stress management techniques and over-the-counter pain medications, with a strong recommendation in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, as stated in the 2023 BMJ guideline 1. The goal of treatment is to decrease pain and functional limitation, and improve quality of life. Conservative approaches are preferred, and may include:
- Rest and soft diet
- Avoiding extreme jaw movements
- Stress management techniques, such as meditation or gentle jaw stretching exercises
- Over-the-counter pain medications, such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours)
- Applying moist heat or ice packs to the affected area for 10-15 minutes several times daily
- A custom-fitted night guard from a dentist to prevent teeth grinding and clenching Some key points to consider when managing TMJ or TMD include:
- The use of intraoral appliances, such as hard full coverage stabilization splints, may be beneficial, but there is insufficient evidence to support the use of low level laser therapy 1
- Cognitive behaviour therapy and physiotherapy may be effective in managing TMJ or TMD, as stated in the 2023 BMJ guideline 1
- Surgery should only be considered after non-response to conservative therapy, including arthrocentesis, arthroscopy, or open surgery of the temporomandibular joint, as recommended by the Royal College of Dental Surgeons of Ontario guideline 1 It is essential to note that the management of TMJ or TMD should be individualized, and a comprehensive treatment plan should be developed in consultation with a dentist or oral surgeon. The 2023 BMJ guideline provides strong recommendations in favour of CBT with or without biofeedback or relaxation therapy, and conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, and acupuncture 1.
From the Research
Definition and Symptoms of Temporomandibular Joint Dysfunction
- Temporomandibular joint disorder is defined by pain and/or loss of function of the temporomandibular joint and its associated muscles and structures 2
- Common symptoms include jaw pain or dysfunction, earache, headache, and facial pain 3
- Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components 3
Treatment Options for Temporomandibular Joint Dysfunction
- Conservative therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, benzodiazepines, antidepressants, and anticonvulsants 2
- Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose 2
- Noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices, are recommended for most patients 3
- Conservative management involving non-pharmacological and pharmacological therapies is effective in the majority of cases 4
Management and Referral Considerations
- Diagnosis is most often based on history and physical examination, with diagnostic imaging beneficial when malocclusion or intra-articular abnormalities are suspected 3
- Referral to an oral and maxillofacial surgeon is indicated for refractory cases 3
- General treatment guidelines are available, but individual patient treatment needs vary, and all treatments should be evidence-based and in the patient's best interests 5
Effective Conservative Management Strategies
- Non-thrust mobilization and high-velocity, low amplitude thrust manipulation techniques to the TMJ and/or upper cervical articulations are generally supported in the literature for reducing pain and disability 6
- Dry needling or acupuncture of the lateral pterygoid and posterior, peri-articular connective tissue can lead to significant improvements in pain and disability in patients with TMD 6